Skip to main content

Advertisement

SpringerLink
Log in

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

  • Sarcoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  CAS  PubMed  Google Scholar 

  6. 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).

    Article  PubMed  Google Scholar 

  7. 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.

    Article  CAS  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Division Musculoskeletal Oncology, Massachusetts General Hospital, Boston, MA, USA

    Adam Kline BS, Pramod Kamalapathy BS, Kevin Raskin MD, Joseph Schwab MD & Santiago Lozano-Calderón MD, PhD

  2. School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA

    Katharine Bruce MPH

Authors
  1. Adam Kline BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pramod Kamalapathy BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katharine Bruce MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kevin Raskin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph Schwab MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Santiago Lozano-Calderón MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Santiago Lozano-Calderón MD, PhD.

Ethics declarations

Disclosure

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kline, A., Kamalapathy, P., Bruce, K. et al. Nutritional Predictors of Wound Infection in Patients with Lower Extremity Soft Tissue Sarcoma. Ann Surg Oncol 28, 7952–7960 (2021). https://doi.org/10.1245/s10434-021-10082-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-10082-2

Search

Navigation