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Death and complications after breast cancer surgery are rare, with wound infection the most common problem

Death and complications after breast cancer surgery are rare. The most common complication of the surgery is wound infection, which is twice as common after mastectomy than breast conserving surgery (lumpectomy and lymph node dissection), according to a new study. Mortality rates 30 days after surgery were 0.24 percent for mastectomy and 0 percent for breast conserving surgery.

Wound infection affected 4.34 percent of women undergoing mastectomy and 1.97 percent of those undergoing lumpectomy. Factors that may contribute to the higher rate of wound infections after mastectomy include extensive tissue dissection, drain placement, formation of seromas (pockets of fluid), and longer operation time.

A woman's overall health status also affected the likelihood of infection. For example, women who were morbidly obese (body mass index over 30), or who had low preoperative albumin (protein) levels and hematocrit greater than 45 percent, were more likely to develop wound complications. Wound healing requires protein synthesis (an albumin level of 4.08 appeared to protect against postoperative wound complications) and adequate nutritional status.

Women with these health problems who undergo mastectomy may be likely candidates for prophylactic antibiotics, suggest the researchers. They analyzed data from a national database on 1,660 women who underwent mastectomy and 1,447 women who underwent breast conserving surgery at 14 university and 4 community medical centers. The women's mean age was 56 years.

Few women who underwent mastectomy experienced cardiac (0.12 percent) or pulmonary (0.66 percent) complications. There were no cardiac or pulmonary complications in the lumpectomy group. Central nervous systems problems were also rare in the mastectomy (0.12 percent) and breast conservation (0.07 percent) group. Since morbidity and mortality rates are so low following breast cancer surgery, it is difficult to compare quality of care among different centers using these criteria.

The study was supported by the Agency for Healthcare Research and Quality (HS11913).

See "Morbidity and mortality following breast cancer surgery in women: National benchmarks for standards of care," by Mahmoud B. El-Tamer, M.D., F.A.C.S., B. Marie Ward, M.D., Tracy Schifftner, M.SC., and others, in the May 2007 Annals of Surgery 245(5), pp. 665-671.

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