Effect of early mobilization on 30-day wound complications following sacral amputation for en bloc tumor resection

OBJECTIVE Sacral amputations for en bloc resection of malignant spinal tumors are associated with significant morbidity, especially wound complications, and require complex plastic surgery reconstructions to achieve wound closure. In this study, the authors investigate wound healing related to early postoperative mobilization (≤ 3 days of bed rest) compared with delayed postoperative mobilization (> 3 days of bed rest). The primary outcome was 30-day postoperative wound complications. METHODS This is a retrospective study of patients who underwent sacral amputation at a single institution with a single neurosurgeon between 2018 and 2023. Demographic information, comorbid conditions, pathological diagnosis, surgical characteristics, length of bed rest, and postoperative wound complications were collected for each patient. Univariate analysis followed by stepwise multivariable logistic regression was utilized to identify independent predictors of 30-day postoperative wound complications, defined as reoperation, infection, or dehiscence at the surgical site. RESULTS Forty-three patients were included in the analysis. Thirty-one patients were placed on standard bed rest (> 3 days; mean 5.9 [SD 2.4] days), while 12 were mobilized early (≤ 3 days; mean 2.3 [SD 1.4] days). The overall wound complication rate was 37.2%. Of the patients with delayed mobilization, 15 (48.4%) experienced wound complications, while 1 (8.3%) with early mobilization experienced wound complications. On multivariable analysis, early mobilization was independently associated with reduced odds of 30-day wound complications (OR 0.035, 95% CI 0.002–0.689; p = 0.0275). CONCLUSIONS These data show that early mobilization after sacral amputation is associated with a decreased incidence of wound complications compared with delayed mobilization. Further prospective studies investigating early mobilization after sacral amputation are warranted.