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Is hypochlorous acid effective at reducing surgical site infection rates in immediate implant-based breast reconstruction?
Matthew A. DePamphilis
*, Alejandro Diaz, Serenity Bennett, Qiao Jiao, Katya Remy, William G. Austen, Katherine Carruthers
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
Background There is no universally accepted best practice for the type of irrigation agent used during implant-based breast reconstruction. Hypochlorous acid has been proposed as an alternative due to its robust antimicrobial characteristics with minimal inflammatory or cytotoxic properties. This study aims to compare the effect of hypochlorous acid to traditional irrigation formulations on surgical site infection (SSI) following implant-based breast reconstruction.
Methods A multicenter retrospective cohort study was conducted on 1,226 immediate implant-based breast reconstructions. The primary outcome was SSI occurring within 90 days as defined by the Center for Disease Control. Minor SSI was defined as SSI successfully treated with oral antibiotics and major SSI was defined as requiring hospitalization for IV antibiotics or operative treatment. Patients that underwent autologous reconstruction or those with <3 months follow-up were excluded.
Results The minor SSI rate was 4.7%, major SSI rate was 4.1%, and overall SSI rate was 8.8%. Irrigation with 0.033% hypochlorous acid was performed in 138 (11.3%) breasts, and pooled sample of traditional formulations in 1,088 (88.7%) breasts. Multivariable regression analysis revealed that irrigation with hypochlorous acid (OR, 0.242; 95% CI, 0.071 to 0.622; P<0.009) was associated with a significantly decreased risk of SSI. Preoperative radiotherapy (OR, 2.536; 95% CI, 1.319 to 4.624; P=0.003) was the strongest predictor of SSI. There was no increased risk of SSI between TE vs DTI (OR, 1.234; 95% CI, 0.786 to 1.942; P=0.361), subpectoral vs prepectoral (OR, 0.704; 95% CI, 0.446 to 1.111; P=0.130) or use of ADM (OR, 0.494; 95% CI, 0.255 to 1.027; P=0.046).
Conclusion Irrigation with hypochlorous acid may reduce the risk of SSI in implant-based breast reconstruction while limiting the inflammatory reaction commonly seen with antibiotic irrigation. Knowing this, surgeons may choose to utilize hypochlorous acid during implant-based reconstructive procedures, particularly in patients with a history of antibiotic sensitivity.
