title: Body mass index (BMI) at diagnosis is associated with surgical wound complications in patients with localized osteosarcoma: a report from the Children's Oncology Group.
abstract: BACKGROUND
  Malnutrition is common at diagnosis and during treatment for sarcoma patients. Poor nutritional status is associated with increased risk of complications, particularly infections. We investigated the role of body mass index (BMI) on the incidence of surgical wound complications in patients with localized osteosarcoma treated on the Children's Oncology Group (COG) legacy trial, INT-0133.
  
  
  METHODS
  Patients considered in this report had localized osteosarcoma, enrolled on COG trial INT-0133, remained on protocol therapy to have definitive surgery 6-16 weeks after study entry, and had adequate height, weight, and surgical complication data for analysis. By protocol design, definitive surgical resection was planned for 10 weeks after induction chemotherapy. Wound complications within 30 days after definitive surgery were considered post-operative. BMI was calculated at the start of neoadjuvant chemotherapy and expressed as age- and gender-adjusted percentile. The incidence of wound complications was evaluated by logistic regression or Fisher's exact test.
  
  
  RESULTS
  A total of 498 patients met criteria for analysis. Low BMI (≤10th percentile) was seen in 73 (14.7%), middle BMI (11th-94th percentile) in 382 (76.7%), and high BMI (≥95th percentile) in 43 (8.6%) patients. Wound infection or slough was seen in low BMI patients (OR = 2.0, P = 0.07) although the results did not reach statistical significance. Arterial thrombosis was more common in high BMI patients (OR = 9.4, P = 0.03).
  
  
  CONCLUSIONS
  Abnormal BMI at the start of treatment for localized osteosarcoma is associated with increased risk of post-operative wound complications such as arterial thrombosis. Future studies should evaluate whether maintenance of age-appropriate BMI reduces the risk of surgical complications.
authors.affiliation: Division of Pediatric Hematology Oncology, Phoenix Children's Hospital, Phoenix, Arizona 85016, USA. phingorani@phoenixchildrens.com
authors.forename: Pooja
authors.initials: P
authors.lastname: Hingorani
authors.forename: Kristy
authors.initials: K
authors.lastname: Seidel
authors.forename: Mark
authors.initials: M
authors.lastname: Krailo
authors.forename: Leo
authors.initials: L
authors.lastname: Mascarenhas
authors.forename: Paul
authors.initials: P
authors.lastname: Meyers
authors.forename: Neyssa
authors.initials: N
authors.lastname: Marina
authors.forename: Ernest U
authors.initials: EU
authors.lastname: Conrad
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Hawkins
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D055815:Young Adult