Morbid Obesity Is Associated With an Increased Risk of Wound Complications and Infection After Lower Extremity Soft-tissue Sarcoma Resection. Issue 21 (1st November 2019)

• Record Type: Journal Article
• Authors: Houdek, Matthew T.; Hevesi, Mario; Griffin, Anthony M.; Wunder, Jay S.; Ferguson, Peter C.
• Is Part Of: Journal of the American Academy of Orthopaedic Surgeons. Volume 27:Issue 21(2019)
• Publication Date: 2019-11-01
• Subjects: Orthopedics -- Periodicals; Orthopedic surgery -- Periodicals; Joint Diseases -- Periodicals; Orthopedics -- Periodicals; Orthopedic surgery; Orthopedics; Periodicals; 616.7005
• DOI: 10.5435/JAAOS-D-18-00536
• Languages: English
• ISSNs: 1067-151X

Abstract

Abstract : Background: Obesity is associated with wound complications after lower extremity surgery. Excision of soft-tissue sarcomas is urgent, and unlike the elective surgery, obesity cannot be modified preoperatively. The purpose of this study was to evaluate the effect of obesity on treatment outcome. Methods: Six hundred fifty-three patients (343 men; mean age, 56 ± 18 years) with a lower extremity soft-tissue sarcoma were reviewed. The mean body mass index (BMI) was 27.1 ± 5.7 kg/m 2, with 189 obese patients (29%) having a BMI of ≥30 kg/m 2 and 27 morbidly obese patients (4%) having a BMI of ≥40 kg/m 2 . Complications and functional and oncologic outcomes were compared between groups. Results: Two hundred eighty-five patients (40%) sustained a postoperative complication, most commonly a dehiscence (n = 175; 24%) and infection (n = 147; 21%). On multivariate analysis, morbid obesity was associated with wound complications ( P = 0.002) and infection ( P = 0.01). Morbid obesity was not associated with local tumor recurrence ( P = 0.56). No difference was found in the mean Toronto Extremity Salvage Score ( P = 0.11) or Musculoskeletal Tumor Society ( P = 0.41) scores between the groups. Discussion: Morbid obesity was associated with postoperative wound complications and infection. However, after surgery, obese patients can expect no difference in oncologic outcome, with an excellent functional result.