Surgical site infection after breast surgery: impact of 2010 CDC reporting guidelines.
BACKGROUND
Reported surgical site infection (SSI) rates after breast operations ranges 0.8-26 % in the literature. The aims of the present study were to characterize SSI after breast/axillary operations and determine the impact on the SSI rate of the 2010 Centers for Disease Control and Prevention (CDC) reporting guidelines that now specifically exclude cellulitis.


METHODS
Retrospective chart review identified 368 patients with 449 operated sides between July 2004 and June 2006. SSI was defined by CDC criteria: purulent drainage (category 1), positive aseptically collected culture (category 2), signs of inflammation with opening of incision and absence of negative culture (category 3), and physician diagnosis of infection (category 4). The impact of excluding cellulitis was assessed.


RESULTS
Prior CDC reporting guidelines revealed that among 368 patients, 32 (8.7 %) experienced SSI in 33 (7.3 %) of 449 operated sides. Of these, 11 (33 %) met CDC criteria 1-3, while 22 (67 %) met CDC criterion 4. Excluding cellulitis cases per 2010 CDC SSI reporting guidelines eliminates 21 of the 22 infections previously meeting CDC criterion 4. Under the new reporting guidelines, the SSI rate is 12 (2.7 %) of 449 operated sides. SSI rates varied by procedure, but these differences were not statistically significant.


CONCLUSIONS
Cellulitis after breast and axillary surgery is much more common than other criteria for SSI, and SSI rates are reduced almost threefold if cellulitis cases are excluded. Recently revised CDC reporting guidelines may result in underestimates of the clinical burden of SSI after breast/axillary surgery.
Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. degnim.amy@mayo.edu
Amy C
AC
Degnim
Alyssa D
AD
Throckmorton
Sarah Y
SY
Boostrom
Judy C
JC
Boughey
Andrea
A
Holifield
Larry M
LM
Baddour
Tanya L
TL
Hoskin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017053:Infection Control / Q000592:standards*; D008408:Mastectomy / Q000592:standards*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014481:United States; D055815:Young Adult