Anemia, Abnormal Body Mass Index, and Sarcopenia Increase Complication Risk in Patients Undergoing Surgical Treatment for Metastatic Bone Disease.

Abstract

Background and objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.