RESUMO
UNLABELLED: Objective. To present a 4-year experience of surveillance and management of surgical wound complications in a cohort of patients who underwent breast cancer surgery at a cancer hospital. METHODS: A descriptive follow-up study was undertaken at a teaching, referral cancer hospital in Mexico City (National Cancer Institute). Patients (n = 1774) underwent 1888 breast cancer surgeries. The main outcome measures were wound complications (surgical site infections [SSI], flap necrosis, and dehiscence). RESULTS: There were 873 (46.2%) wound complications recorded. The most frequent complications were SSI (n = 387, 20.5%), flap necrosis (n = 274, 14.5%), and dehiscence (n = 212, 11.2%). Most patients with infections were treated with oral antibiotics and local wound management (n = 353, 91.9%) with positive results. Flap necrosis and dehiscence were treated under the wound bed preparation model with debridement plus combined (concomitant or sequential) dressings and ointments that favored wound healing, achieving closure at the last appointment in 189 (48.4%) patients. Average time to closure for necrotized and dehisced wounds was 52.4 ± 45.7 and 45.2 ± 36.1 days, respectively. CONCLUSION: An average delay of 10 days on the initiation of adjuvant treatment was observed in patients with a wound complication (SSI, flap necrosis, or dehiscence) compared to patients without wound complications (P = 0.002). The frequency of wound complications was high. Active surveillance allowed the authors to diagnose wound complications early in their development. Local wound management under the wound preparation model and use of antibiotics when an infection is suspected were successful therapies in most patients.
RESUMO
BACKGROUND: We analyzed variations in surgical site infections (SSIs) during 5 years of a prospective surveillance program and investigated possible contributors to SSIs in a cohort of patients who underwent surgery for breast cancer. METHODS: All breast surgeries performed between January 2001 and December 2005 were registered. Patients were followed-up by direct observation for at least 30 days under standardized conditions. The main outcome studied was SSI. A case-control analysis was conducted to identify SSI-associated risk factors and to evaluate SSI variations by means of a control chart. RESULTS: During the study period, a total of 2338 breast cancer surgeries were recorded, and 441 SSIs (18.9%) were diagnosed. SSI frequency varied across the 5-year period, with a sharp decline seen after the introduction of preventive policies. After 2002, 3 out-of-confidence limits of SSIs were observed, 2 related to the use of evacuation systems and 1 associated with a group of rotating residents. Concomitant preoperative chemoradiation (odds ratio [OR]=3.47; 95% confidence interval [CI]=2.51 to 4.80), hematoma (OR=3.05; 95% CI=1.70 to 5.52), age > or = 58 years (OR=1.83; 95% CI=1.27 to 2.65), body mass index > or = 30.8 (OR=1.58; 95% CI=1.14 to 2.18), and duration of surgery > or = 160 minutes (OR=1.73; 95% CI=1.20 to 2.50) were found to be SSI-associated risk factors. CONCLUSIONS: After 5 years of a continuous prospective surveillance program, we were able to decrease the rate of SSIs in patients undergoing breast cancer surgery (from 33.3% in 2000 to 18.9% in 2005), identify SSI-associated risk factors, and improve the quality of care delivered to these patients.