No abstract

No abstract

Medicare Advantage healthcare plans may present undue impediments that result in disparities in patient outcomes. This study aims to compare the outcomes of patients who underwent STS resection based on enrollment in either traditional Medicare (TM) or Medicare Advantage (MA) plans. The Premier Healthcare Database was utilized to identify all patients ≥65 years old who underwent surgery for resection of a lower-extremity STS from 2015 to 2021. These patients were then subdivided based on their Medicare enrollment status (i.e., TM or MA). Patient characteristics, hospital factors, and comorbidities were recorded for each cohort. Bivariable analysis was performed to assess the 90-day risk of postoperative complications. Multivariable analysis controlling for patient sex, as well as demographic and hospital factors found to be significantly different between the cohorts, was also performed. From 2015 to 2021, 1858 patients underwent resection of STS. Of these, 595 (32.0%) had MA coverage and 1048 (56.4%) had TM coverage. The only comorbidities with a significant difference between the cohorts were peripheral vascular disease (p = 0.027) and hypothyroidism (p = 0.022), both with greater frequency in MA patients. After controlling for confounders, MA trended towards having significantly higher odds of pulmonary embolism (adjusted odds ratio (aOR): 1.98, 95% confidence interval (95%-CI): 0.58–6.79), stroke (aOR: 1.14, 95%-CI: 0.20–6.31), surgical site infection (aOR: 1.59, 95%-CI: 0.75–3.37), and 90-day in-hospital death (aOR 1.38, 95%-CI: 0.60–3.19). Overall, statistically significant differences in postoperative outcomes were not achieved in this study. The authors of this study hypothesize that this may be due to study underpowering or the inability to control for other oncologic factors not available in the Premier database. Further research with higher power, such as through multi-institutional collaboration, is warranted to better assess if there truly are no differences in outcomes by Medicare subtype for this patient population.

Background and ObjectiveThis study describes the complication profile of modern cryoablation utilizing probes as an adjuvant during open surgical treatment of orthopedic tumors.MethodsA retrospective, single‐surgeon study was performed for patients receiving cryoprobe cryoablation. Demographic information, malignancy‐related and operative details, and clinical courses were collected. Outcomes assessed included rates of complications, recurrence, and correlations between the number of probes or cryoablation cycles performed.ResultsIn this 148‐patient study, 67.6% had metastatic carcinoma to bone, 27.7% had benign bone tumors, and 4.7% had soft tissue tumors. An average of 3.4 ± 1.7 cryoablation probes were utilized and 1.7 ± 0.6 freezing cycles were performed. The overall cohort aggregate complication rate was 16.9%. These complications included postoperative fracture (3.4%), nerve palsy (2.7%), wound complications (7.4%), and infection (3.4%). The number of cycles and probes was significantly correlated with the incidence of aggregate complications in the overall cohort (Pearson = 0.162, p = 0.049) and metastatic bone cohort (Pearson = 0.222, p = 0.027). There were 13 recurrences.ConclusionThis study describes the complication rates involving cryoablation probes used as surgical adjuvants. Greater probe number usage was correlated with increased aggregate complications in patients with metastatic disease to bone; meanwhile, more treatment cycles were associated with increased aggregate complications in the overall cohort.