Thirty Days Outcomes of Limb Salvage Surgery in Pediatric Patients Treated at a Tertiary Care Hospital
Muhammad Younus Khan Durrania, Usman Alia, Javeria Saeeda, Masood Umera
- aOrthopaedic Surgery, Aga Khan University Hospital, Karachi, PAK
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Abstract
Background Managing primary bone and soft tissue sarcomas in pediatric patients poses significant challenges, with surgical resection remaining essential for cure. While limb salvage surgery has emerged as the standard approach, concerns persist regarding post-operative complications. Our study aims to evaluate the 30-day morbidity and mortality of limb salvage surgery in pediatric tumor patients, bridging critical knowledge gaps and contributing to enhancing the standard of care in low- and middle-income countries (LMICs). Materials and methods A prospective cohort study was conducted on pediatric patients (aged 18 years or younger) who presented at a tertiary care hospital's orthopedics department and required limb salvage surgery due to various tumors from May 2021 to October 2023. Results Nineteen cases met the inclusion criteria. The average patient age was 12.2 years (SD = 4.71), with 5 (20.8%) females and 14 (79.2%) males. Bone tumors accounted for 12 (63.2%) cases, and soft tissue tumors for 7 (36.8%). Osteosarcoma was the most common tumor (36.8%), followed by Ewing Sarcoma (31.57%) and Synovial Sarcomas (15.8%). Free fibular grafts were used in 6 (31.6%) cases, and Mega prosthesis in 3 (15.8%). Overall, 26.3% of cases experienced post-surgical complications within 30 days, notably including surgical site infections (21.05%) and flap necrosis (10.53%). No significant differences in demographic and clinical variables were observed between patients with and without complications. Conclusion Our study highlights immediate post-operative outcomes and complications of limb salvage surgery in pediatric musculoskeletal tumor patients, particularly in LMIC settings. Despite advancements, early complications remain challenging, with nearly one-quarter of patients experiencing adverse events within 30 days. The prevalence of surgical site infections emphasizes the urgent need for improved infection control measures in LMICs.