Surgical site infection among women discharged with a drain in situ after breast cancer surgery

Abstract

Background: There are scarce data on the factors associated with surgical site infection (SSI) among women who are discharged with a drain in situ after breast cancer surgery. The aim of this study was to determine the incidence and the factors associated with SSI in a center where women are routinely discharged with a drain in place.

Methods: A prospective cohort study included 354 women who underwent surgical treatment for breast cancer at a referral center in Rio de Janeiro, Brazil.

Results: SSI was diagnosed in 60 patients (17%) after a median follow-up of 17 days. Most infections were caused by Staphylococcus aureus. The probability of bacterial colonization of the drain was 33% on postoperative day (POD) 7 and rose to 80.8% up to the POD 14. In 83% of the cases of microbiologically documented infection, SSI was caused by the same bacterial species that had been previously isolated from the drainage fluid. In multivariate regression analyses, age 50 years (p < 0.001), skin flap necrosis (p < 0.001), and bacterial colonization of the drain (p = 0.03) were independently associated with a higher incidence of SSI.

Conclusion: The incidence of SSI among women who were routinely discharged with a drain in place was high. Older age, skin flap necrosis, and bacterial colonization of the drain were independent predictors of SSI. Modifications of the surgical technique aimed at reducing the risk of wound necrosis and early removal of the drain may contribute to lowering the risk of SSI among these patients.