Analysis of Surgical Site Infection after Musculoskeletal Tumor Surgery: Risk Assessment Using a New Scoring System

Abstract

Surgical site infection (SSI) has not been extensively studied in musculoskeletal tumors (MST) owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases) treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P = 0.0002) and intraoperative blood loss (P = 0.0005) was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI) index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials). The MOSI index (0–4 points) score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points). The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI.

Robot‐assisted approach improves surgical outcomes in obese patients undergoing partial nephrectomy

“…By excluding highly comorbid patients, we minimized the confounding effect of medical disease on postoperative morbidity, instead highlighting the impact of greater body habitus and adiposity. Larger incision size and longer operating duration are factors previously found to be associated with increased risk of surgical site infection, possibly explaining why wound infections were lower in the RAPN group, which is associated with smaller incisions and shorter operating time . Urine leakage was also lower in our RAPN group, which may be related to the enhanced magnification and technical precision of robotic instrumentation .…”

Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections in Orthopaedic Oncology - A Narrative Review of Current Concepts

“…Many authors maintain a standard prophylactic preoperative antibiotic regimen of cephalosporin for a maximum of 24 hours after surgery despite reporting SSI rates of up to 15% (10,28) and do not discuss their attitude and motives (14,28). A large Japanese center with almost 500 own cases remains with a 24 h prophylaxis, even though many of their cases involve technically difficult surgeries such as hip disarticulations, pelvectomies and others (2). Another report from a highly specialized Italian research group advocates that a single-shot of cefazolin 2 g would be enough (19).…”

“…In elective orthopedic oncologic surgery (musculoskeletal malignancies), surgical site infections (SSI; 1) occur much more frequently than after non-oncologic surgeries. The incidence of oncologic SSI has been reported from 4 to 38% (2), largely depending on the case-mix, but being certainly higher than for any other elective orthopedic surgery. SSI rates in non-oncologic orthopedic surgery usually range from 0.1% to 4% (1).…”

Weichteilsarkome: Wie lassen sich posttherapeutische Veränderungen von Rezidiven unterscheiden?

“…Die Wahrscheinlichkeit steigt mit langer Operationsdauer, größeren Blutverlusten, präoperativer Chemotherapie (die Auswirkung einer Radiatio wurde nicht untersucht) und nach Implantaten. Bei 3-4 dieser Risikofaktoren steigt die Wahrscheinlichkeit für die Entwicklung eines Infekts auf 38,5 % [55]. Das Gewebe (beispielsweise Muskellappen) kann durch die Infektion per continuitatem zerstört werden oder durch einen erhöh-ten Stoffwechsel nekrotisch werden [70].…”