Stopping Traffic: An Analysis of Number of Scrubbed Personnel and Infection in Implant-Based Breast Reconstruction

Abstract

Background: Postoperative surgical site infection (SSI) is a devastating complication of implant-based breast reconstruction. Its occurrence may require additional hospitalization and ultimately necessitate prosthesis removal. The effect of foot traffic in the operating room has not yet been investigated within plastic surgery.

Objectives: This study analyzed the influence of scrubbed and unscrubbed personnel on postoperative SSI in immediate implant-based breast reconstruction.

Methods: This was a retrospective review of 223 consecutive patients who underwent immediate implant-based reconstruction from 2015 to 2021 at the authors' institution. Patient demographics, comorbidities, smoking status, laterality, number of personnel, use of drains, and length of surgery were collected. The primary outcome assessed was surgical site infection with secondary outcomes of delayed wound healing, skin necrosis, hematoma, seroma, and reoperation within 90 days.

Results: Patients who had a postoperative SSI had a mean number of 8.7 scrubbed individuals, whereas those who did not have a postoperative SSI had a mean number of 7.9 individuals scrubbed (P < .05). Univariate analysis demonstrated that increasing number of scrubbed individuals was predictive of SSI (odds ratio [OR]: 1.239, CI: 1.064-1.444, P < .05). A multivariate logistic regression demonstrated increased likelihood of SSI with increasing number of individuals scrubbed (OR: 1.232, CI: 1.027-1.478, P < .05).

Conclusions: This study demonstrates an increased risk of SSI in immediate, implant-based breast reconstruction with an increased number of personnel in the operative field. The findings highlight the importance of reducing foot traffic in the operating room when feasible to reduce risk of postoperative SSI and its associated morbidity.