The Effects of Wound Complications on Quality of Life Following Breast Cancer Surgery

Background: Wound complications following breast cancer surgery result in increased morbidity, hospital readmissions, repeat surgery, and prolonged antibiotic use.

Objective: Characterize the impact on wound complications, including surgical site infection (SSI), seroma, hematoma, dehiscence, and necrosis, on quality of life in patients undergoing surgery for breast cancer.

Methods: Women at high risk of developing wound complications were recruited after breast-conserving surgery, mastectomy, or mastectomy plus immediate reconstruction. Three telephone interviews were administered 3-4 weeks, 7-8 weeks, and 6 months after surgery. The interviews included the RAND Health Survey to measure 8 quality of life subscales (higher scores indicate better quality of life). Data were collected from the original surgical admission and all hospital readmissions and surgeon clinic visits ≤ 7 months after surgery to track signs and symptoms of complications, treatments, and antibiotic use. Wound complications were categorized as none, mild, or serious (if surgical intervention was required). The RAND subscale scores were compared at each time point using the Kruskal-Wallis test. Repeated measures generalized linear models (GLM) were used to examine the effects of time and wound complication group on the RAND subscale scores.

Results: 100 women completed all 3 interviews. 73% of the participants were Caucasian and the mean age was 53 years. 64 women had no wound complications, 22 had mild (8 SSI), and 14 had serious wound complications (7 SSI). Subscale scores for pain and role limitations due to physical health problems at 6 months were significantly lower in women with mild and serious wound complications compared to women with no complications (p<.05). Subscale scores were lower for the emotional well-being, social functioning, physical functioning, role limitations due to emotional health, energy/fatigue, and general health subscales in women with mild and severe wound complications, although they were not significantly different by wound complication group. In repeated measures GLM models, there were significant main effects of time for the physical functioning, role limitations due to physical health, emotional well-being, social functioning, and pain subscales (each p≤.001). The interaction of time and wound complication group was marginally significant for the role limitations due to physical health subscale (p=.070, see Figure) and the emotional well-being subscales (p=.078).

Conclusions: Six months after surgery, women with mild and serious infectious and noninfectious wound complications reported more pain and more limitations due to physical health problems than women without wound complications.  This exploratory study suggests that wound complications adversely impact quality of life in women after breast cancer surgery.