Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis

Breast surgical site infections (SSIs) are major sources of postoperative morbidity and mortality, and it's established that surveillance of risk factors is effective in reducing hospital-acquired infections. However, studies about risk factors for breast SSIs were still under controversy because of limited data, contradictory results and lack of uniformity.

We searched the electronic database of PubMed for case-control studies about risk factors for breast SSIs, and a meta-analysis was conducted.

Eight studies including 681 cases and 2064 controls were eligible, and data was combined if the risk factor was studied by at least two studies. Of the 20 possible risk factors involved, 14 were proved significant for SSIs as follows: increased age, hypertension, higher body mass index (BMI), diabetes mellitus, American society of anesthesiologists (ASA) 3 or 4, previous breast biopsy or operation, preoperative chemoradiation, conservation therapy versus other surgical approaches, hematoma, seroma, more intraoperative bleeding, postoperative drain, longer drainage time and second drainage tube placed. However, other factors like smoking habit, immediate reconstruction, axillary lymph node dissection, preoperative chemotherapy, corticosteroid usage and prophylactic antibiotic didn't show statistical significance.

This meta-analysis provided a list of predictable or preventable factors that could be taken measures to reduce the rate of breast SSIs and excluded some negligible factors. This could be useful for developing effective prevention and treatment policies for patients with SSIs and improving the overall quality of life.