Plastic Surgeon Involvement and Post-operative Complication Risk Factors During Soft Tissue Sarcoma Resection

Abstract

PURPOSE: Given the invasiveness of margin negative radical resection for soft tissue sarcoma (STS), some plastic surgeons and orthopaedic oncologists have opted for a multidisciplinary approach to index resection dubbed ‘orthoplasty’ that includes plastics assistance during complex wound closure.[1,2] This study assesses risk factors of STS index resection complications at a single institution to determine the impact that plastic surgeon involvement during such procedures has on patient outcomes. METHOD: Adult patients that underwent index STS resection between January 2005 and December 2018 were queried from an institutional database using CPT codes. Cases were excluded if the patient underwent head or neck malignancy resection or previous same-site resection at our institution. Primary outcomes analyzed include same-site reoperation, any-cause readmission, and wound healing complications, all assessed within 90-days post-resection. Predictor variables including gender, age, tumor size, operative time, ASA classification, hospital LOS, BMI, smoking, diabetes, radiation, and plastic surgeon involvement. Outcomes were verified with chart review. Univariate logistic regression was used to identify risk factors for complications, with multivariate logistic regression used to assess significant univariate predictors. Patients were then split into two cohorts: those with and without plastic surgeon involvement. Chi-squared and unpaired t-tests were used to compare categorical and continuous variables, respectively. RESULTS: 234 patients were included in the final analysis. Univariate regression suggested the following risk factors for readmission: operative time (p<0.001) and hospital LOS (p=0.002); reoperation: operative time (p=0.009) and hospital LOS (p=0.004); and wound complications: operative time (p<0.001) and hospital LOS (p<0.001). Multivariate regression demonstrated the following independent predictors for readmission: operative time (p=0.039); reoperation: hospital LOS (p=0.036); and wound-healing complications: operative time (p=0.009) and hospital LOS (p=0.006). Upon separation into two cohorts based on plastic surgeon involvement, patients whose resection included a plastic surgeon (104 vs. 130 patients) experienced statistically similar rates of all primary outcomes despite patients with plastics involvement having expectedly longer operative times (219 vs. 107 minutes, p<0.001) and hospital LOS (3.96 vs. 1.33 days, p <0.001)–both independent predictors of complications. CONCLUSION: Operative time and hospital LOS emerged via multivariate logistic regression as independent predictors of short term readmission (operative time), reoperation (hospital LOS), and wound healing complications (both). In our analysis of plastic surgeon involvement in STS index resection cases, patients whose cases included a plastic surgeon achieved statistically similar complication rates in all categories relative to patients without plastics involvement. Similar complication rates for plastic surgery patients were achieved despite significantly longer operative time and hospital LOS, both identified as independent risk factors for complications. As the partnership between plastic surgeons and orthopaedic oncologists evolves, risk factor analysis and patient selection will become increasingly central to limiting complications and promoting healthy outcomes. REFERENCES: 1. Angelini A, Tiengo C, Sonda R, Berizzi A, Bassetto F, Ruggieri P. One-Stage Soft Tissue Reconstruction Following Sarcoma Excision: A Personalized Multidisciplinary Approach Called ‘Orthoplasty’. J Pers Med. 2020;10. 2. Frobert P, Vaucher R, Vaz G, Gouin F, Meeus P, Delay E. The role of reconstructive surgery after soft tissue sarcoma resection. Ann Chir Plast Esthet. 2020;65:394-422.