title: Factors associated with infection after reconstructive shoulder surgery for proximal humerus tumors.
abstract: BACKGROUND
  The main reconstruction techniques for proximal humerus tumors include osteoarticular allografts (OAs), endoprostheses (EPs), or allograft prosthetic composites (APCs). A common complication is infection, and constructs involving the use of allografts are believed to be at a higher risk of infection. Literature comparing infection rates between different modalities of reconstruction is scarce and underpowered. The study purposes were (1) to determine and compare the prevalence of infection in patients who underwent reconstruction of the proximal humerus including OAs, EPs, and APCs; (2) to identify preoperative, perioperative, and postoperative predictors of infection that might be modifiable; and (3) to present our protocol of treatment in patients with superficial and deep infections.
  
  
  METHODS
  We reviewed 150 patients of all ages with proximal humerus tumors treated by an OA, EP, or APC at 2 tertiary institutions. The prevalence of infection for each modality was calculated and compared between groups. We identified potential predictors of infection with stepwise backward multivariate Cox regression analysis.
  
  
  RESULTS
  An infection developed in 19 patients (12%): 5 of 45 (11%) in the OA group, 12 of 85 (14%) in the EP group, and 2 of 20 (10%) in the APC group (P = .740). A lower preoperative hemoglobin blood level and low preoperative albumin blood level were independently associated with infection.
  
  
  CONCLUSIONS
  We found similar infection rates compared with previously reported series. However, we did not identify a higher infection prevalence in constructs using allografts. Patients with a lower preoperative hemoglobin or albumin level are at higher risk of infection and should undergo optimization before surgery.
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA. Electronic address: s.t.meijer@gmail.com.
authors.forename: Sjoerd Th
authors.initials: ST
authors.lastname: Meijer
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
authors.forename: Nuno R
authors.initials: NR
authors.lastname: Paulino Pereira
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
authors.forename: Sjoerd P F Th
authors.initials: SPFT
authors.lastname: Nota
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital-Harvard Medical School, 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: Joseph H
authors.initials: JH
authors.lastname: Schwab
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
mesh_terms: D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods*; D001859:Bone Neoplasms / Q000097:blood / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D058430:Humeral Head / Q000601:surgery*; D007239:Infections / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D057234:Preoperative Period; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012785:Shoulder Joint / Q000601:surgery; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin
keywords: Proximal humerus tumors; allograft; endoprosthesis; infection; reconstruction; revision