2016 myresearch Science Internship Program: Applied Medicine. Civic Education Office of Government and Community Relations

Transcription

1 2016 myresearch Science Internship Program: Applied Medicine Civic Education Office of Government and Community Relations

2 Nadia Paskert Science Internship Program: Applied Medicine

3 Breast Reconstruction & Surgical Site Infection Nadia Paskert Mark F. Hendrickson, MD, MS

4 Abstract Breast cancer can be treated with a mastectomy and afterwards with a tissue expander, silicone implants or saline implants. The goal of this study was to determine whether there is a positive correlation between tissue expanders and higher infection rates when compared with the two types of implants.

5 Background The following diseases, procedures and surgical options were included in this study: Breast Cancer Mastectomy Breast Options Reconstruction Tissue Expanders Implants

6 Background (cont.) Surgical Site Infection (SSI) Different levels Superficial Deep Organ Space Wound Disruption

7 Problem/Purpose Infection Rates Silicone Implants Saline Implants Tissue Expanders Tissue Expander Saline and Silicone Implant

8 Hypothesis In breast cancer patients who have received mastectomies, those with breast reconstruction in the form of a tissue expander have higher infection rates than those who have received silicone or saline implants.

9 Methodology Review of patient s record s using EPIC (electronic medical record system) 19 Patients 29 Patients in previous years Medical Record Audit and database construction through REDCap

10 Methodology (cont.) Medical Record Audit included: Demographics Oncologic Treatment First Reconstruction Attempt

11 Data (Current Study) Number of subjects: 22 Surgeons: plastics (8) & general (7) Facilities: Main ORs (8), A60 (11), Beachwood (2), Hillcrest (1) Reconstruction: immediate (18), delayed (4) Diagnosed with SSI infections <90 days: 11

12 Results (Current Study) Infection: superficial (11); deep (3); organ/space (1) Culture results Main ORs & A-60: Diphtheroid bacilli, Streptococcus, Staphylococcus, Pseudomonas aeruginosa Hillcrest: Candida parapsilosis Beachwood: Bacteroides fragilis

13 Data (Previous Studies) Number of subjects: 29 Surgeons: plastics (13) & general (9) Facilities: Beachwood (1), Strongsville (1), Main ORs (17), A60 (6), Hillcrest (3), Avon (1) Reconstruction: immediate (23) & delayed (4) Diagnosed with SSI infections <90 days: 25

14 Results (Previous Studies) Infection: superficial (7); deep (1); organ/space (17) Culture results Main ORs: Serratia marcescens, Gram-positive cocci, Streptococcus, Enterococcus faecalis A60: Pseudomonas, beta-hemolytic streptococcal Hillcrest: Enterococcus faecalis

15 Data (Both) Number of

16 Conclusions Positive Correlation between: Higher Infection Rates Tissue Expanders Anticipated Results: Causes of SSIs Possible links with confounding variables

17 Recommendations Larger Population BRCA1 & BRCA2 EPIC Shortcuts Specified Templates: Oncologic Treatment/Regime Included more detail on prior surgeries Medical Record Audit for prior surgeries

18 References Breast Cancer. (2015). Retrieved July 21, 2015, from Breast Cancer: Causes, Symptoms and Treatments. (2015, July 10). Retrieved July 21, 2015, from Craft, MD, R., Damjanovic, MD, B., & Colwell, MD, FACS, A. (2012). Evidence-Based Protocol for Infection Control in Immediate Implant-Based Breast Reconstruction. Retrieved July 24, 2015 DJ, J., & F, B. (2014, March 9). Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Retrieved July 21, 2015, from Healthcare Infection Control Practices Advisory Committee (HICPAC). (2011, May 2). Guideline for Prevention of Surgical Site Infection, Retrieved July 22, 2015, from Phillips, MD, MBA, B., Bishawi, BS, M., Dagnum, MD, A., & Bui, MD, D. (2012). A Systematic Review of Antibotic Use and Infection in Breast Reconstruction: What Is the Evidence? Retrieved June 15, Surgical Site Infections. (2015, January 18). Retrieved July 22, 2015, from 4,144/

19 Special Thanks Mark F. Hendrickson, MD Taleisha Gibson, MA Autumn McCurdy, CNP Plastic Surgery & General Surgery Department Nedra Starling, MA, MPH, ABD/DrPH Bryan Pflaum, MFA Office of Government and Community Relations Civic Education Department

20 Copyright 2016 Cleveland Clinic Foundation