Early experience of the MIAMI Protocol: Minimizing Infection After Mastectomy and Implants
Emily Finkelstein1, Federico Perez-Quirante1, Dylan Treger*1, Samantha A. McLaughlin1, Meaghan Clark2, Aziz Shittu1, Chloe Shields1, Anshumi Desai1, Juan R. Mella-Catinchi1, Zubin Panthaki1, John Oeltjan1, Wrood Kassira1, Devinder Singh1, Sara Danker1
1University of Miami Miller School of Medicine, Miami, FL; 2Ross University School of Medicine, Bridgetown, Barbados
Reported infection rates following implant-based breast reconstruction (IBBR) range from 1-35%. Surgical QI projects have had ample success in the past, but few have been described targeting IBBR complications. The purpose of this study is to present the 90-day outcomes of the MIAMI protocol (Minimizing Infection After Mastectomy with Implants), a QI project to standardize preoperative, intraoperative, and postoperative IBBR protocol.
The MIAMI protocol was instituted on December 1, 2022 at the University of Miami and Jackson Memorial Hospital Systems. Incidence of infection, wounds, hematoma, seroma, and flap necrosis and rates of reoperation for a complication and implant loss were evaluated for patients of six faculty members and compared before (01/01/2022-11/30/2022) and after (12/01/2022-02/05/2023) adopting the protocol.
Four-hundred and twenty IBBR procedures were performed, 360 (86%) before implementing the MIAMI protocol and 60 (14%) after the protocol was in place. Average patient age was 51 years and body mass index was 27.3 kg/m2. Total infection rate was 14.5%. IBBR procedures performed after adopting the protocol were found to have significantly fewer infections (16% vs 5%; p<0.0238), wounds or dehiscence (24% vs 7%; p<0.0022), and seromas (14% vs 0%; p<0.005). Though nonsignificant, rate of reoperation for complications declined from 14.7% to 8.3% (p=0.1842), and implant removal declined from 13.3% to 8.3% (p=0.2802). The most common cause for reoperation before (n=35, 66%) and after (n=4, 80%) the MIAMI protocol was infection, either with (n=9) or without (n=30) concurrent wound dehiscence or mastectomy flap necrosis.
The MIAMI protocol had a significant impact on short-term surgical outcomes for IBBR. Significant decreases were noted for incidence of infection, wounds or dehiscence, and seroma, and rates of reoperation for a complication and operative implant removal declined. Authors will continue to evaluate outcomes up to one postoperative year to determine long-term efficacy of the protocol.
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