ReviewRisk factors for surgical site infections after breast surgery: A systematic review and meta-analysis
Introduction
Surgical site infections (SSIs) are major sources of adverse operation-related events in patients undergoing surgery, including increased morbidity, psychological trauma, additional cost and delay of postoperative adjuvant therapies.1, 2 The rate of breast SSIs range from 1% to 30%, depending on definition of SSIs, type of operation, comorbidities of the patients, time of follow up, perioperative therapy and reporting institution. It's higher than other clean operations in which the infection rate is less than 5%.3, 4, 5, 6
Several studies were performed to identify risk factors for SSIs after breast procedure, but quite a few limits existed in these studies: some studies just focused on one or a small list of potential risk factors and the variant criteria of some risk factors made conclusions hard to be drawn from them7, 8, 9, 10, 11, 12; there were also some studies which had such a small sample (patients' number of SSIs < 20) that the results might be biased.13, 14, 15, 16 Besides, some results remain conflicting rather than conclusive: smoking and prolonged use of surgical drain were considered as risk factors to SSIs in some studies,7, 17 but some other results didn't show statistically significance between them,13, 14, 15, 18, 19 preoperative chemotherapy, breast reconstruction and the administration of antibiotic prophylaxis were reported to influence the incidence of SSIs in some studies,8, 19, 20; however, the opposite results were observed in other studies.13, 18, 19, 20, 21
There were also 3 cohort studies in research of risk factors for SSIs.7, 37, 38 However, patients recruited in each study were all pretreated with different influencing factors from each other. Therefore, the data from these 3 studies were not suitable to combine as a meta-analysis.
Therefore, to give surgeons more precise information to tailor their treatment to individual patients, the objective of our study was to systemically review observational case–control data to investigate possible contributing factors for SSIs after breast surgery.
Section snippets
Search strategy and selection criteria
Meta-analysis was performed as described previously.22, 23 Relevant articles were selected by searching PubMed databases (updated on November 2011), using the following terms in the searching algorithm: case–control, breast surgery or breast procedure, surgical site infections or wound infections. Two reviewers (DX and CQ) independently screened titles and abstracts of the identified papers. References in identified articles and previous reviews were also reviews for possible inclusion. We
Eligible studies
Of 513 articles, 145 studies received full text review, of which eight met our inclusion criteria. Of these eight included studies, four were in United States of America; three were in Mexico and one from China. These articles were published between the years 1998–2010, including 681 SSIs cases and 2064 controls.13, 14, 15, 16, 18, 19, 20, 21 The detailed information of the studies was shown in Table 1.
Risk factors for SSIs
Meta-analysis of combinable data was conducted, and main results were shown in Table 2. In
Discussion
This meta-analysis of eight case–control studies gave a more precise estimation of independent risk factors for breast SSIs in patients undergoing breast surgery. Meanwhile, risk factors evaluated in single study also provided some guiding suggestion for further research.
Conflict of interest
There are no conflicts of interest.
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- c
These authors contributed equally to this work.