Study of Inflammatory and Infection Markers in Periprosthetic Fluid: Correlation with Blood Analysis in Retrospective and Prospective Studies

Abstract

Background. Surgical site infection represents the most severe complication in prosthetic breast reconstruction. Risk profiling represents a useful tool for both clinicians and patients. Materials and Methods. In our hospital, 534 breast reconstructions with tissue expander implants, in 500 patients, were performed. Several clinical variables were collected. In our study, we evaluated the different inflammatory markers present in the periprosthetic fluid and we compared them with the ones present in plasma. Results. The surgical site infection rate resulted to be 10.5%, and reconstruction failed in 4.5% of the cases. The hazard ratio for complications was 2.3 in women over 60 (CI: 1.3-4.07; $p=0.004$ ), 2.57 in patients with $\text{expander}\text{volume}\ge 500\text{cc}$ (CI: 1.51-4.38; $p<0.001$ ), 2.14 in patients submitted to previous radiotherapy (CI: 1.05-4.36; $p<0.037$ ), and 1.05 in prolonged drain use (CI: 1.03-1.07; $p<0.001$ ). 25-OH, PCT, and total protein were less concentrated, and ferritin and LDH were more concentrated in the periprosthetic fluid than in plasma ( $p<0.001$ ). CRP ( $p=0.190$ ) and β-2 microglobulin ( $p=0.344$ ) did not change in the two fluids analyzed. PCT initial value is higher in patients who underwent radiotherapy, and it could be related to the higher rate of their postoperative complications. Patients with a tissue expander with a $\text{volume}\ge 500\text{cc}$ show an increasing trend for CRP in time ( $p=0.009$ ). Conclusions. Several risk factors (prolonged time of drains, age older than 60 years, and radiotherapy) have been confirmed by our study. The study of markers in the periprosthetic fluid with respect to their study in plasma could point toward earlier infection detection and support early management.