title: Complications after surgery for metastatic humeral lesions.
abstract: BACKGROUND
  Knowledge of surgical outcome and its predictors helps inform patients and aids in surgical decision-making. We aimed to assess the outcome-reoperation and systemic complication rate-of surgery for humeral metastases, myeloma, or lymphoma. Our null hypothesis was that there are no factors associated with these outcomes.
  
  
  METHODS
  We included 295 consecutive patients in this retrospective study: 134 (45%) proximal, 131 (44%) diaphyseal, and 30 (10%) distal impending or pathologic fractures. Proximal lesions were treated by intramedullary nailing (43%, n = 57), prosthesis (34%, n = 46), plate-screw fixation (22%, n = 30), and a combination (n = 1). Diaphyseal lesions were treated by intramedullary nailing (69%, n = 91), plate-screw fixation (30%, n = 39), and a combination (n = 1). Distal lesions were treated by plate-screw fixation (97%, n = 29) and intramedullary nailing (3.3%, n = 1).
  
  
  RESULTS
  We found 25 (8.5%) reoperations, and 17 (5.8%) patients had 18 systemic complications: pneumonia (3.7%, n = 11), pulmonary embolism (1.3%, n = 4), sepsis (0.68%, n = 2), and fat embolism (0.34%, n = 1). No factors were independently associated with reoperation. Logistic regression analysis demonstrated that favorable cancer status (i.e., a higher modified Bauer score: odds ratio, 0.48; 95% confidence interval, 0.29-0.80; P = .005) was independently associated with a decreased systemic complication rate.
  
  
  CONCLUSIONS
  Poor cancer status was an independent predictor of postoperative systemic complications. This could help inform the patient and anticipate postoperative problems.
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA. Electronic address: steinjanssen@gmail.com.
authors.forename: Stein J
authors.initials: SJ
authors.lastname: Janssen
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Dijke
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
authors.forename: Santiago A
authors.initials: SA
authors.lastname: Lozano-Calderón
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Ready
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Raskin
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Marco L
authors.initials: ML
authors.lastname: Ferrone
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Hornicek
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Schwab
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D004620:Embolism, Fat / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D011655:Pulmonary Embolism / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Humerus; carcinoma; lymphoma; myeloma; operative; surgery metastases