{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:27:01Z","timestamp":1787671621825,"version":"build-2736575974"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Am Acad Orthop Surg","JAAOS"],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Six hundred fifty-three patients (343 men; mean age, 56 \u00b1 18 years) with a lower extremity soft-tissue sarcoma were reviewed. The mean body mass index (BMI) was 27.1 \u00b1 5.7 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , with 189 obese patients (29%) having a BMI of \u226530 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and 27 morbidly obese patients (4%) having a BMI of \u226540 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Complications and functional and oncologic outcomes were compared between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002) and infection (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01). Morbid obesity was not associated with local tumor recurrence (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.56). No difference was found in the mean Toronto Extremity Salvage Score (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.11) or Musculoskeletal Tumor Society (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.41) scores between the groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5435\/jaaos-d-18-00536","type":"journal-article","created":{"date-parts":[[2018,12,31]],"date-time":"2018-12-31T02:36:58Z","timestamp":1546223818000},"page":"807-815","source":"Crossref","is-referenced-by-count":28,"title":["Morbid Obesity Is Associated With an Increased Risk of Wound Complications and Infection After Lower Extremity Soft-tissue Sarcoma Resection"],"prefix":"10.5435","volume":"27","author":[{"given":"Matthew T.","family":"Houdek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Hevesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.","family":"Griffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay S.","family":"Wunder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Ferguson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230714","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1016\/S0140-6736(02)09292-9","article-title":"Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: A randomised trial","volume":"359","author":"O'Sullivan","year":"2002","journal-title":"Lancet"},{"key":"R2-20230714","doi-asserted-by":"crossref","first-page":"40","DOI":"10.5435\/00124635-200901000-00006","article-title":"Soft-tissue sarcoma","volume":"17","author":"Gilbert","year":"2009","journal-title":"J Am Acad Orthop Surg"},{"key":"R3-20230714","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1245\/s10434-010-0915-5","article-title":"Function and health status outcomes following soft tissue reconstruction for limb preservation in extremity soft tissue sarcoma","volume":"17","author":"Davidge","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"R4-20230714","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/00000658-199109000-00015","article-title":"The role of multimodality therapy in soft-tissue sarcoma","volume":"214","author":"Brennan","year":"1991","journal-title":"Ann Surg"},{"key":"R5-20230714","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1002\/jso.24357","article-title":"Can the ACS-NSQIP surgical risk calculator predict post-operative complications in patients undergoing flap reconstruction following soft tissue sarcoma resection?","volume":"114","author":"Slump","year":"2016","journal-title":"J Surg Oncol"},{"key":"R6-20230714","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1016\/j.ejso.2017.01.016","article-title":"Patient, tumour and treatment factors affect complication rates in soft tissue sarcoma flap reconstruction in a synergistic manner","volume":"43","author":"Slump","year":"2017","journal-title":"Eur J Surg Oncol"},{"key":"R7-20230714","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1097\/00006534-199404001-00012","article-title":"Wound-healing complications after soft-tissue sarcoma surgery","volume":"93","author":"Peat","year":"1994","journal-title":"Plast Reconstr Surg"},{"key":"R8-20230714","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/BLO.0b013e3180514c50","article-title":"Soft tissue sarcoma resection volume associated with wound-healing complications","volume":"459","author":"Geller","year":"2007","journal-title":"Clin Orthop Relat Res"},{"key":"R9-20230714","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.ejso.2014.10.045","article-title":"Major wound complication risk factors following soft tissue sarcoma resection","volume":"40","author":"Moore","year":"2014","journal-title":"Eur J Surg Oncol"},{"key":"R10-20230714","doi-asserted-by":"crossref","first-page":"326","DOI":"10.2106\/JBJS.N.00515","article-title":"Morbid obesity: A significant risk factor for failure of two-stage revision total hip arthroplasty for infection","volume":"97","author":"Houdek","year":"2015","journal-title":"J Bone Joint Surg Am"},{"key":"R11-20230714","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1007\/s11999-015-4283-0","article-title":"Morbid obesity: Increased risk of failure after aseptic revision TKA","volume":"473","author":"Watts","year":"2015","journal-title":"Clin Orthop Relat Res"},{"key":"R12-20230714","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.2106\/JBJS.16.00093","article-title":"Effect of body mass index on reoperation and complications after total knee arthroplasty","volume":"98","author":"Wagner","year":"2016","journal-title":"J Bone Joint Surg Am"},{"key":"R13-20230714","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2106\/JBJS.O.00430","article-title":"Effect of body mass index on complications and reoperations after total hip arthroplasty","volume":"98","author":"Wagner","year":"2016","journal-title":"J Bone Joint Surg Am"},{"key":"R14-20230714","doi-asserted-by":"crossref","first-page":"e154","DOI":"10.2106\/JBJS.M.01289","article-title":"Morbid obesity: A significant risk factor for failure of two-stage revision total knee arthroplasty for infection","volume":"96","author":"Watts","year":"2014","journal-title":"J Bone Joint Surg Am"},{"key":"R15-20230714","doi-asserted-by":"crossref","first-page":"3446","DOI":"10.1007\/s11999-015-4278-x","article-title":"Are there modifiable risk factors for hospital readmission after total hip arthroplasty in a US healthcare system?","volume":"473","author":"Paxton","year":"2015","journal-title":"Clin Orthop Relat Res"},{"key":"R16-20230714","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.radonc.2004.12.020","article-title":"Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma","volume":"75","author":"Davis","year":"2005","journal-title":"Radiother Oncol"},{"key":"R17-20230714","doi-asserted-by":"crossref","first-page":"4472","DOI":"10.1200\/JCO.2002.03.084","article-title":"Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma","volume":"20","author":"Davis","year":"2002","journal-title":"J Clin Oncol"},{"key":"R18-20230714","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1200\/JCO.1997.15.1.350","article-title":"Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma","volume":"15","author":"Guillou","year":"1997","journal-title":"J Clin Oncol"},{"key":"R19-20230714","first-page":"241","article-title":"A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system","author":"Enneking","year":"1993","journal-title":"Clin Orthop Relat Res"},{"key":"R20-20230714","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1007\/BF00540024","article-title":"Development of a measure of physical function for patients with bone and soft tissue sarcoma","volume":"5","author":"Davis","year":"1996","journal-title":"Qual Life Res"},{"key":"R21-20230714","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.arth.2009.05.016","article-title":"Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates","volume":"24","author":"Malinzak","year":"2009","journal-title":"J Arthroplasty"},{"key":"R22-20230714","doi-asserted-by":"crossref","first-page":"e101","DOI":"10.2106\/JBJS.J.01935","article-title":"Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: A single-center analysis of 7181 primary hip and knee replacements for osteoarthritis","volume":"94","author":"Jamsen","year":"2012","journal-title":"J Bone Joint Surg Am"},{"key":"R23-20230714","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/00000658-199111000-00011","article-title":"Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients","volume":"214","author":"Jonsson","year":"1991","journal-title":"Ann Surg"},{"key":"R24-20230714","first-page":"47","article-title":"Oxygen tension and wound infection","volume":"23","author":"Hunt","year":"1972","journal-title":"Surg Forum"},{"key":"R25-20230714","first-page":"561","article-title":"The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis","volume":"135","author":"Hunt","year":"1972","journal-title":"Surg Gynecol Obstet"},{"key":"R26-20230714","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1128\/MCB.01300-08","article-title":"Metabolic dysregulation and adipose tissue fibrosis: Role of collagen VI","volume":"29","author":"Khan","year":"2009","journal-title":"Mol Cell Biol"},{"key":"R27-20230714","doi-asserted-by":"crossref","first-page":"E1990","DOI":"10.1210\/jc.2011-1567","article-title":"Adipose tissue extracellular matrix and vascular abnormalities in obesity and insulin resistance","volume":"96","author":"Spencer","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"R28-20230714","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.arth.2013.02.011","article-title":"Obesity and total joint arthroplasty: A literature based review","volume":"28","year":"2013","journal-title":"J Arthroplasty"},{"key":"R29-20230714","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.1007\/s11999-014-3714-7","article-title":"Obesity does not affect survival outcomes in extremity soft tissue sarcoma","volume":"472","author":"Alamanda","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"R30-20230714","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1038\/sj.bjc.6690781","article-title":"Body weight and risk of soft-tissue sarcoma","volume":"81","author":"Tavani","year":"1999","journal-title":"Br J Cancer"},{"key":"R31-20230714","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s10549-010-0990-0","article-title":"Effect of obesity on survival of women with breast cancer: Systematic review and meta-analysis","volume":"123","author":"Protani","year":"2010","journal-title":"Breast Cancer Res Treat"},{"key":"R32-20230714","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1158\/1078-0432.CCR-09-2636","article-title":"Obesity is an independent prognostic variable in colon cancer survivors","volume":"16","author":"Sinicrope","year":"2010","journal-title":"Clin Cancer Res"},{"key":"R33-20230714","doi-asserted-by":"crossref","first-page":"193","DOI":"10.5435\/JAAOS-22-03-193","article-title":"Evaluation of malnutrition in orthopaedic surgery","volume":"22","author":"Cross","year":"2014","journal-title":"J Am Acad Orthop Surg"},{"key":"R34-20230714","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1097\/BRS.0000000000001591","article-title":"Malnutrition predicts infectious and wound complications following posterior lumbar spinal fusion","volume":"41","author":"Bohl","year":"2016","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["Journal of the American Academy of Orthopaedic Surgeons"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-18-00536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:48:46Z","timestamp":1787669326000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-18-00536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,1]]},"references-count":34,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.5435\/jaaos-d-18-00536","relation":{},"ISSN":["1067-151X","1940-5480"],"issn-type":[{"value":"1067-151X","type":"print"},{"value":"1940-5480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,1]]}}}