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Morbid Obesity Is Associated With an Increased Risk of Wound Complications and Infection After Lower Extremity Soft-tissue Sarcoma Resection

Houdek, Matthew T. MD; Hevesi, Mario MD; Griffin, Anthony M. MSc; Wunder, Jay S. MD; Ferguson, Peter C. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: November 1, 2019 - Volume 27 - Issue 21 - p 807-815
doi: 10.5435/JAAOS-D-18-00536
Research Article

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/m2, with 189 obese patients (29%) having a BMI of ≥30 kg/m2 and 27 morbidly obese patients (4%) having a BMI of ≥40 kg/m2. 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.

From the University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada (Dr. Houdek, Mr. Griffin, Dr. Wunder, and Dr. Ferguson), and the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Dr. Houdek and Dr. Hevesi).

Correspondence to Dr. Houdek:

Dr. Ferguson or an immediate family member serves as a paid consultant to Stryker and serves as a board member, owner, officer, or committee member of the Musculoskeletal Tumor Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Houdek, Dr. Hevesi, Mr. Griffin, and Dr. Wunder.

Ethics: Before the start of this study, we obtained approval from our IRB.

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Copyright 2018 by the American Academy of Orthopaedic Surgeons.
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