Is Preoperative Bevacizumab Associated with Increased Complications After Urgent Hip Fracture Surgery? A Retrospective Review

Document Type : RESEARCH PAPER

Authors

1 Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

2 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Abstract

Objectives: To investigate whether patients with impending or completed fracture of the proximal femur 
who were treated with bevacizumab in the six weeks prior to surgery are at higher risk of surgical 
complications than patients given bevacizumab outside of the six-week period.
Methods: We retrospectively reviewed cases of hip fracture treated between 1995 and 2020 at our institution. 
Patients were included if they were age 18 years or older, underwent hip surgery for impending or completed 
fracture, and received bevacizumab preoperatively but not postoperatively. Charts were reviewed for demographic, 
surgical, and postoperative details. A Cox model was applied to assess whether the timing of preoperative 
bevacizumab administration (≤6 weeks vs. >6 weeks) was associated with the risk of a postoperative complication.
Results: Two of the 23 patients who received bevacizumab ≤6 weeks before surgery experienced complications 
(deep vein thrombosis [n=1] and intraoperative fracture related to progression of disease [n=1]). Of the 53 patients 
who received bevacizumab more than six weeks preoperatively, five experienced complications (wound drainage 
[n=2] and deep vein thrombosis [n=3]). In the Cox model, timing of bevacizumab was not associated with 
postoperative complications (univariable hazard ratio, 0.92; 95% confidence interval, 0.18–4.73).
Conclusion: In this cohort of patients who underwent surgery for hip fractures, we did not observe an increased 
risk of postoperative complications among those who received bevacizumab within six weeks of surgery relative to 
those who received bevacizumab more than six weeks before surgery. The retrospective nature of the study and 
small sample size are limiting factors in this study.
 Level of evidence: III

Keywords

Main Subjects

References

  1. Habermann ET, Sachs R, Stern RE, Hirsh DM, Anderson WJ. The pathology and treatment of metastatic disease of the femur. Clin Orthop Relat Res. 1982 ;( 169):70-82.
  2. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989 ;( 249):256-264.
  3. Bickels J, Dadia S, Lidar Z. Surgical management of metastatic bone disease. J Bone Joint Surg Am. 2009; 91(6):1503-1516. doi:10.2106/JBJS.H.00175.
  4. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009; 302(14):1573-1579. doi:10.1001/jama.2009.1462.
  5. Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int. 2004; 15(11):897-902. doi:10.1007/s00198-004-1627-0.
  6. Tay E. Hip fractures in the elderly: operative versus nonoperative management. Singapore Med J. 2016; 57(4):178-181. doi:10.11622/smedj.2016071.
  7. Khattak MJ, Ashraf U, Nawaz Z, Noordin S, Umer M. Surgical management of metastatic lesions of proximal femur and the hip. Ann Med Surg (Lond). 2018; 36:90-95. doi:10.1016/j.amsu.2018.09.042.
  8. Boateng B, Bartelstein M. Timing of systemic cancer therapy relative to surgery to optimize wound healing: Do guidelines exist? Presented at: Annual Biomedical Research Conference for Minority Students. 2021; virtual meeting.
  9. Mellor JD, Cassumbhoy M, Jefford M. Clinical guidance on the perioperative use of targeted agents in solid tumor oncology. Asia Pac J Clin Oncol. 2011; 7(2):106-113. doi:10.1111/j.1743-7563.2011.01394.x.
  10. Yang Y, Lu Y, Tan H, et al. The optimal time of starting adjuvant chemotherapy after curative surgery in patients with colorectal cancer. BMC Cancer. 2023; 23(1):422. doi:10.1186/s12885-023-10863-w.
  11. Imran H, Enders F, Krailo M, et al. Effect of time to resumption of chemotherapy after definitive surgery on prognosis for non-metastatic osteosarcoma. J Bone Joint Surg Am. 2009; 91(3):604-612. doi:10.2106/JBJS.H.00449.
  12. Deptuła M, Zieliński J, Wardowska A, Pikuła M. Wound healing complications in oncological patients: perspectives for cellular therapy. Postepy Dermatol Alergol. 2019; 36(2):139-146. doi:10.5114/ada.2018.72585.
  13. Keating GM. Bevacizumab: a review of its use in advanced cancer. Drugs. 2014; 74(16):1891-1925. doi:10.1007/s40265-014-0302-9.
  14. Sharma K, Marcus JR. Bevacizumab and wound-healing complications: mechanisms of action, clinical evidence, and management recommendations for the plastic surgeon. Ann Plast Surg. 2013; 71(4):434-440. doi:10.1097/SAP.0b013e31824e5e57.
  15. Scappaticci FA, Fehrenbacher L, Cartwright T, et al. Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab. J Surg Oncol. 2005; 91(3):173-180. doi:10.1002/jso.20301.
  16. Erinjeri JP, Fong AJ, Kemeny NE, Brown KT, Getrajdman GI, Solomon SB. Timing of administration of bevacizumab chemotherapy affects wound healing after chest wall port placement. Cancer. 2011; 117(6):1296-1301. doi:10.1002/cncr.25573.
  17. Gordon MS, Margolin K, Talpaz M, et al. Phase I safety and pharmacokinetic study of recombinant human anti-vascular endothelial growth factor in patients with advanced cancer. J Clin Oncol. 2001; 19(3):843-850. doi:10.1200/JCO.2001.19.3.843.
  18. Gordon CR, Rojavin Y, Patel M, et al. A review on bevacizumab and surgical wound healing: an important warning to all surgeons. Ann Plast Surg. 2009; 62(6):707-709. doi:10.1097/SAP.0b013e3181828141.
  19. Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004; 350(23):2335-42. doi:10.1056/NEJMoa032691.
  20. Ellis LM, Curley SA, Grothey A. Surgical resection after downsizing of colorectal liver metastasis in the era of bevacizumab. J Clin Oncol. 2005; 23(22):4853-4855. doi:10.1200/JCO.2005.23.754.
  21. Utsumi H, Honma Y, Nagashima K, et al. Bevacizumab and postoperative wound complications in patients with liver metastases of colorectal cancer. Anticancer Res. 2015; 35(4):2255-2261.
  22. Zhang H, Huang Z, Zou X, Liu T. Bevacizumab and wound-healing complications: a systematic review and meta-analysis of randomized controlled trials. Oncotarget. 2016; 7(50):82473-82481. doi:10.18632/oncotarget.12666.
  23. Mahfud M, Breitenstein S, El-Badry AM, et al. Impact of preoperative bevacizumab on complications after resection of colorectal liver metastases: case-matched control study. World J Surg. 2010; 34(1):92-100. doi:10.1007/s00268-009-0251-8.
  24. Clark AJ, Butowski NA, Chang SM, et al. Impact of bevacizumab chemotherapy on craniotomy wound healing. J Neurosurg. 2011; 114(6):1609-1616. doi:10.3171/2010.10.JNS101042.

 

  1. Drake DB, Oishi SN. Wound healing considerations in chemotherapy and radiation therapy. Clin Plast Surg. 1995; 22(1):31-37.
  2. Giakoustidis A, Morrison D, Neofytou K, Giakoustidis D, Mudan S. Emergency open incarcerated hernia repair with a biological mesh in a patient with colorectal liver metastasis receiving chemotherapy and bevacizumab uncomplicated wound healing. Case Rep Emerg Med. 2014:2014:848030. doi:10.1155/2014/848030.
  3. Hyldig N, Birke-Sorensen H, Kruse M, et al. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg. 2016; 103(5):477-486. doi:10.1002/bjs.10084.
  4. Meynard P, Seguineau A, Laumonerie P, et al. Surgical management of proximal femoral metastasis: fixation or hip replacement? A 309 case series. Orthop Traumatol Surg Res. 2020; 106(6):1013-1023. doi:10.1016/j.otsr.2020.05.007.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 9
September 2024
Pages 645-651

Files

History

  • Receive Date: 28 September 2023
  • Revise Date: 06 June 2024
  • Accept Date: 15 May 2024

Share

How to cite

Statistics