Determinants of surgical site infection after breast surgery

Surgical site infection (SSI) after breast procedures may result in significant morbidity, psychologic trauma, and additional cost, SSI rates in patients at the Cleveland Clinic Foundation having biopsy, partial mastectomy, or modified radical mastectomy were higher during April and May 1995 than during the previous 12 months (8 infections for 74 procedures [10.8%] vs 10 for 378 [2.6%]; p < 0.006). Since 1993 one surgeon has performed most of these procedures, with no change in operative technique, skin preparation, or surgical team. A case-control study was performed to identify risk factors for infection.

A case patient was defined as any patient having a breast procedure from April 1994 through May 1995 with culture of a pathogen from surgical site drainage or aspiration or with erythema or presence of cellulitis treated by incision and drainage and/or antibiotic therapy. Randomly selected control patients were matched by time and procedure. There were 18 case patients and 37 control patients.

Factors associated with SSI were obesity (78% of cases vs 40% of controls; p = 0.02) and older age (mean 66 years in cases vs 56 years in controls; p = 0.005). After introduction of cefazolin sodium prophylaxis, SSI rate was reduced to 0.9% (3 infections for 332 procedures).

Host factors may contribute to SSI in breast procedures. Cefazolin sodium prophylaxis was useful in preventing SSI after breast surgery.