Morbid Obesity Increases the Risk of Postoperative Wound Complications, Infection, and Repeat Surgical Procedures Following Upper Extremity Limb Salvage Surgery for Soft Tissue Sarcoma. (January 2019)

• Record Type: Journal Article
• Authors: Houdek, Matthew T.; Griffin, Anthony M.; Ferguson, Peter C.; Wunder, Jay S.
• Is Part Of: Hand. Volume 14:Number 1(2019)
• Page Start: 114
• Page End: 120
• Publication Date: 2019-01
• Subjects: upper extremity -- limb salvage -- morbid obesity -- soft tissue sarcoma; Hand -- Surgery -- Periodicals; Hand -- Surgery; Periodicals; 617.57005
• DOI: 10.1177/1558944718797336
• Languages: English
• ISSNs: 1558-9447

Abstract

Background: Obesity is a known risk factor for wound complications; however, unlike elective upper extremity procedures, where obesity can be modified preoperatively, excision of soft tissue sarcomas (STSs) is not elective, and as such, obesity cannot be modified. There is a paucity of data concerning the impact of obesity on wound healing in upper extremity sarcoma surgery.Methods: A total of 261 (159 males and 102 females) patients with a STS of the upper extremity from 2006-2014 were reviewed. The mean age and body mass index (BMI) were 56 (18-97) years and 26.6 (15.4-40.8) kg/m 2, respectively. Sixty-nine patients (26%) were classified as obese (BMI ⩾30 kg/m 2 ): class I (obese, BMI = 30-34.9 kg/m 2 ; n = 48, 18%), class II (severely obese, BMI = 35.0-39.9 kg/m 2 ; n = 16, 6%), and class III (morbidly obese, BMI ≥ 40 kg/m 2 ; n = 5, 2%). Functional outcomes were also compared between obese and nonobese patients using the Musculoskeletal Tumor Society (MSTS) 1993 rating system and Toronto Extremity Salvage Scores (TESS).Results: Forty-nine patients (19%) sustained a wound dehiscence, delayed healing, or infection. Class III obesity increased the risk of wound complications (hazard ratio [HR] = 8.19, 95% confidence interval [CI] = 1.96-22.96, P < .001) and infection (HR = 10.09, 95% CI = 1.60-34.83, P = .01). There was no difference in the mean TESS (93 vs 90, P = .13) or MSTS93 (95 vs 93, P = .39) between obese and nonobese patients.Conclusions: The results of this study indicate morbid obesity significantly increased the risk of a postoperative wound complication and infection. However, following upper extremity limb salvage surgery, obese patients should expect to have excellent functional outcome.