A Comparative Analysis of Surgical Wound Infection Methods: Predictive Valuesof the CDC ASEPSIS and Southampton Scoring Systems in Evaluating Breast ReconstructionSurgical Site Infections

摘要

Infection is the most significant complication in breast reconstruction surgery. Whilethe Center for Disease Control and Prevention (CDC) is the most prevalent tool forsurgical site infection (SSI) diagnosis, ASEPSIS and Southampton scoring methods have beenspeculated to be more sensitive. The ASEPSIS scoring system previously demonstrated muchbetter interrater reliability than the CDC. We sought to assess the predictive value ofvarious wound scoring methods in breast reconstruction SSIs. A retrospective analysis ofall single-institution breast reconstruction infections from January 2013 to June 2016 wasperformed. Patients’ postoperative wound-related complications were collected.Southampton, CDC, and modified ASEPSIS scores—extended to 30 postoperative days—werecalculated. Relative predictive values for implant-based reconstruction were evaluated.Among the 22 reviewed cases, ASEPSIS scores greater than 30 resulted in a more than 50%rate of implant-based breast reconstruction failure. There was a significant positivecorrelation between ASEPSIS score and failure rate ( = .022). ASouthampton classification of B—minor complication (60% failure)—had a greater associativerisk of reconstruction failure than a classification of C—major complication (23%failure)—or classification of D—major hematoma (0% failure). The CDC score had nopredictive value of success versus failure of reconstruction. While the CDC criteria andSouthampton scoring systems demonstrated little clinical use, the ASEPSIS scoring systemshows substantial predictive value for breast reconstruction SSIs. New procedure protocolsshould be implemented to require detailed surgical notes including the proportion of thewounds affected by inflammatory responses to allow for easier wound score calculation bythese alternate scoring systems.