Exploring Risk Factors for Predicting 30-Day Postoperative Morbidity in Musculoskeletal Tumor Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Tumor Classification and Surgical Interventions
2.3. Study Population and Data Collection
2.4. Assessment of Comorbidities
2.5. Statistical Analysis
3. Results
3.1. Patient and Tumor Characteristics
3.2. Demographic Overview
3.3. Comorbidities and Medication
3.4. Therapy
3.5. Association between Reconstruction and 30-Day Postoperative Morbidity
3.6. Complications
3.7. Risk Factors of 30-Day Postoperative Morbidity
3.8. Association between Charlson Comorbidity Index and 30-Day Postoperative Morbidity
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Condition | Weight |
---|---|
Myocardial infection | 1 |
Congestive Heart Failure | 1 |
Peripheral Vascular Disease | 1 |
Cerebrovascular Disease | 1 |
Dementia | 1 |
Chronic Pulmonary Disease | 1 |
Rheumatic Disease | 1 |
Peptic Ulcer Disease | 1 |
Mild Liver Disease | 1 |
Diabetes without Complications | 1 |
Diabetes with Complications | 2 |
Hemiplegia or Paraplegia | 2 |
Renal Disease | 2 |
Any Malignancy | 2 |
Moderate or Severe Liver Disease | 3 |
Metastatic Solid Tumor | 6 |
AIDS/HIV | 6 |
I | Any deviation from the normal postoperative course without the need for pharmacological treatment re surgical, endoscopic, and radiological interventions. Allowed therapeutic regimens are drugs as antiemetics, antipyretics, analgesics, diuretics, electrolytes, and physiotherapy. Also included is wound infection opened at the bedside. |
II | Requiring pharmacological treatment with drugs other than those allowed for grade I complications. Also included are blood transfusions and total parenteral nutrition. |
IIIa | Requiring surgical, endoscopic, or radiological intervention. |
IIIb | Intervention under general anesthesia. |
IVa | Life-threatening complication (including CNS complications) requiring ICU management; single organ dysfunction. |
IVb | Multiorgan dysfunction. |
V | Death of patient |
Category | Total Number | Malignant | Intermediate * | Benign | Specific Types (Number) |
---|---|---|---|---|---|
Total Patients | 187 | 100 | 42 | 45 | |
Soft Tissue Lesions | 146 | 76 | 34 | 36 | Lipomatous (64), Undifferentiated Sarcomas (18), Myo-/Fibroblastic (27), Uncertain Origin (14), Smooth Muscle (9), Nerve Sheath (4), Fibrohistiocytic (3) |
Bone Lesions | 41 | 24 | 8 | 9 | Chondrogenic (14), Osteoblastic (12), Ewing Sarcomas (3), Giant-cell rich (2), giant cell tumor (2) |
Category | Total (n = 187) | Sarcoma (n = 129) | Benign Tumor (n = 58) |
---|---|---|---|
Age [years] median (Q1, Q3) | 57 (42, 67) | 58 (46, 70) | 50 (37, 63) |
Female | 86 (46%) | 58 (45%) | 28 (48%) |
Caucasian | 185 (99%) | 127 (98%) | 58 (100%) |
Functional Status | |||
Independent | 137 (92%) | 86 (91%) | 51 (94%) |
Partially Independent | 10 (6.7%) | 9 (9.5%) | 1 (1.9%) |
Dependent | 2 (1.3%) | 0 (0.0%) | 2 (3.7%) |
Unknown | 36 (19.3%) | 34 (26.4%) | 4 (6.9%) |
ASA Status | |||
1 | 41 (22%) | 20 (16%) | 21 (36%) |
2 | 115 (61%) | 82 (64%) | 33 (57%) |
3 | 31 (17%) | 27 (21%) | 4 (6.9%) |
Current Smoker | 24 (13%) | 13 (10%) | 11 (20%) |
Disseminated Cancer | 7 (3.7%) | 5 (3.9%) | 0 (0.0%) |
Tumor Location | |||
Appendicular | 148 (79%) | 102 (79%) | 46 (79%) |
Axial | 39 (21%) | 27 (21%) | 12 (21%) |
Tumor Type | |||
Bone | 41 (22%) | 26 (20%) | 15 (26%) |
Soft Tissue | 146 (78%) | 103 (80%) | 43 (74%) |
Charlson Comorbidity score > 5 | 24 (13%) | 22 (17%) | 2 (3.4%) |
Category | Total (n = 196) | Sarcoma (n = 134) | Benign Tumor (n = 62) |
---|---|---|---|
Complications according to Clavien-Dindo | |||
No complications | 148 (75.5%) | 94 (70.1%) | 54 (87.1%) |
Grade 1 | 25 (12.8%) | 20 (14.9%) | 5 (8.1%) |
Grade 2 | 13 (6.6%) | 13 (9.7%) | 0 (0%) |
Grade 3 | 10 (5.1%) | 7 (5.2%) | 3 (4.8%) |
Presence of complication | 48 (24.5%) | 40 (29.8%) | 8 (12.9%) |
Comorbidity | Number of Patients (%) |
---|---|
Hematologic Disease | 21 (11.2%) |
Central Nervous System Disorder | 20 (10.7%) |
Gastrointestinal Disease | 17 (9.1%) |
Chronic Obstructive Pulmonary Disease | 1 (0.5%) |
History of Other Pulmonary Disease | 7 (3.7%) |
Congestive Heart Failure | 1 (0.5%) |
Neuromuscular Disorder | 1 (0.5%) |
Previous Childhood Malignancy | 2 (1.1%) |
Bleeding Disorder | 2 (1.1%) |
Diabetes mellitus | 6 (3.2%) |
Treatment Type | Number of Sarcoma Patients | Percentage (%) |
---|---|---|
Neoadjuvant Radiotherapy | 64 | 32.7 |
Adjuvant Radiotherapy | 7 | 3.6 |
Neoadjuvant Chemotherapy | 18 | 9.2 |
Neoadjuvant and Adjuvant Chemotherapy | 3 | 1.5 |
Patient Group | Surgeries with Reconstruction n = 89 | p-Value | Surgeries without Reconstruction n = 107 |
---|---|---|---|
Overall Complication Rate | 30/89 (33.7%) | 0.008 * | 18/107 (16.3%) |
Complication Rate by Tumor | |||
Sarcoma | 27/79 (34.2%) | 0.98 ** | 13/55 (23.6%) |
Benign Tumor | 3/10 (30%) | 5/52 (9.6%) | |
Complication Rate by Tissue Type | |||
Bone Tumor | 13/27 (48.2%) | 0.09 ** | 4/17 (23.5%) |
Soft Tissue Tumor | 17/62 (27.4%) | 14/90 (15.6%) |
Category | Total (n = 196) | Complication (n = 89) | No Complication (n = 107) | p-Value |
---|---|---|---|---|
Age [years] (median (Q1, Q3)) | 56 (42, 67) | 60 (48, 69) | 51 (38, 63) | 0.01 |
Female | 86 (46%) | 44 (49%) | 47 (44%) | 0.40 |
Caucasian | 185 (99%) | 89 (100%) | 105 (98%) | 0.93 |
Functional Status | 0.002 | |||
Independent | 137 (92%) | 56 (62.9%) | 89 (83.1%) | |
Partially Independent | 10 (6.7%) | 9 (10.1%) | 1 (0.9%) | |
Dependent | 2 (1.3%) | 2 (2.2%) | 1 (0.9%) | |
Unknown | 36 (19.3%) | 22 (24.7%) | 16 (15.1%) | |
ASA Status | <0.001 | |||
1 | 41 (22%) | 10 (11%) | 33 (31%) | |
2 | 115 (61%) | 54 (61%) | 65 (61%) | |
3 | 31 (17%) | 25 (28%) | 9 (8.4%) | |
Current Smoker | 24 (13%) | 8 (9.0%) | 17 (16%) | 0.14 |
Disseminated Cancer | 7 (3.7%) | 6 (6.7%) | 5 (4.7%) | 0.60 |
Tumor Location | 0.44 | |||
Appendicular | 148 (79%) | 65 (75%) | 87 (81%) | |
Axial | 39 (21%) | 22 (25%) | 20 (19%) | |
Tumor Type | 0.33 | |||
Bone | 41 (22%) | 27 (30%) | 17 (16%) | |
Soft Tissue | 146 (78%) | 62 (70%) | 90 (84%) | |
Charlson Comorbidity Score > 5 | 24 (13%) | 18 (20%) | 11 (10%) | 0.05 |
Radiotherapy None Neoadjuvant Adjuvant | (n = 187) * 118 (63%) 64 (34%) 5 (2.7%) | (n = 85) * 39 (46%) 42 (49%) 4 (4.7%) | (n = 102) * 79 (77%) 22 (22%) 1 (1.0%) | <0.001 |
Chemotherapy None Neoadjuvant Adjuvant Sandwich | (n = 187) * 164 (88%) 17 (9.1%) 3 (1.6%) 3 (1.5%) | (n = 85) * 69 (81%) 13 (15%) 2 (2.4%) 1 (1.2%) | (n = 102) * 95 (93%) 4 (3.9%) 1 (1.0%) 2 (2.1%) | 0.01 |
Type of Infection | Number | Percentage (%) |
---|---|---|
Surgical Site Infections | 8/196 | 4.1 |
Pneumonia | 2/196 | 1.0 |
Sepsis | 2/196 | 1.0 |
Wound Dehiscence (Deep) | 7 /196 | 3.6 |
Wound Dehiscence (Superficial) | 7/196 | 3.6 |
Venous Thromboembolism | 4/196 | 2.0 |
Allograft Failure | 1/196 | 0.5 |
Prosthesis Failure | 1/196 | 1.0 |
Flap Failure | 1/196 | 0.5 |
Blood Transfusion | 17/196 | 8.7 |
Reoperation | 10/196 | 5.1 |
Re-Admission | 6/196 | 3.1 |
Variable | Odds Ratio (95% CI) | p-Value |
---|---|---|
Age | 1.0 (0.98, 1.01) | 0.06 |
Gender (Male vs. Female) | 1.15 (0.60, 2.24) | 0.71 |
Tumor Type | ||
-Bone (vs. Soft Tissue) | 2.46 (1.18, 5.06) | 0.02 |
Presence of Metastasis | 4.09 (1.18, 14.8) | 0.03 |
Tumor Classification | ||
-Sarcoma (vs. benign) | 2.87 (1.31, 7.02) | 0.01 |
Radiotherapy | ||
-Neoadjuvant (vs. adjuvant vs. none) | 1.18 (0.59, 2.32) | 0.60 |
Systemic Therapy | ||
-Neoadjuvant (vs. adjuvant vs. none) | 2.27 (0.84, 5.87) | 0.01 |
ASA Status | ||
-ASA 2 (vs. ASA 1) | 1.05 (0.44, 2.69) | 0.92 |
-ASA 3 (vs. ASA 1) | 4.38 (1.62, 12.7) | 0.01 |
Charlson Comorbidity Index (CCI) | 1.13 (0.96, 1.33) | 0.14 |
Functional Status | 2.29 (0.91, 5.85) | 0.07 |
Number of Erythrocyte Concentrations | 3.00 (1.67, 7.24) | 0.01 |
Outcome | Odds Ratio (OR) | 95% Confidence Interval (CI) | p-Value |
---|---|---|---|
Occurrence of Complications | 1.13 | 0.96,1.33 | 0.14 |
Complication Severity | 1.09 | 0.83–1.43 | 0.54 |
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Heesen, P.; Elyes, M.; Domanski, J.; Schelling, G.; Könneker, S.; Fuchs, B., on behalf of the Swiss Sarcoma Network . Exploring Risk Factors for Predicting 30-Day Postoperative Morbidity in Musculoskeletal Tumor Surgery. J. Clin. Med. 2024, 13, 2681. https://doi.org/10.3390/jcm13092681
Heesen P, Elyes M, Domanski J, Schelling G, Könneker S, Fuchs B on behalf of the Swiss Sarcoma Network . Exploring Risk Factors for Predicting 30-Day Postoperative Morbidity in Musculoskeletal Tumor Surgery. Journal of Clinical Medicine. 2024; 13(9):2681. https://doi.org/10.3390/jcm13092681
Chicago/Turabian StyleHeesen, Philip, Maria Elyes, Jan Domanski, Georg Schelling, Sören Könneker, and Bruno Fuchs on behalf of the Swiss Sarcoma Network . 2024. "Exploring Risk Factors for Predicting 30-Day Postoperative Morbidity in Musculoskeletal Tumor Surgery" Journal of Clinical Medicine 13, no. 9: 2681. https://doi.org/10.3390/jcm13092681