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Prospective Identification of Risk Factors for Wound Infection After Lower Extremity Oncologic Surgery

From the Division of Orthopaedic Surgery (CDM, PJB, JH), Infectious Disease Service (KS, CF, JE), and Department of Quality Assessment (NM, JM), Memorial Sloan-Kettering Cancer Center, New York, New York. Affiliated with Weill College of Medicine, Cornell University, New York, New York.

Correspondence: Address correspondence and reprint requests to: Carol D. Morris, MD, MS, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021; Fax: 212-794-4075; E-mail: morrisc{at}mskcc.org

Background: Surgical site infections (SSI) are frequent causes of morbidity and mortality after orthopaedic oncologic procedures. This study was conducted to identify the surgical site infection rate following a lower extremity or pelvic procedure and assess the risk factors for acquiring SSI by direct observation of orthopaedic oncology patients’ wounds at a comprehensive cancer center.

Methods: One hundred ten consecutive patients were prospectively studied. The surveillance of surgical site infections was carried out by a surgeon-trained nurse from the Infectious Disease Service. Nineteen variables were analyzed as risk factors.

Results: The overall SSI rate was 13.6% (15 of 110). Excluding those patients with known preoperative infections, the SSI rate was 9.5% (10 of 105). Two statistically significant risk factors for surgical site infection in these patients emerged in the multivariate analysis: blood transfusion (P = .007) and obesity (P = .016). Procedure category was significant in univariate analysis only. Preoperative length of stay, length of procedure, prior adjuvant treatment (chemotherapy or radiotherapy), prior surgery, and use of an implant or allograft were not statistically significant risk factors for wound infection. Antibiotic usage patterns did not influence SSI rate.

Conclusions: Blood transfusion and obesity should be considered individual risk factors for the development of wound infection in patients having orthopaedic oncologic procedures.

Key Words: Surgical site infection • Orthopaedic oncology • Wound infection • Complications

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