CL_VII_L: Clinical Medicine VII. Lectures
Kristóf Koch MD, National Center for Spinal Disorders, Budapest
Zsolt Szövérfi MD. PhD, National Center for Spinal Disorders, Budapest
Introduction Primary tumors of the sacrum can grow large before diagnosis involving a decisive part of the sacrum. The gold standard therapy of these pathologies is en bloc resection, even a total sacrectomy if it is necessary. Due to the anatomy and the complexity of these operation techniques, resection of primary sacral tumors (pST) can have a high complication rate. However, the literature about these complications and their effect on hospital length of stay (LOS) is scarce.
Aims Objective of this study is analyzing the complications after pST surgeries in different patient populations. Second aim is to investigate the possible effect of some perioperative variables on postoperative complications, and to identify which complications are influencing the LOS of the patient.
Methods We analyzed clinical data of 159 pST surgeries and the consequent 134 local recurrence surgeries in four subgroups (index surgery, local recurrence surgery, malignant tumor, benign tumor). The prognostic value of several perioperative factors on the emergence of surgical site infection (SSI) bowel and bladder dysfunction (BBD) and length of hospital stay (LOS) were investigated in logistic (LR) and linear regression (LiR) models.
Results The overall complication rate was 55.3% after index surgeries and 49.2% after local recurrence surgeries. Age, OR time, blood loss and the use of transfusion had a predictive effect on the emergence of SSI in the IM subgroup in a LR model (p<0.01, R2=0.44). Bilateral S2 resection had an OR of 8 and bilateral S3 resection has an OR of 5 (p<0.01, R2=0.38) significantly elevating the risk of BBD in a LR model. In a multiple LiR model SSI, wound dehiscence, BBD, systemic infection, urinary tract infection, CSF leak, had a significant effect on LOS (p<0.01, R2=0.57).
Conclusion The present study describes the pattern of complications in different patient populations and identifies risk factors of SSI, of BBD and LOS thus giving a deeper insight in the management of pST surgeries and help to focus on minimizing the effect of risk factors of postoperative complications.
Semmelweis University, Károly Rácz Doctoral School of Clinical Medicine