Ippolito Joseph, Castan Ashley, Dias Rosamaria, Kadkoy Yazan, Gotoff Katie, Thomson Jennifer, Beebe Kathleen, Benevenia Joseph
Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
J Surg Oncol. 2025 Jul;132(1):210-216. doi: 10.1002/jso.28135. Epub 2025 May 15.
Metastatic bone disease (MBD) is a common complication of primary cancers and is typically managed surgically. Overall health status and nutritional optimization are essential in surgical outcomes. The objective of this study was to report the intersectionality of previously studied laboratory, imaging, and clinical characteristics on postoperative complications.
Patients treated surgically for metastatic disease of the femur or tibia from 2001 to 2022 were reviewed. Age, gender, diagnosis, perioperative BMI, hemoglobin, albumin, method of surgical treatment, history of chemotherapy, history of radiation to the site, return to the operating room (OR), and complication type were collected for analysis. Psoas cross-sectional area was measured.
Following review, 119 patients (61 F, 58 M) treated at 128 anatomic sites, with mean age 61.9 ± 15.6 and mean follow-up 23.7 ± 9.3 met the inclusion criteria. The rate of wound dehiscence was 7/128 (5.47%) and infection was 7/128 (5.47%). Hemoglobin < 12 [OR 1.091 (95% CI 1.023-1.164, p < 0.05)] and abnormal BMI [OR 9.000 (95% CI 0.962-84.208, p < 0.05)] were both associated with an increased risk of deep infection. Hemoglobin < 12 [OR 1.091 (95% CI 1.023-1.164, p < 0.05)] was also associated with increased risk in superficial infection. Abnormal BMI [OR 3.783 (95% CI 1.209-11.831, p < 0.05)] was associated with an increased risk of return to the OR. History of chemotherapy [OR 2.965 (95% CI 1.173-7.493, p < 0.05)] was associated with an increased risk in overall complications. There was no association found between history of diabetes and complications. No statistically significant difference was found between the method of fixation when comparing complications between those that received an endoprosthesis, intramedullary nail (IMN), or plate.
The complication risk for patients with metastatic disease is multifactorial, with anemia, abnormal BMI, and sarcopenia as measured by psoas cross-sectional area increasing risk for nononcologic complications. In the future, large-scale studies can help quantify the impact of each factor to allow for preoperative optimization to reduce complications.
转移性骨病（MBD）是原发性癌症的常见并发症，通常通过手术治疗。总体健康状况和营养优化对手术结果至关重要。本研究的目的是报告先前研究的实验室、影像学和临床特征与术后并发症之间的交叉关系。
回顾了2001年至2022年因股骨或胫骨转移性疾病接受手术治疗的患者。收集年龄、性别、诊断、围手术期体重指数（BMI）、血红蛋白、白蛋白、手术治疗方法、化疗史、该部位放疗史、返回手术室（OR）情况及并发症类型进行分析。测量腰大肌横截面积。
经回顾，119例患者（61例女性，58例男性）在128个解剖部位接受治疗，平均年龄61.9±15.6岁，平均随访23.7±9.3个月，符合纳入标准。伤口裂开率为7/128（5.47%），感染率为7/128（5.47%）。血红蛋白<12[比值比（OR）1.091（95%置信区间1.023 - 1.164，p<0.05）]和BMI异常[OR 9.000（95%置信区间0.962 - 84.208，p<0.05）]均与深部感染风险增加相关。血红蛋白<12[OR 1.091（95%置信区间1.023 - 1.164，p<0.05）]也与浅表感染风险增加相关。BMI异常[OR 3.783（95%置信区间1.209 - 11.831，p<0.05）]与返回手术室的风险增加相关。化疗史[OR 2.965（95%置信区间1.173 - 7.493，p<0.05）]与总体并发症风险增加相关。未发现糖尿病史与并发症之间存在关联。在比较接受假体、髓内钉（IMN）或钢板固定的患者的并发症时，固定方法之间未发现统计学上的显著差异。
转移性疾病患者的并发症风险是多因素的，贫血、BMI异常以及通过腰大肌横截面积测量的肌肉减少症会增加非肿瘤性并发症的风险。未来，大规模研究有助于量化每个因素的影响，以便进行术前优化以减少并发症。
