Morbid Obesity Is Associated With an Increased Risk of Wound Complications and Infection After Lower Extremity Soft-tissue Sarcoma Resection

Background: Obesity is associated with wound complications after lower extremity surgery. Excision of soft-tissue sarcomas is urgent, and unlike the elective surgery, obesity cannot be modified preoperatively. The purpose of this study was to evaluate the effect of obesity on treatment outcome. Methods: Six hundred fifty-three patients (343 men; mean age, 56 +/- 18 years) with a lower extremity soft-tissue sarcoma were reviewed. The mean body mass index (BMI) was 27.1 +/- 5.7 kg/m(2), with 189 obese patients (29%) having a BMI of >= 30 kg/m(2) and 27 morbidly obese patients (4%) having a BMI of >= 40 kg/m(2). Complications and functional and oncologic outcomes were compared between groups. Results: Two hundred eighty-five patients (40%) sustained a postoperative complication, most commonly a dehiscence (n = 175; 24%) and infection (n = 147; 21%). On multivariate analysis, morbid obesity was associated with wound complications (P = 0.002) and infection (P = 0.01). Morbid obesity was not associated with local tumor recurrence (P = 0.56). No difference was found in the mean Toronto Extremity Salvage Score (P = 0.11) or Musculoskeletal Tumor Society (P = 0.41) scores between the groups. Discussion: Morbid obesity was associated with postoperative wound complications and infection. However, after surgery, obese patients can expect no difference in oncologic outcome, with an excellent functional result.