Surgical site infection (SSI) has not been extensively studied in musculoskeletal tumors (MST) owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases) treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery ( ) and intraoperative blood loss ( ) was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI) index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials). The MOSI index (0–4 points) score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points). The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI. 1. Introduction Surgical site infection (SSI) is defined as an infection at the site of direct operative manipulation that develops within 30 days of operation if no artificial materials (implants) are used or within 1 year if artificial materials are used [1]. In general, the incidence of SSI following orthopaedic surgery has been reported to be 1% to 3% [2]. The incidence of SSI following orthopaedic surgery in Japan is 0.83% for cases of spinal canal stenosis, 0.28% for cases of disc herniation, 0.80% for cases of total hip arthroplasty (THA), and 0.96% for cases of total knee arthroplasty (TKA) [3]. This indicates that the incidence of SSI following surgery with the use of artificial materials is higher than that in cases without the use of artificial materials. The incidence of SSI following surgical treatment for cancer is relatively high, with large variations observed depending on the type of cancer (breast cancer 5.2% [1], rectal cancer 10% [2], gastric cancer 13.8% [3], liver cancer 21% [4], and oral cancer 40.6% [5]). Surgery for malignant musculoskeletal tumors is performed in the aseptic osteoarticular area. However, the incidence of SSI following surgery for this kind of tumor is anticipated to be higher than the incidence following orthopaedic surgery in general and the reasons for this include the following: (1)
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