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Breast surgery

Introduction

Breast surgery is expected to be associated with a low risk of surgical site infection (SSI) and minimal associated costs however the range of rates published can be attributed to variations within data collection methods.1

A surveillance programme, developed and published by Tanner et al (2011)1, determined surgical site infection rates for primary breast surgery (mastectomy and wide local excision) over a period of four months. Following a review of 159 patients who had undergone primary breast surgery, 10.1% (16 patients) developed a surgical site infection:

  • 15 patients were classified as having a superficial infection
  • 1 patient was classified as having a deep infection
  • Two SSIs were identified while the patients were in hospital
  • Five patients were readmitted due to an infected wound
  • Nine SSIs were identified post-discharge
  • Level one risk factors for SSI were BMI, smoking status, operation duration and diabetic status

The total additional cost incurred for the 16 patients with an SSI was an average of £1,443 per patient with the greatest hospital inpatient costs resulting from inpatient length of stay and readmissions.

In addition to Surgical Site Infections, other post-surgery complications can include wound dehiscence which can result in local wound care or even serious cases with multiple reoperations and a high morbidity.2

As surgical case loads are progressively more complex and high-risk patients are increasingly common, it's more critical than ever to protect against post-operative complications.

The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which the application of innovative technologies can minimise complications.3

References

  1. Tanner J et al, (2011) The rate, risk factors and cost of surgical site infections in primary breast surgery. Journal of Infection Prevention; 12(5): 204-209
  2. Galliano R et al, (2014) The effects of a single use canister-free Negative Pressure Wound Therapy (NPWT) System* on the prevention of postsurgical wound complications in patients undergoing bilateral breast reduction surgery. Poster presentation, The British Association of Aesthetic Plastic Surgeons (BAAP’s) 30th Annual Scientific Meeting, London, September 2014.
  3. Karlakki S et al., (2013) Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery. Bone and Joint Research; 2: 276-84.

PICO can help

Improving outcomes with incisional NPWT

Negative Pressure Wound Therapy (NPWT) has a mechanism of action that improves the speed, strength and quality of incisional wound healing, thus minimising the failures of healing that lead to infection and/or dehiscence.

PICO Mode of Action

Considerable evidence shows NPWT delivers clinical benefits as part of effective incision management.1

Introducing PICO

PICO is a canister-free, single-use system offering the ultimate in portable, accessible and affordable NPWT.

PICO Delivers Active Therapy

A poster recently presented at the British Association of Aesthetic Plastic Surgeons (BAAPs) published interim results of a study considering the effects of a single use canister-free Negative Pressure Wound Therapy (NPWT) System on the prevention of postsurgical wound complications in patients undergoing bilateral breast reduction surgery.

200 patients undergoing bilateral reduction mammoplasty were recruited into a prospective, randomised, intra-patient, comparative, open, multi-centre study.  Each patient was treated with both PICO and standard care for up to 14 days to enable a within patient comparison.

Follow-up assessments were carried out to evaluate the difference in incision healing complications between PICO and standard care up to 21 days post-surgery (Primary Endpoint).  Healing complications were defined as delayed healing (incision not 100% closed by 7 days), or occurrence of dehiscence or infection within 21 days.  Differences in scar quality and aesthetic appearance were also assessed using The Patient and Observer Scar Assessment Scale (POSAS) and The Visual Analogue Scale (VAS) at 42 and 90 days.

Results

Significantly fewer overall healing complications had occurred by 21 days post-surgery when treated with PICO compared to Standard Care (5%, p=0.004) (95% CI 2.0% to 9.2%).

Treatment with PICO resulted in significantly fewer incidences of dehiscence compared to standard care (32 patients (16.2%) v 52 patients (26.4%) by day 21 (p<0.001).

Scar quality as measured by the VAS and POSAS scoring systems was shown to be significantly better on PICO treatment than Standard Care, both at the 42 day and 90 day assessment (p<0.001).

Click here to view the poster in full.

References

  1. Karlakki S et al, Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery, Bone Joint Res 2013; 2:276-84.

Recommended Pathway and Clinical Cases

Stannard et al (2009)1 proposed a grading system based on existing knowledge of risk factors for infection and dehiscence, seroma and hematoma.

  • Grade 1 – No risk factors
  • Grade 2 – Single risk factor
  • Grade 3 – Multiple risk factors

Known risk factors are diabetes, obesity, smoker, hypertension etc.

Results suggest that at-risk patients may benefit from NPWT immediately post-op; click here to see our Risk Identification pathway, which can help determine at-risk patients.

References

  1. Stannard JP et al.  Use of negative pressure therapy on closed surgical incisions: a case series.  Ostomy Wound Manage. 2009 Aug 1;55(8):58-66.

Economic Benefits

Prevention of complications is cheaper than the cure

There is increasing focus on clinical effectiveness and reduction in hospital length of stay.

PICO Breast Economics

References

  1. Jenks PJ et al., Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital, Journal of Hospital Infection 86 (2014) 24-33.

PICO Video

This video shows how PICO aids wound healing on incisions, and how its mode of action compares to a standard dressing.

NEW PUBLICATION

A new case series with closed incisions in oncoplastic breast procedures following the introduction of PICO

Click here to read the case series