The measurement of wound infection after breast surgery

Infection in breast wounds often occurs in the form of cellulitis, but the conventional criteria for wound infection are the presence of either pus or a serous discharge containing pathogens. Wound scoring systems may offer a more quantitative and clinically relevant approach when evaluating the morbidity caused by infection in wounds. The aim of this study was to develop a wound scoring system for patients undergoing breast surgery. The components of previously described wound scoring systems were measured in 218 women undergoing nonreconstructive breast surgery. Using conventional criteria, the incidence of wound infection was 5.5% (12/218). However, 22% of the patients exhibited at least one sign of wound infection, and 11% of the patients received antibiotics for cellulitis without any other indication of a wound infection. The validity of the wound scoring system was supported by its strong content validity, the presence of construct validity as evidenced by concordance with the conventional criteria (p < 0.001), and criterion validity in the form of an association between the presence of a seroma and a positive wound score (p < 0.001). It was also noted that 27% of the patients with an appreciable wound score (more than 40 points) had cellulitis but did not satisfy the conventional criteria for a wound infection. In conclusion, it is advisable to use a wound scoring system that includes cellulitis when evaluating patients who have undergone breast surgery.