Surgical-Site Infection is Associated With Increased Risk of Breast Cancer-Related Lymphedema: A Nationwide Cohort Study

Surgical-site infection (SSI) is a common short-term complication following breast cancer treatment and may increase the risk of long-term breast cancer-related lymphedema (BCRL). This This nationwide registry-based study showed that SSI was associated with an overall 10% increased risk of BCRL. These findings may be used to identify patients at high risk of BCRL that would benefit from enhanced BCRL surveillance. Background: Surgical-site infection (SSI) is one of the most common short-term complications following breast cancer treatment and can inhibit lymphatic drainage. It is currently not known whether SSI increases the risk of long-ter m breast cancer-related lymphedema (BCRL). Thus, the objective of this study was to examine the association between surgicalsite infection and the risk of BCRL Methods: This nationwide study identified all patients treated for unilateral, primary invasive, nonmetastatic breast cancer in Denmark between January 1, 2007, and December 31, 2016 (n = 37,937). A redemption of antibiotics after breast cancer treatment was used as a disease proxy for SSI, included as a time-varying exposure. The risk of BCRL was analyzed up to 3 years after breast cancer treatment using multivariate Cox regression and adjusted for cancer treatment, demographics, comorbidities, and socioeconomic variables. Results: There were 10,368 (27.33%) patients with a SSI and 27,569 (72.67%) without a SSI (incidence rate per 100 patients, 33.10 (95%CI, 32.47-33.75). The BCRL incidence rate per 100 person-years for patients with SSI was 6.72 (95%CI: 6.41-7.05) and 4.86 (95%CI: 4.70-5.02) for patients without an SSI. There was an overall significant increased risk of BCRL in patients with an SSI (adjusted HR, 1.11; 95%CI: 1.04-1.17), with the highest risk 3 years after breast cancer treatment (adjusted HR, 1.28; 95%CI: 1.08-1.51) Conclusion: This large nationwide cohort study showed that SSI was associated with an overall 10% increased risk of BCRL. These findings may be used to identify patients at high risk of BCRL that would benefit from enhanced BCRL surveillance.

Automated summary

Surgical-site infection is a common complication after breast cancer treatment and may increase the risk of breast cancer-related lymphedema. A nationwide registry-based study showed that there was a 10% increased risk of breast cancer-related lymphedema associated with surgical-site infection. These findings can help identify high-risk patients who would benefit from enhanced surveillance.