The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy

McMillan, Angus; Ho, Ning; Izard, Charlie; Matteucci, Paolo; Totty, Joshua

Abstract

Background
Lymph node surgery, is commonly performed in staging of, and treatment of metastatic skin cancer. Previous studies have demonstrated sentinel lymph node biopsy (SLNB) and particularly lymph node dissection (LND) to be plagued by high rates of wound complications including surgical site infection (SSI) and seroma formation. This study evaluated the incidence of wound complications following lymph node surgery and provides the first published cost estimate of SSI associated with lymph node surgery in the UK.

Patients and methods
A retrospective cohort study was undertaken of 169 patients with a histological diagnosis of primary skin malignancy who underwent SLNB or LND of the axilla and/or inguinal region at a single tertiary centre during a 2 year period. Demographic, patient risk factor and operation characteristic data was collected and effect on SSI and seroma formation was analysed. Cost-per-infection was estimated using National Health Service (NHS) reference costs, and antibiotic costs.

Results
146 patients underwent SLNB, the SSI rate in this group was 4.1% and the seroma incidence was 12.3%. 23 patients underwent LND, the SSI rate was 39.1% and the seroma incidence was 39.1%. Seroma formation was strongly associated with development of SSI in both the SLNB (Odds ratio (OR) =18.0, p <0.001) and LND (OR = 21.0, p = 0.007) group. The median additional cost of care events and treatment for SSI in the SLNB and LND groups was £199.46 and £5187.04 respectively.

Conclusion
SSI remains a troublesome and costly event following both SLNB and LND. Further research into perioperative care protocols and methods of reducing lymph node surgery morbidity is required and could in turn produce significant cost savings to the NHS.

Citation

McMillan, A., Ho, N., Izard, C., Matteucci, P., & Totty, J. (in press). The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, https://doi.org/10.1016/j.bjps.2023.10.086

• Journal Article Type: Article
• Acceptance Date: Oct 11, 2023
• Online Publication Date: Oct 13, 2023
• Deposit Date: Oct 12, 2023
• Publicly Available Date: Oct 14, 2024
• Journal: Journal of plastic, reconstructive & aesthetic surgery : JPRAS
• Print ISSN: 1748-6815
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.bjps.2023.10.086
• Public URL: https://hull-repository.worktribe.com/output/4416191