Factors Associated With 30-day Soft Tissue Complications and Reoperation Following Upper Extremity Sarcoma Surgery

Abstract

PURPOSE: To identify risk factors for the occurrence of 30-day soft tissue complications and reoperations following upper extremity sarcoma excision. NULL HYPOTHESIS: There are no pre- or perioperative factors associated with a soft tissue complication or reoperation during the first 30 days following upper extremity sarcoma surgery. N AND FOLLOW-UP: Six hundred twenty patients, 30-day postoperative follow-up. METHODS: Using the American College of Surgeons National Surgery Quality Improvement Program (NSQIP)1 database, a total of 620 patients were identified who underwent surgical treatment of an upper extremity (UE) sarcoma between 2005 and 2018. The primary outcomes were the 30-day occurrence of a soft tissue complication (including surgical site infections, wound dehiscence, and soft tissue-related reoperations) and any unplanned reoperation. The median age was 62.5 years (interquartile range [IQR], 49–73), and most tumors were soft tissue sarcomas (n = 496; 80%) with the upper arm being the most commonly affected location (n = 424; 68%). Tumor extirpation was the most common surgical treatment (n = 559; 90%), and amputation was performed in 61 patients (10%). To evaluate the factors associated with reoperation, a bivariate analysis was performed, and to evaluate the factors associated with soft tissue complication, a multivariable analysis was performed. RESULTS: The 30-day soft tissue complication rate was 4.7%, and the 30-day unplanned reoperation rate was 5.5%. The reoperation rate was higher in patients who underwent preoperative radiotherapy (30% versus 6.1%; P = 0.027) and in those with longer operative times (median, 129 minutes [IQR, 59–280] versus 88 minutes [IQR, 50–156]; P = 0.035). Soft tissue complications were more common in patients with a higher BMI (β = 0.048; P = 0.047) and following longer operations (β = 0.003; P = 0.002) based on the multivariable analysis. In the subset of patients who underwent soft tissue tumor extirpation (n = 451), bivariate analysis of tumor characteristics showed that a tumor size ≥5 cm (12% versus 3.8%; P = 0.015) was associated with a soft tissue complication. CONCLUSIONS: The risk of developing a soft tissue complication or undergoing an unplanned reoperation is approximately 1 in 20 following upper extremity sarcoma surgery. Longer operative time and patients with a higher BMI are at higher odds of developing a soft tissue complication following upper extremity sarcoma surgery. Preoperative radiotherapy and longer operative procedures are risk factors for unplanned reoperations. Larger tumor size seems to be a risk factor in developing a soft tissue complication following tumor extirpation. REFERENCE: 1. About ACS NSQIP. https://www.facs.org/quality-programs/acs-nsqip/about. Accessed February 23, 2020.