Analysis of surgical site infection after musculoskeletal tumor surgery: risk assessment using a new scoring system

Area of Science:

• Orthopedic Surgery
• Oncology
• Infectious Disease

Background:

• Surgical site infection (SSI) is a significant complication in musculoskeletal tumor (MST) surgery.
• Limited research exists on SSI incidence and risk factors specifically within the MST patient population due to disease rarity.

Purpose of the Study:

• To investigate the incidence of SSI in both benign and malignant MST cases.
• To identify key risk factors associated with SSI development in MST patients, particularly those with malignant tumors.
• To develop a predictive index for SSI risk in musculoskeletal oncology.

Main Methods:

• Retrospective analysis of 457 consecutive MST cases (310 benign, 147 malignant).
• Detailed evaluation of patient clinical data, pre- and postoperative hematological parameters, and surgical factors for malignant MST.
• Development and validation of the Musculoskeletal Oncological Surgery Invasiveness (MOSI) index, incorporating blood loss, operation duration, preoperative chemotherapy, and use of artificial materials.

Main Results:

• SSI incidence was significantly higher in malignant MST (12.2%) compared to benign MST (0.32%).
• Prolonged surgery duration and greater intraoperative blood loss were significant risk factors for SSI in malignant MST.
• The MOSI index demonstrated a strong correlation with SSI risk, with high scores (3-4 points) associated with a 38.5% SSI incidence.

Conclusions:

• Malignant MST surgery carries a substantial risk of SSI, influenced by factors like surgery duration and blood loss.
• The MOSI index, combined with postoperative laboratory data, offers a valuable tool for early risk assessment and diagnosis of SSI in musculoskeletal oncology.
• Further research and clinical application of the MOSI index can aid in mitigating SSI complications in complex MST surgeries.