Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction
Background and Objectives: Functional outcomes are important for oncology patients undergoing lower extremity reconstruction. The objective of the current study was to describe patient reported function after surgery and identify predictors of postoperative function in musculoskeletal oncology patie...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/29/10/600 |
| _version_ | 1797473915809824768 |
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| author | Aaron M. Gazendam Patricia Schneider Diane Heels-Ansdell Mohit Bhandari Jason W. Busse Michelle Ghert |
| author_facet | Aaron M. Gazendam Patricia Schneider Diane Heels-Ansdell Mohit Bhandari Jason W. Busse Michelle Ghert |
| author_sort | Aaron M. Gazendam |
| collection | DOAJ |
| description | Background and Objectives: Functional outcomes are important for oncology patients undergoing lower extremity reconstruction. The objective of the current study was to describe patient reported function after surgery and identify predictors of postoperative function in musculoskeletal oncology patients undergoing lower extremity endoprosthetic reconstruction. Methods: We performed a cohort study with functional outcome data from the recently completed <i>Prophylactic Antibiotic Regimens in Tumor Surgery</i> (PARITY) trial. We utilized the 100-point Toronto Extremity Salvage Score (TESS), which was administered pre-operatively and at 3, 6 and 12 months post-operatively. Higher scores indicate better physical functioning, and the minimally important difference is 11 points. We calculated mean functional scores at each timepoint after surgery and developed a logistic regression model to explore predictors of failure to achieve excellent post-operative function (TESS ≥ 80) at 1 year after surgery. Results: The 555 patients included in our cohort showed important functional improvement from pre-surgery to 1 year post-surgery (mean difference 14.9 points, 95%CI 12.2 to 17.6; <i>p</i> < 0.001) and 64% achieved excellent post-operative function. Our adjusted regression model found that poor (TESS 0–39) pre-operative function (odds ratio [OR] 3.3, 95%CI 1.6 to 6.6); absolute risk [AR] 24%, 95%CI 8% to 41.2%), older age (OR per 10-year increase from age 12, 1.32, 95%CI 1.17, 1.49; AR 4.5%, 95%CI 2.4% to 6.6%), and patients undergoing reconstruction for soft-tissue sarcomas (OR 2.3, 95%CI 1.03 to 5.01; AR 15.3%, 95%CI 0.4% to 34.4%), were associated with higher odds of failing to achieve an excellent functional outcome at 1-year follow-up. Patients undergoing reconstruction for giant cell tumors were more likely to achieve an excellent functional outcome post-operatively (OR 0.40, 95%CI 0.17 to 0.95; AR −9.9%, 95%CI −14.4% to −0.7%). Conclusions: The majority of patients with tumors of the lower extremity undergoing endoprosthetic reconstruction achieved excellent function at 1 year after surgery. Older age, poor pre-operative function, and endoprosthetic reconstruction for soft tissue sarcomas were associated with worse outcomes; reconstruction for giant cell tumors was associated with better post-operative function. Level of Evidence: Therapeutic Level IV. |
| first_indexed | 2024-03-09T20:23:54Z |
| format | Article |
| id | doaj.art-06c74dc202094560b655cce5fbefa7e5 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-09T20:23:54Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-06c74dc202094560b655cce5fbefa7e52023-11-23T23:40:47ZengMDPI AGCurrent Oncology1198-00521718-77292022-10-0129107598760610.3390/curroncol29100600Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic ReconstructionAaron M. Gazendam0Patricia Schneider1Diane Heels-Ansdell2Mohit Bhandari3Jason W. Busse4Michelle Ghert5Division of Orthopaedic Surgery, McMaster University, Hamilton, ON L8S 4L8, CanadaDivision of Orthopaedic Surgery, McMaster University, Hamilton, ON L8S 4L8, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, CanadaDivision of Orthopaedic Surgery, McMaster University, Hamilton, ON L8S 4L8, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, CanadaDivision of Orthopaedic Surgery, McMaster University, Hamilton, ON L8S 4L8, CanadaBackground and Objectives: Functional outcomes are important for oncology patients undergoing lower extremity reconstruction. The objective of the current study was to describe patient reported function after surgery and identify predictors of postoperative function in musculoskeletal oncology patients undergoing lower extremity endoprosthetic reconstruction. Methods: We performed a cohort study with functional outcome data from the recently completed <i>Prophylactic Antibiotic Regimens in Tumor Surgery</i> (PARITY) trial. We utilized the 100-point Toronto Extremity Salvage Score (TESS), which was administered pre-operatively and at 3, 6 and 12 months post-operatively. Higher scores indicate better physical functioning, and the minimally important difference is 11 points. We calculated mean functional scores at each timepoint after surgery and developed a logistic regression model to explore predictors of failure to achieve excellent post-operative function (TESS ≥ 80) at 1 year after surgery. Results: The 555 patients included in our cohort showed important functional improvement from pre-surgery to 1 year post-surgery (mean difference 14.9 points, 95%CI 12.2 to 17.6; <i>p</i> < 0.001) and 64% achieved excellent post-operative function. Our adjusted regression model found that poor (TESS 0–39) pre-operative function (odds ratio [OR] 3.3, 95%CI 1.6 to 6.6); absolute risk [AR] 24%, 95%CI 8% to 41.2%), older age (OR per 10-year increase from age 12, 1.32, 95%CI 1.17, 1.49; AR 4.5%, 95%CI 2.4% to 6.6%), and patients undergoing reconstruction for soft-tissue sarcomas (OR 2.3, 95%CI 1.03 to 5.01; AR 15.3%, 95%CI 0.4% to 34.4%), were associated with higher odds of failing to achieve an excellent functional outcome at 1-year follow-up. Patients undergoing reconstruction for giant cell tumors were more likely to achieve an excellent functional outcome post-operatively (OR 0.40, 95%CI 0.17 to 0.95; AR −9.9%, 95%CI −14.4% to −0.7%). Conclusions: The majority of patients with tumors of the lower extremity undergoing endoprosthetic reconstruction achieved excellent function at 1 year after surgery. Older age, poor pre-operative function, and endoprosthetic reconstruction for soft tissue sarcomas were associated with worse outcomes; reconstruction for giant cell tumors was associated with better post-operative function. Level of Evidence: Therapeutic Level IV.https://www.mdpi.com/1718-7729/29/10/600Toronto extremity salvage scorefunctional outcomesorthopaedic oncologysarcoma |
| spellingShingle | Aaron M. Gazendam Patricia Schneider Diane Heels-Ansdell Mohit Bhandari Jason W. Busse Michelle Ghert Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction Current Oncology Toronto extremity salvage score functional outcomes orthopaedic oncology sarcoma |
| title | Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction |
| title_full | Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction |
| title_fullStr | Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction |
| title_full_unstemmed | Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction |
| title_short | Predictors of Functional Recovery among Musculoskeletal Oncology Patients Undergoing Lower Extremity Endoprosthetic Reconstruction |
| title_sort | predictors of functional recovery among musculoskeletal oncology patients undergoing lower extremity endoprosthetic reconstruction |
| topic | Toronto extremity salvage score functional outcomes orthopaedic oncology sarcoma |
| url | https://www.mdpi.com/1718-7729/29/10/600 |
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