Impact of Surgical Care Bundle on Surgical Site Infection after Non-Reconstructive Breast Cancer Surgery: A Single-Centre Retrospective Comparative Cohort Study

SIMPLE SUMMARY: Wound infection or so-called surgical-site infection (SSI) is a common occurrence after surgery. For some breast cancer patients, these infections can lead to delays in starting their onward systemic treatments such as chemotherapy and/or radiotherapy after surgery. More importantly, treatment delays in patients can lead to worsened overall survival. SSIs also have considerable negative impacts on financial and staffing resources in healthcare. The World Health Organization has recommended the usage of a surgical care bundle (SCB), which is a group of preventative measures that are effective in reducing SSIs. However, the impact of care bundles on SSIs has not been well documented in the context of breast cancer surgery. Therefore, we aimed to investigate the outcomes of SSI following the implementation of a surgical care bundle protocol for non-reconstructive breast cancer surgery. ABSTRACT: Background: Surgical-site infections (SSIs) are the commonest cause of healthcare-related infections. Although a surgical care bundle (SCB), defined as a group of preventative measures, is effective in reducing SSIs, it has not been well documented in breast cancer surgery. We aimed to investigate the impact of SCB on SSI. Methods: A single-centre retrospective comparative cohort study between 2016 and 2020 was carried out. An SCB including eight different measures was implemented in October 2018 at Sahlgrenska University Hospital, Sweden. Patients who underwent non-reconstructive breast cancer surgery were included for analysis. The primary endpoint was SSI within 30 days after surgery. Results: Overall, 10.4% of patients (100/958) developed SSI. After SCB implementation, the overall SSI rate reduced from 11.8% to 8.9% (p = 0.15). The largest SSI rate reduction was seen in the subgroup that underwent breast conservation and sentinel lymph node biopsy (SLNB), from 18.8% to 9.8% (p = 0.01). In this multivariable analysis adjusting for patient and treatment factors, the implementation of SCB resulted in a statistically significant reduction in SSI risk (OR 0.63, 95% CI 0.40–0.99, p = 0.04). Conclusions: The implementation of a SCB could reduce the incidence of SSI in breast cancer surgery.