84 - Percutaneous Drainage vs Operative Washout for Suspected Pocket Infection After Implant-Based Breast Reconstruction: Lower Infection Complications with IR in a Propensity-Matched Multicenter Cohort

Purpose: To compare interventional radiology (IR) percutaneous drainage/aspiration versus operative washout/debridement (OR) as first-line management for suspected pocket infection after implant-based breast reconstruction. As well as the necessity for subsequent reintervention or reconstruction procedures.

Materials and Methods: We used the TriNetX federated network to identify adults with prior implant-based breast reconstruction who underwent a first qualifying intervention for postoperative fluid collection. Exposure at index was IR percutaneous drainage/aspiration (e.g., CPT 10030/10160; ICD-10-PCS percutaneous breast drainage) versus OR washout/debridement (e.g., CPT 10180; ICD-10-PCS open breast drainage). All cases with same-day explant (CPT 19328/11971 or facility removal codes) were excluded. We then performed propensity score matching which yielded two balanced cohorts of 1,324 patients each. Outcomes were assessed between 8–30 and 8–90 days for reconstructive failure (implant/expander removal), as well as infection-related events, reintervention, and readmission. Outcomes were compared using risk ratios (RRs) and hazard ratios (HRs) from Cox models.

Results: After 1:1 propensity matching, both analyses included 2,648 patients (1,324 IR vs 1,324 OR) with near-identical demographics. Mean age at index was 52.5 ± 12.2 (IR) vs 52.6 ± 12.6 years (OR), with comparable comorbidities, including hypertension 34.4% vs 33.6% and diabetes 10.0% vs 9.6%. Pocket infection was significantly lower with IR vs OR at both time windows: 7.6% vs 12.1% at 8–30 days (RR 0.63; HR 0.62; both p< 0.001; absolute risk reduction 4.5%) and 12.8% vs 17.7% at 8–90 days (RR 0.72; HR 0.70; both p< 0.001; ARR 4.9%). Effect sizes were concordant across binary and time-to-event analyses, supporting a sustained reduction in infection risk with IR through 90 days. However, reintervention was observed more frequently after IR (8–30 d: 9.8% vs 3.2%; 8–90 d: 12.9% vs 6.5%), while reconstruction/device removal rates remained similar at 90 days (11.3% vs 11.4%).

Conclusion: Across a large, propensity-matched cohort, first-line IR drainage/aspiration was associated with fewer pocket infections at 30 and 90 days compared with operative washout, without increasing device removal. Our data support IR as a preferred initial strategy for suspected pocket infection, acknowledging a higher likelihood of subsequent, but typically less invasive, reintervention.