Mastectomy Surgical Site Complications in Mexico
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.
Breast cancer is a public health problem and represents the most common cancer among women in high-income, and some middle-income, countries. In Mexico it is the leading malignant tumor among women and is rapidly increasing. In contrast to reports from industrialized countries where screening is widely available, in Mexico most patients have locally advanced breast cancer at the time of diagnosis.
Surgery is the cornerstone in breast cancer treatment. In patients with locally advanced breast cancer, multimodal treatment with chemotherapy, radiation, and surgery is mandatory, resulting in higher surgical morbidity. In this subset of patients the rate of surgical site infections (SSI), flap necrosis, and dehiscence is higher, especially in those patients who were previously radiated. These patients frequently develop difficult-to-heal wounds, which can increase the costs of medical care and patient suffering. Chronic wounds can delay the treatment of cancer and compromise disease-free and overall survival.
The following report presents a 4-year experience of surveillance and management of surgical wound complications in a cohort of patients who underwent breast cancer surgery at the National Institute of Cancer in Mexico City.
Abstract and Introduction
Abstract
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.
Introduction
Breast cancer is a public health problem and represents the most common cancer among women in high-income, and some middle-income, countries. In Mexico it is the leading malignant tumor among women and is rapidly increasing. In contrast to reports from industrialized countries where screening is widely available, in Mexico most patients have locally advanced breast cancer at the time of diagnosis.
Surgery is the cornerstone in breast cancer treatment. In patients with locally advanced breast cancer, multimodal treatment with chemotherapy, radiation, and surgery is mandatory, resulting in higher surgical morbidity. In this subset of patients the rate of surgical site infections (SSI), flap necrosis, and dehiscence is higher, especially in those patients who were previously radiated. These patients frequently develop difficult-to-heal wounds, which can increase the costs of medical care and patient suffering. Chronic wounds can delay the treatment of cancer and compromise disease-free and overall survival.
The following report presents a 4-year experience of surveillance and management of surgical wound complications in a cohort of patients who underwent breast cancer surgery at the National Institute of Cancer in Mexico City.