Surgical site infection in malignant soft tissue tumors

• Published in: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2012-01, Vol.17 (1), p.51-57
• Main Authors: Morii, Takeshi, Mochizuki, Kazuo, Tajima, Takashi, Ichimura, Shoichi, Satomi, Kazuhiko
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Incidence; Japan - epidemiology; Length of Stay - trends; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Retrospective Studies; Rheumatology; Risk Factors; Soft Tissue Neoplasms - surgery; Surgical Wound Infection - epidemiology; Survival Rate - trends; Wound Healing; Young Adult
• ISSN: 0949-2658; 1436-2023
• DOI: 10.1007/s00776-011-0179-3

Postoperative wound complications, including surgical site infections, which frequently occur in the course of management of musculoskeletal sarcomas, sometimes necessitate repeat surgeries, including amputation, and may result in a prolonged healing time, prolonged hospital stay, or fatal outcome. A comprehensive understanding of surgical site infections associated with specific diseases is needed to reduce the risk. This series comprised 84 patients with malignant soft tissue tumors treated at our institute. The occurrence rate, management modality and clinical course of surgical site infections, impact of surgical site infections on the length of hospitalization, risk factors for the development of surgical site infections, and the impact of surgical site infections on the oncological outcomes were analyzed. Surgical site infection was defined according to Centers for Disease Control and Prevention guidelines. Surgical site infections occurred in 7 cases (8.3%). Although successful clinical cure was achieved in all cases, surgical site infection was identified as one of the independent risk factors for prolongation of hospitalization. Both univariate and multivariate analyses identified larger intraoperative blood loss and a trunk location as risk factors associated with deep infections. No association was detected between age, tumor grade, chemotherapy, tumor volume, or plastic surgery and the risk of surgical site infections. Although the differences were not statistically significant, patients with surgical site infections showed worse oncological outcomes in terms of local recurrence and total survival. The incidence rate of surgical site infection was larger than that associated with conventional orthopedic surgeries, such as osteosynthesis, spine surgery, or arthroplasty. Surgical site infections remain a critical and frequent complication of surgical treatment of soft-tissue malignancies and often result in prolongation of hospital stay. Although practical options to prevent surgical site infections seem quite limited, the present data provide a rationale for perioperative evaluation in patients at a high risk of surgical site infections.