Authors (including presenting author) :
Wong L, Chang YK, Suen TKD, Kwong A
Affiliation :
Department of Surgery, Queen Mary Hospital, and Tung Wah Hospital
Introduction :
Pre-pectoral implants are increasingly popular due to their lower complication rates and improved patient-reported outcomes. However, infection remains a significant complication. The service at Tung Wah Hospital commenced in October 2023, highlighting the necessity of developing an evidence-based nursing guideline to empower nurses to practice with confidence and safety.
Objectives :
The objective was to develop a nursing guideline aimed at reducing postoperative infections following pre-pectoral implant-based breast reconstruction
Methodology :
A comprehensive literature search was conducted to formulate a nursing guideline for preventing postoperative wound infections, and endorsed by breast division by the end of December 2023. Preoperatively, the importance of smoking cessation and the optimization of hypertension and diabetes management was implemented. Additionally, Initiating a low-fat diet one week prior to surgery was suggested, as it may contribute to a reduction in the duration of drain placement, based on a local study. In the operating theatre, the application of a single-use, negative pressure wound therapy dressing (PICO sNPWT) over the surgical wounds located at the inferior mammary fold was implemented, in order to facilitate early wound healing. The sNPWT dressing was removed on postoperative day 6 (POD 6), after which a foam dressing was applied to protect the wound(s). Drains were removed when the drainage volume reached approximately 20 ml per day for two consecutive days. For postoperative wound care, a 10% iodine-povidone lotion was utilized for dressing changes prior to drain removal. Furthermore, a comprehensive patient education program was emphasized before discharge, covering essential topics such as strict personal hygiene, adherence to prophylactic antibiotics before drain removal, compliance with regular follow-up schedules, and prompt medical consultation for any signs or symptoms of infection. The data on mastectomies with implant-based reconstruction were compared between the pre-implementation group (pre-group) in 2023 and post-implementation group (post-group) in 2024.
Result & Outcome :
Results: From October to December 2023, there were 6 mastectomies with implant-based reconstruction in the pre-group, compared to 17 mastectomies in the post-group from January to December 2024. The baseline characteristics of the pre-group indicated a mean age of 49.7 years (SD=9.8), while the post-group had a mean age of 49.4 years (SD=8.2). The body mass index (BMI) for the pre-group averaged 20.8 kg/m² (SD=0.9), compared to a mean of 23.9 kg/m² (SD=3.08) in the post-group. The prevalence rates of hypertension, diabetes mellitus (DM), and a history of radiotherapy on the operative side was 13.3%, 13.3% and 13.3% in the pre-group, versus 5.9%, 5.9%, and 23.5% in the post-group. The post-group demonstrated a shorter duration of drain usage, averaging 12.4 ± 8.6 days compared to the pre-group’s 20.3 ± 3.4 days (P=0.04). The incidence of wound infection and wound dehiscence over the inferior mammary folds was recorded at 13.3% and 26.6% in the pre-group, while no cases of wound infection or dehiscence were observed in the post-group. Conclusion: One-year data suggest that the implementation of the evidence-based nursing guideline effectively shortens the duration of drain usage and improves infection rates following implant-based reconstruction. This evidence-based nursing guideline serves as a valuable resource for nurses, ensuring standardized practice and promoting optimal patient outcomes.
