Surgical Site Infection in Patients Managed with an Endoprosthesis for the Treatment of Cancer

Abstract

Background: Surgical site infection (SSI) after segmental endoprosthetic reconstruction in patients treated for oncologic conditions remains both a devastating and a common complication. The goal of the present study was to identify variables associated with the success or failure of treatment of early SSI following the treatment of a primary bone tumor with use of a segmental endoprosthesis. Methods: The present study used the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) data set to identify patients who had been diagnosed with an SSI after undergoing endoprosthetic reconstruction of a lower extremity primary bone tumor. The primary outcome of interest in the present study was a dichotomous variable: the success or failure of infection treatment. We defined failure as the inability to eradicate the infection, which we considered as an outcome of amputation or limb retention with chronic antibiotic suppression (>90 days or ongoing therapy at the conclusion of the study). Multivariable models were created with covariates of interest for each of the following: surgery characteristics, cancer treatment-related characteristics, and tumor characteristics. Multivariable testing included variables selected on the basis of known associations with infection or results of the univariable tests. Results: Of the 96 patients who were diagnosed with an SSI, 27 (28%) had successful eradication of the infection and 69 had treatment failure. Baseline and index procedure variables showing significant association with SSI treatment outcome were moderate/large amounts of fascial excision ≥1 cm2) (OR, 10.21 [95% CI, 2.65 to 46.21]; p = 0.001), use of local muscle/skin graft (OR,11.88 [95% CI, 1.83 to 245.83]; p = 0.031), and use of a deep Hemovac (OR, 0.24 [95% CI, 0.05 to 0.85]; p = 0.041). In the final multivariable model, excision of fascia during primary tumor resection was the only variable with a significant association with treatment outcome (OR, 10.21 [95% CI, 2.65 to 46.21]; p = 0.018). Conclusions: The results of this secondary analysis of the PARITY trial data provide further insight into the patient-, disease-, and treatment-specific associations with SSI treatment outcomes, which may help to inform decision-making and management of SSI in patients who have undergone segmental bone reconstruction of the femur or tibia for oncologic indications. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses—A Review of the Literature

“…However, their prevalence is considerably lower in this population and pre-operative patient optimization, which often involves delaying the surgery to manage the underlying condition, is one of the cornerstones of total joint arthroplasty. Chemotherapy [32][33][34] Length of stay [35] Radiation therapy [18,36,37] Perioperative antibiotic regimen [38] Immunosuppression [32,34] Adequate soft tissue coverage (gastrocnemius flap, free flaps) [39,40] Soft tissue condition [23,41] Deep Hemovac drain α [42] Tibial site [9,36,39] Operative time [20,21] Amount of fascia excised [42] α Although a protective factor in separate multivariate logistic regression, it was not a significant factor in final multivariate logistic regression (p = 0.06).…”

“…Radiotherapy also contributes to the poor state of the soft tissue, which is among the most important risk factors for developing a PJI as well as failure to treat them [41]. In addition, larger exposures and more extensive fascial resections have been described as predictors of PJI [39,42]. Notably, a recent secondary analysis of the PARITY dataset indicated that moderate to large fascial excision (≥1 cm 2 ) was a risk factor for megaprostheses infection [42].…”

“…In addition, larger exposures and more extensive fascial resections have been described as predictors of PJI [39,42]. Notably, a recent secondary analysis of the PARITY dataset indicated that moderate to large fascial excision (≥1 cm 2 ) was a risk factor for megaprostheses infection [42].…”