Risk factors associated with 30‐day complications following lower extremity sarcoma surgery: A national surgical quality improvement project analysis

Abstract

Background Our study aims to identify risk factors associated with complications in lower extremity (LE) sarcoma surgery, as well as the prevalence and complications associated with concurrent plastic surgery procedures (CPSP). Methods ACS‐NSQIP database was accessed to identify patients treated for LE sarcoma (2010−2019). Patient demographics, preoperative lab, comorbidities, tumor type, location, principle procedure, and presence/characteristics of CPSPs were recorded. Thirty‐day soft tissue complications were analyzed. Bivariate and multivariate logistic regression was performed on IBM SPSS.™ Results Nine hundred eighteen patients were included (483 males and 435 females), average age and body mass index (BMI) of 57 and 27.4 kg/m,2 respectively. Comorbidities included smoking (13.9%, 128), hypertension (37.3%, 342), and insulin‐dependent diabetes (3.7%, 34). Preoperative lab values included albumin <3.5 (6.8%, 63), hematocrit <30% (8.2%, 75), and platelet count <150 000 (5.9%, 54). Thirty‐day soft tissue complication rate was 5.7% (52 of 918). On multivariate logistic regression, increased age (p = 0.039), higher BMI (p = 0.017), and longer operative times (p = 0.002) were significant risk factors independently associated with soft tissue complications. Conclusions Soft tissue complications within 30 days occur in 6% of patients. Graft procedures carry a 20% risk of complications. Risk factors independently associated with complications include increased age, increased BMI, and longer operative times.

Risk factors for 30‐day soft tissue complications after pelvic sarcoma surgery: A National Surgical Quality Improvement Program study

“…[15][16][17][18][19] Additional studies on bone and ST sarcomas of the upper and lower extremity using the NSQIP have also described lower complication rates than those reported by the literature. 3,20 Our lower rates might be explained by the shorter timeframe analyzed and the higher proportion of tumors requiring reconstruction procedures in other treatment centers. A study by Angelini et al in 270 patients undergoing pelvic bone tumor resection reported a 15% SSI rate in patients without reconstruction and 26% for those that underwent pelvic reconstruction.…”

“…In pelvic tumors, the risk is even higher due to their larger size, proximity to vital organs and neurovascular structures, difficulty attaining adequate resection margins, and inadequate radiation delivery to the area. 3,5,6,8 In these patients, postoperative ST complication rates between 29% and 34.1% have been reported, 5,9 in comparison with the 14%-22% rate reported for extremity sarcomas. 10,11 Studies on pelvic sarcomas have identified histologic grade, surgical margins, and tumor size as risk factors for postoperative wound complications.…”

“…current standard of care instead of amputation. 3,8 Although limbsalvage procedures have led to drastically improved functional outcomes, postoperative complication rates remain particularly high.…”

Immediate Plastic Surgery Intervention after Soft Tissue Sarcoma Resection: Examining Wound Healing, Readmission, and Reoperation

“…The goals and benefits of early plastic surgeon involvement include preserving patient function, limiting limb amputation, meeting the increased need of flap reconstruction, and optimizing closure and postoperative healing outcomes. 25–30…”

“…The goals and benefits of early plastic surgeon involvement include preserving patient function, limiting limb amputation, meeting the increased need of flap reconstruction, and optimizing closure and postoperative healing outcomes. [25][26][27][28][29][30] The purpose of this study is to build upon research examining collaboration between plastic surgeons and orthopedic or surgical oncologists by investigating and comparing complication rates of the following two cohorts: (1) patients who underwent index STS resection with immediate plastic surgeon intervention and (2) patients who underwent STS resection without a plastic reconstructive surgeon attending the case. The authors hypothesize minimal variation in primary outcomes of short-term any-cause readmission, same-site reoperation, and wound healing complications despite expectedly longer and potentially more complicated surgeries for patients whose cases involve plastic surgeon intervention.…”