scholarly journals Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Kathryn E. Gallaway ◽  
Junho Ahn ◽  
Alexandra K. Callan
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Soft Tissue Sarcomas ◽  
Surgical Site Infections ◽  
Small Sample ◽  
Wound Complications ◽  
Complication Rates ◽  
Improvement Program ◽  
Primary Bone ◽  
Tract Infections

Background. Primary bone and soft tissue sarcomas are rare tumors requiring wide surgical resection and reconstruction to achieve local control. Postoperative complications can lead to delays in adjuvant therapy, potentially affecting long-term oncologic outcomes. Understanding postoperative complication risks is essential; however, past studies are limited by small sample sizes. Purpose. This study uses a large national registry to characterize the incidence of complications and mortality in the first thirty days following surgical management of primary bone and soft tissue sarcomas of the extremities. Methods. A retrospective review of patients in the National Surgical Quality Improvement Program database was performed. Cases were identified using diagnosis codes for malignant neoplasm of soft tissue or bone and procedure codes for amputation and radical resection. The cohort was subdivided by bone versus soft tissue sarcoma, upper versus lower extremity, and amputation versus limb salvage. Results. One thousand, one hundred eleven patients were identified. The most frequent complications were surgical site infections, sepsis, and venous thromboembolism. The overall incidence of complications was 14.0%. Unplanned readmission and reoperation occurred after 7.0% and 8.0% of cases, respectively. Thirty-day mortality was 0.3%, with one intraoperative death. Patient factors and complication rates varied by tumor location and surgical modality. Lower extremity cases were associated with higher rates of wound complications and infectious etiologies such as surgical site infections, urinary tract infections, and systemic sepsis. In contrast, patients undergoing amputation were more likely to experience major medical complications including acute renal failure, cardiac arrest, and myocardial infarction. Conclusion. Approximately 1 in 7 patients will experience a complication in the first thirty days following surgery for primary bone and soft tissue sarcomas of the extremities. The unique risk profiles of lower extremity and amputation cases should be considered during perioperative planning and surveillance.

Neoadjuvant chemotherapy for adult soft tissue sarcomas: A phase II trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10069-10069
Author(s):  
Samuel Aguiar ◽  
Fabio Oliveira Ferreira ◽  
Ranyell Spencer Sobreira Batista ◽  
Alexsander Kurowa Bressan ◽  
Celso Lopes Mello ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Phase Ii ◽  
Soft Tissue Sarcomas ◽  
Pathological Response ◽  
Amputation Rate ◽  
Wound Complications ◽  
Complication Rates ◽  
Preoperative Radiation ◽  
Chemotherapeutic Regimen

10069 Background: Treatment of soft tissue sarcomas (STS) is characterized by high rates of local control, but poor overall survival because of distant relapses and high rates of wound complications, when preoperative radiation is used. The objective of this study was to test the effectiveness of a protocol with neoadjuvant chemotherapy for STS. Methods: A phase II single-arm prospective trial was carried out. Only adult patients with high grade extremity lesions and tumors deep and larger than 5 cm were included. A total of four cycles of chemotherapy was administered pre-operatively. The chemotherapeutic regimen was: ifosfamide – total of 9.0 g/m2 per cycle, infused in 2 hours from Day 1 to Day 5 (1.8 mg/m2/day). Half of the equivalent dose of mesna was infused 15 min pre-ifosfamide and 4 hours post-ifosfamide. Doxorubicin – total of 60mg/m2 per cycle, was infused in bolus on Day 1. Filgrastima 300 mcg, SC, was administered after the last dose of chemotherapy for 5 days. Radiation was given after surgery. Toxicity was classified by the NIH Toxicity Criteria and response was determined by the RECIST criteria. The others endpoints were the amputation and the wound-related complication rates. Results: Between January, 2005 and May, 2011, 42 patients were included. 21(50%) patients have completed the 4 cycles. Nineteen patients (45.2%) have grade 3 or 4 toxicity, and one (2.3%) death related to treatment had occurred. Between severe complications, febrile neutropenia was the most frequent. By using the RECIST criteria, we observed 10(24.5%) cases of progression, 24(58.5%) cases of stable disease, and 7(17%) partial responses. No complete clinical or radiological response was observed. In the pathological analysis of the surgical specimens, 4(9.7%) cases showed no residual disease (complete pathological response), and a total of 6 (14.6%) showed ≤ 5% of viable residual cells. The amputation rate was 4.8% (2 cases) and complications related to the wound were observed in 9 patients (21.9%). Conclusions: The protocol showed a good rate of objective and pathological response, low rate of complications related to the operative wound, and maintained an acceptable amputation rate. On the other hand, we observed high rate of progression, by RECIST criteria.

scholarly journals Quality Improvement–Focused Departmental Grand Rounds Reports: A Strategy to Engage General Surgery Residents

2016 ◽  
Vol 8 (2) ◽  
pp. 232-236 ◽  
Author(s):  
Jonathan S. Abelson ◽  
Katrina B. Mitchell ◽  
Cheguevera Afaneh ◽  
Barrie S. Rich ◽  
Theresa J. Frey ◽  
...  
Keyword(s):  
New York ◽  
Quality Improvement ◽  
Surgical Site Infections ◽  
Data Sources ◽  
Complication Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Surgical Trainees ◽  
Tract Infections ◽  
Grand Rounds

ABSTRACT  Many institutions are seeking ways to enhance their surgical trainees' quality improvement (QI) skills.Background  To educate trainees about the importance of lifelong performance improvement, chief residents at New York Presbyterian Hospital–Weill Cornell Medicine are members of a multidisciplinary QI team tasked with improving surgical outcomes. We describe the process and the results of this effort.Objective  Our analysis used 2 data sources to assess complication rates: the National Surgical Quality Improvement Program (NSQIP) and ECOMP, our own internal complication database. Chief residents met with a multidisciplinary QI team to review complication rates from both data sources. Chief residents performed a case-by-case analysis of complications and a literature search in areas requiring improvement. Based on this information, chief residents met with the multidisciplinary team to select interventions for implementation, and delivered QI-focused grand rounds summarizing the QI process and new interventions.Methods  Since 2009, chief residents have presented 16 QI-focused grand rounds. Urinary tract infections (UTIs) and surgical site infections (SSIs) were the most frequently discussed. Interventions to improve UTIs and SSIs were introduced to the department of surgery through these reports in 2011 and 2012. During this time we saw improvement in outcomes as measured by NSQIP odds ratio.Results  Departmental grand rounds are a suitable forum to review NSQIP data and our internal, resident-collected data as a means to engage chief residents in QI improvement, and can serve as a model for other institutions to engage surgery residents in QI projects.Conclusions

scholarly journals Coagulation Laboratory Testing Is Predictive of Wound Complications Following Microdiscectomy

2018 ◽  
Vol 9 (2) ◽  
pp. 138-142
Author(s):  
Vadim Goz ◽  
Nikita Lakomkin ◽  
Ali Jalali ◽  
Darrel S. Brodke ◽  
William R. Spiker
Keyword(s):  
Postoperative Complications ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Cost Effective ◽  
International Normalized Ratio ◽  
Wound Complications ◽  
Improvement Program ◽  
Logistic Regression Models ◽  
American Society ◽  
Tract Infections

Study Design: Retrospective review. Objective: To determine whether abnormal preoperative testing is associated with postoperative complications in patients undergoing a microdiscectomy. Methods: Patients undergoing a microdiscectomy between 2006 and 2013 were identified in the National Surgical Quality Improvement Program database based on appropriate current procedural terminology coding. Thirty-day postoperative complications were analyzed in addition to patient demographics, comorbidities, and abnormal preoperative laboratory values. A series of over 650 univariate analyses to determine which independent variables to include for each complication were completed. Based on those analyses, 12 logistic regression models were built, one for each specific complication. Each model adjusted for age, gender, comorbidities, American Society of Anesthesiologists classification, as well as operative time. Results: A total of 5947 patients undergoing a microdiscectomy were included in the study. Abnormal preoperative international normalized ratio (odds ratio [OR] = 5.85, P < .05) was associated with any wound infection, superficial or deep, and abnormal partial thromboplastin time was significantly associated with wound dehiscence (OR = 6.80, P < .05). Postoperative urinary tract infections were associated with abnormal preoperative hematocrit (OR = 8.00, P < .05). None of the identified preoperative labs were independently associated with pulmonary embolism, organ space surgical site infections, or intubation. Conclusions: Abnormal preoperative coagulation labs were significantly associated with postoperative wound complications. However, the majority of tests were not associated with adverse events following microdiscectomy. Further study is necessary to conclude whether these tests provide information that can modify perioperative management and whether widespread testing is cost-effective.

scholarly journals Postoperative Wound Complications in Fungating Extremity Soft Tissue Sarcomas

2019 ◽  
pp. 273-279
Author(s):  
Blakely AM ◽  
Chow W ◽  
Sampath S ◽  
Femino JD ◽  
Lozano-Calderon S ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Excision ◽  
Soft Tissue Sarcomas ◽  
Wound Complication ◽  
Wound Complications ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Pleomorphic Sarcoma ◽  
Extremity Soft Tissue Sarcoma ◽  
Clinically Significant

Background: Among deep extremity soft tissue sarcomas, skin ulceration is infrequent. Fungating sarcomas may lead to infection or clinically significant bleeding. Data regarding management of ulcerating sarcomas is lacking. We sought to evaluate the outcomes of different treatments for these tumors.Patients and methods: A retrospective review of patients treated at two sarcoma referral centers with histologically confirmed extremity soft tissue sarcoma was performed from 2000-2018. Patient demographics, clinicopathologic, and treatment factors were analyzed in terms of method of resection, receipt of radiation, and wound complications.Results: Overall, 22 patients had fungating lesions. Most patients were male with tumors of the distal extremity.Median tumor size was 8 cm. Half had undifferentiated pleomorphic sarcoma histology, followed by myxofibrosarcoma (n=5), leiomyosarcoma (n=3), or other (n=3). Fifteen patients (68%) underwent limb-preserving resection, of which 7 underwent adjuvant radiation. Six patients (27%) developed wound complications, which occurred equally between amputation versus local excision (p = 0.93). Among local excision patients, one who received adjuvant radiation developed a wound complication (14%), which was not significantly different from those who did not undergo radiation (n=3 of 8, 38%; p = 0.31).Conclusions: Similar rates of wound complications were seen between amputation and limb-preserving groups.Among patients who underwent local excision, the administration of adjuvant radiation therapy did not significantly increase wound complication rates.

ARST1321: Pazopanib neoadjuvant trial in non-rhabdomysarcoma soft tissue sarcomas: A report of major wound complications.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11059-11059
Author(s):  
Thomas Scharschmidt ◽  
Yen-Lin Chen ◽  
Dian Wang ◽  
Yueh-Yun Chi ◽  
Mark Kayton ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitor ◽  
Kinase Inhibitor ◽  
Soft Tissue Sarcomas ◽  
Wound Complication ◽  
Wound Complications ◽  
High Grade ◽  
Grade Iii

11059 Background: The care of soft tissue sarcomas is complex and multidisciplinary in nature. Even without radiation or chemotherapy wound complications are common after surgical resection with a reported incidence of 6-42%. Wound complication rates with the use of neoadjuvant chemoradiation for high-grade soft tissue sarcomas has been reported and supported in the literature to be approximately 30%. Relevant to this study, a trial evaluating the use of a VEGF receptor inhibitor (bevacizumab) in combination with radiation pre-operatively in soft tissue sarcomas reported a wound complication rate of 25%. ARST 1321 is a phase II/III study evaluating the tyrosine kinase inhibitor Pazopanib +/- chemotherapy and radiation in select high-grade soft tissue sarcomas. The dose-finding phase has been completed and the objective of this report is to detail the major wound complications observed with this protocol. Methods: Patient enrolled on all arms of the study (Pre-operative radiation, +/- pazopanib, +/- doxorubicin and ifosphamide) were evaluated for wound complications (Grade I/II and Grade III). Patient demographics, tumor characteristics, and complication details were compiled and analyzed. Results: There were a total of 130 evaluable patients (100 patients on chemotherapy arm, 30 on non-chemotherapy arm). There were 38 overall wound complications reported (38/130, 29%). 23/38 (60%) occurred on the chemotherapy arm; therefore that cohort had 23/100 (23%) wound complication rate, while the non-chemotherapy cohort had an overall rate of 50% (15/30). Grade III wound complications represented 23/38 (66%) of all the complications. 30/38 (79%) of the complications were in the lower extremity. 23/38 (60%) patients were aged > 18 years. Conclusions: The overall rate of wound complications observed was 29% (38/130) which remains within the accepted historical rate based upon literature review without the use of a tyrosine kinase inhibitor. The overall major wound complication (grade III) rate was 19% (25/130). Also consistent with the literature is the finding that a majority of the complications occurred in the lower extremity. In conclusion, the addition of a tyrosine kinase inhibitor (pazopanib) has a wound complication toxicity profile comparable to current and historical literature. Clinical trial information: NCT02180867.

Flap Reconstruction of Sarcoma Defects in the Setting of Neoadjuvant and Adjuvant Radiation

2018 ◽  
Vol 35 (04) ◽  
pp. 287-293 ◽  
Author(s):  
Rohini Kadle ◽  
Catherine Motosko ◽  
George Zakhem ◽  
John Stranix ◽  
Timothy Rapp ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Radiation Treatment ◽  
Soft Tissue Sarcomas ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Fasciocutaneous Flaps ◽  
Musculoskeletal Tumor Society

Background Limb-sparing treatment of extremity soft tissue sarcomas requires wide resections and radiation therapy. The resulting complex composite defects necessitate reconstructions using either muscle or fasciocutaneous flaps, often in irradiated wound beds. Methods A retrospective chart review was performed of all limb-sparing soft tissue sarcoma resections requiring immediate flap reconstruction from 2012 through 2016. Results Forty-four patients with 51 flaps were identified: 25 fasciocutaneous and 26 muscle-based flaps. Mean defect size, radiation treatment, and follow-up length were similar between groups. More often, muscle-based flaps were performed in younger patients and in the lower extremity. Seventeen flaps were exposed to neoadjuvant radiation, 12 to adjuvant radiation, 5 to both, and 17 to no radiation therapy. Regardless of radiation treatment, complication rates were comparable, with 28% in fasciocutaneous and 31% in muscle-based groups (p < 0.775). Muscle-based flaps performed within 6 weeks of undergoing radiotherapy were less likely to result in complications than those performed after greater than 6 weeks (p < 0.048). At time of follow-up, Musculoskeletal Tumor Society scores for fasciocutaneous and muscle-based reconstructions, with or without radiation, showed no significant differences between groups (mean [SD]: 91% [8%] vs. 89% [13%]). Conclusion The similar complication rates and functional outcomes in this study support the safety and efficacy of both fasciocutaneous flaps and muscle-based flaps in reconstructing limb-sparing sarcoma resection defects, with or without radiotherapy.

What Is the Relationship between Operative Time and Adverse Events after Colon and Rectal Surgery?

2018 ◽  
Vol 84 (5) ◽  
pp. 712-716 ◽  
Author(s):  
Gabriela Poles ◽  
Caitlin Stafford ◽  
Todd Francone ◽  
Patricia L. Roberts ◽  
Rocco Ricciardi
Keyword(s):  
Colorectal Surgery ◽  
Adverse Events ◽  
Operative Time ◽  
Primary Anastomosis ◽  
Multivariable Analysis ◽  
Rectal Surgery ◽  
Surgical Site Infections ◽  
Colon And Rectal Surgery ◽  
Improvement Program ◽  
Tract Infections

We propose that prolonged colorectal surgery operative times are associated with increased 30-day adverse events. We identified a cohort from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from January 2005 through December 2012. Patients who underwent colectomy with primary anastomosis were selected using CPT codes. Operative time was categorized into short, average, and long based on mean operative times 61 SD. NSQIP-approved multivariate models were used to identify associations between operative time and 30-day adverse events. A total of 113,615 patients underwent colorectal resection of which 46 per cent were laparoscopic and 12 per cent were identified as long operative times. Patients with long operative procedures had 34 per cent more superficial surgical site infections, 65 per cent more organ space infections, 69 per cent more abdominal dehiscences, 44 per cent more thrombotic complications, 45 per cent more urinary tract infections, 40 per cent more returns to the operating room, and 36 per cent more prolonged lengths of stay ( P < 0.05 for all analyses). The multivariable analysis revealed an association between long operative times and increased adverse events despite adjustment for all NSQIP recommended covariates. Our results reveal increased 30-day adverse events with increased operative time. We propose that operative time may serve as a proxy for surgical complexity in colorectal surgery.

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