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01-11-2021 | Wound Infection | Sarcoma

Nutritional Predictors of Wound Infection in Patients with Lower Extremity Soft Tissue Sarcoma

Authors: Adam Kline, BS, Pramod Kamalapathy, BS, Katharine Bruce, MPH, Kevin Raskin, MD, Joseph Schwab, MD, Santiago Lozano-Calderón, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2021

Abstract

Background

Soft tissue sarcoma (STS) frequently requires high-risk surgery that predisposes patients to complex wounds. Past studies have identified a variety of tumor characteristics as risk factors for wound infection (WI); however, physiologic characteristics have not yet been studied in this population. Thus, the objective of this study is to identify any nutritional indicators and physiologic characteristics associated with the development of WI.

Patients and Methods

633 patients from a large tertiary care center institution were identified with lower extremity STS removed from 1992 to 2017. The primary outcomes of interest were WI at patient’s surgical site within 90 days of surgery and additional procedure due to wound infection. Patients’ laboratory values, comorbidities, and other characteristics were assessed using multivariable analysis to determine risk factors for WI. Receiver operator characteristic (ROC) curves were used for analysis of plasma glucose and albumin levels to determine a useful risk threshold. Significance was determined to be p < 0.05.

Results

Postoperative plasma glucose levels were significantly higher among patients with WI compared with those without (p < 0.001) and showed predictivity in ROC analysis (AUC 0.77, 95% CI 0.72–0.82). Preoperative albumin (p < 0.001) and prognostic nutritional index score (p = 0.002) were significantly lower among patients with WI. Partial thromboplastin time (PTT), international normalized ratio (INR), white blood cell count (WBC), and platelet count values had no effect on WI. Smoking elevated risk for WI (OR 1.64, p < 0.01). Significant risk factors were the same when assessed for those with WI undergoing additional procedures.

Conclusions

Postoperative plasma glucose levels, preoperative albumin levels, and smoking status are useful nutritional variables in predicting WI in STS excisional procedures.

Schwartz A, Rebecca A, Smith A, et al. Risk factors for significant wound complications following wide resection of extremity soft tissue sarcomas. Clin Orthop Relat Res. 2013;471(11):3612–7. https://doi.org/10.1007/s11999-013-3130-4.CrossRefPubMedPubMedCentral

Hoftiezer YAJ, Lans J, Freniere BB, Eberlin KR, Chen NC, Lozano-Calderón SA. Factors associated with 30-day soft tissue complications following upper extremity sarcoma surgery. J Surg Oncol. 2021;123(2):521–31. https://doi.org/10.1002/jso.26311.CrossRefPubMed

Houdek MT, Hevesi M, Griffin AM, Wunder JS, Ferguson PC. Morbid obesity is associated with an increased risk of wound complications and infection after lower extremity soft-tissue sarcoma resection. JAAOS. 2019;27(21):807–15. https://doi.org/10.5435/JAAOS-D-18-00536.CrossRefPubMed

Okajima K, Kobayashi H, Okuma T, et al. Prognosis and surgical outcome of soft tissue sarcoma with malignant fungating wounds. Jpn J Clin Oncol. 2021;51(1):78–84. https://doi.org/10.1093/jjco/hyaa176.CrossRefPubMed

Perrault DP, Lee GK, Yu RP, et al. Risk factors for wound complications after soft tissue sarcoma resection. Ann Plast Surg. 2021;86(3S Suppl 2):S336–41. https://doi.org/10.1097/SAP.0000000000002592.CrossRefPubMed

Brennan MF, Antonescu CR, Moraco N, Singer S. Lessons learned from the study of 10,000 patients with soft tissue sarcoma. Ann Surg. 2014;260(3):416–21. https://doi.org/10.1097/SLA.0000000000000869 (discussion 421-422).CrossRefPubMed

Moore J, Isler M, Barry J, Mottard S. Major wound complication risk factors following soft tissue sarcoma resection. Eur J Surg Oncol. 2014;40(12):1671–6. https://doi.org/10.1016/j.ejso.2014.10.045.CrossRefPubMed

Geller DS, Hornicek FJ, Mankin HJ, Raskin KA. Soft tissue sarcoma resection volume associated with wound-healing complications. Clin Orthop Relat Res. 2007;459:182–5. https://doi.org/10.1097/BLO.0b013e3180514c50.CrossRefPubMed

10.

Miller ED, Mo X, Andonian NT, et al. Patterns of major wound complications following multidisciplinary therapy for lower extremity soft tissue sarcoma. J Surg Oncol. 2016;114(3):385–91. https://doi.org/10.1002/jso.24313.CrossRefPubMedPubMedCentral

11.

Sanniec KJ, Swanson S, Casey WJ, Schwartz A, Bryant L, Rebecca AM. Predictive factors of wound complications after sarcoma resection requiring plastic surgeon involvement. Ann Plast Surg. 2013;71(3):283–5. https://doi.org/10.1097/SAP.0b013e31827c7973.CrossRefPubMed

12.

Peat BG, Bell RS, Davis A, et al. Wound-healing complications after soft-tissue sarcoma surgery. Plast Reconstr Surg. 1994;93(5):980–7. https://doi.org/10.1097/00006534-199404001-00012.CrossRefPubMed

13.

Devisetty K, Kobayashi W, Suit HD, et al. Low-dose neoadjuvant external beam radiation therapy for soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2011;80(3):779–86. https://doi.org/10.1016/j.ijrobp.2010.02.067.CrossRefPubMed

14.

Bedi M, King DM, Mendez C, et al. Postoperative day 1 glucose may be associated with wound complications in sarcomas treated with preoperative radiation. Clin Orthop Relat Res. 2018;476(3):580–6. https://doi.org/10.1007/s11999.0000000000000056.CrossRefPubMedPubMedCentral

15.

Baldini EH, Lapidus MR, Wang Q, et al. Predictors for major wound complications following preoperative radiotherapy and surgery for soft-tissue sarcoma of the extremities and trunk: importance of tumor proximity to skin surface. Ann Surg Oncol. 2013;20(5):1494–9. https://doi.org/10.1245/s10434-012-2797-1.CrossRefPubMed

16.

file.pdf. https://www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/555-bpr-prevention-and-management-of-surgical-wound-complications-v2/file. Accessed 3 Dec 2020.

17.

Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9. https://doi.org/10.3322/caac.21388.CrossRefPubMed

18.

Lee JY, Kim H-I, Kim Y-N, et al. Clinical significance of the prognostic nutritional index for predicting short- and long-term surgical outcomes after gastrectomy. Medicine (Baltimore). 2016;95:18. https://doi.org/10.1097/MD.0000000000003539.CrossRef

19.

Wang P-Y, Chen X-K, Liu Q, et al. Application of four nutritional risk indexes in perioperative management for esophageal cancer patients. J Cancer Res Clin Oncol. 2021. https://doi.org/10.1007/s00432-021-03585-8.CrossRefPubMedPubMedCentral

20.

Clinical Impact of the Prognostic Nutritional Index as a Predictor of Outcomes in Patients with Stage II/III Gastric Cancer: A Retrospective Cohort Study - PubMed. https://pubmed.ncbi.nlm.nih.gov/33677434/. Accessed 10 Mar 2021.

21.

Barta A. Coding root operations with ICD-10-PCS. J AHIMA. 2014;85(2):64–6.PubMed

22.

Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med. 2013;4(2):627–35.PubMedPubMedCentral

23.

Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315–6. https://doi.org/10.1097/JTO.0b013e3181ec173d.CrossRefPubMed

24.

Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF. Youden index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J. 2008;50(3):419–30. https://doi.org/10.1002/bimj.200710415.CrossRefPubMedPubMedCentral

25.

Okubo K, Arigami T, Matsushita D, et al. Clinical impact of the prognostic nutritional index as a predictor of outcomes in patients with stage II/III gastric cancer: a retrospective cohort study. Oncology. 2021. https://doi.org/10.1159/000514572.CrossRefPubMed

26.

de Vries FEE, Gans SL, Solomkin JS, et al. Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection. Br J Surg. 2017;104(2):e95–105. https://doi.org/10.1002/bjs.10424.CrossRefPubMed

27.

Huang P, Lin M, Wen J, et al. Correlation of early postoperative blood glucose levels with postoperative complications, hospital costs, and length of hospital stay in patients with gastrointestinal malignancies. Endocrine. 2015;48(1):187–94. https://doi.org/10.1007/s12020-014-0291-1.CrossRefPubMed

28.

Russell L. The importance of patients’ nutritional status in wound healing. Br J Nurs. 2001;10(6):S42. https://doi.org/10.12968/bjon.2001.10.Sup1.5336.CrossRefPubMed

29.

Sugino H, Hashimoto I, Tanaka Y, Ishida S, Abe Y, Nakanishi H. Relation between the serum albumin level and nutrition supply in patients with pressure ulcers: retrospective study in an acute care setting. J Med Invest. 2014;61(1–2):15–21. https://doi.org/10.2152/jmi.61.15.CrossRefPubMed

30.

Busher JT. Serum Albumin and Globulin. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990. http://www.ncbi.nlm.nih.gov/books/NBK204/. Accessed 10 Mar 2021.

31.

Freiman A, Bird G, Metelitsa AI, Barankin B, Lauzon GJ. Cutaneous effects of smoking. J Cutan Med Surg. 2004;8(6):415–23. https://doi.org/10.1007/s10227-005-0020-8.CrossRefPubMed

32.

Alamanda VK, Moore DC, Song Y, Schwartz HS, Holt GE. Obesity does not affect survival outcomes in extremity soft tissue sarcoma. Clin Orthop Relat Res. 2014;472(9):2799–806. https://doi.org/10.1007/s11999-014-3714-7.CrossRefPubMedPubMedCentral

33.

Tavani A, Soler M, La Vecchia C, Negri E, Gallus S, Franceschi S. Body weight and risk of soft-tissue sarcoma. Br J Cancer. 1999;81(5):890–2. https://doi.org/10.1038/sj.bjc.6690781.CrossRefPubMedPubMedCentral

Title: Nutritional Predictors of Wound Infection in Patients with Lower Extremity Soft Tissue Sarcoma
Authors: Adam Kline, BS
Pramod Kamalapathy, BS
Katharine Bruce, MPH
Kevin Raskin, MD
Joseph Schwab, MD
Santiago Lozano-Calderón, MD, PhD
Publication date: 01-11-2021
Publisher: Springer International Publishing
Keywords: Wound Infection
Soft Tissue Sarcoma
Published in: Annals of Surgical Oncology / Issue 12/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-10082-2

2024 ASCO Annual Meeting

Springer Medicine

Nutritional Predictors of Wound Infection in Patients with Lower Extremity Soft Tissue Sarcoma

Abstract

Background

Patients and Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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