Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database

Abstract

Background. Primary bone and soft tissue sarcomas are rare tumors requiring wide surgical resection and reconstruction to achieve local control. Postoperative complications can lead to delays in adjuvant therapy, potentially affecting long-term oncologic outcomes. Understanding postoperative complication risks is essential; however, past studies are limited by small sample sizes. Purpose. This study uses a large national registry to characterize the incidence of complications and mortality in the first thirty days following surgical management of primary bone and soft tissue sarcomas of the extremities. Methods. A retrospective review of patients in the National Surgical Quality Improvement Program database was performed. Cases were identified using diagnosis codes for malignant neoplasm of soft tissue or bone and procedure codes for amputation and radical resection. The cohort was subdivided by bone versus soft tissue sarcoma, upper versus lower extremity, and amputation versus limb salvage. Results. One thousand, one hundred eleven patients were identified. The most frequent complications were surgical site infections, sepsis, and venous thromboembolism. The overall incidence of complications was 14.0%. Unplanned readmission and reoperation occurred after 7.0% and 8.0% of cases, respectively. Thirty-day mortality was 0.3%, with one intraoperative death. Patient factors and complication rates varied by tumor location and surgical modality. Lower extremity cases were associated with higher rates of wound complications and infectious etiologies such as surgical site infections, urinary tract infections, and systemic sepsis. In contrast, patients undergoing amputation were more likely to experience major medical complications including acute renal failure, cardiac arrest, and myocardial infarction. Conclusion. Approximately 1 in 7 patients will experience a complication in the first thirty days following surgery for primary bone and soft tissue sarcomas of the extremities. The unique risk profiles of lower extremity and amputation cases should be considered during perioperative planning and surveillance.

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

“…However, it is lower than the 3.3% mortality rate of adults undergoing spinal tumor resections in the adult NSQIP database between 2011 and 2014 [22]. Additionally, in our previous NSQIP study of adult bone and soft tissue sarcomas of the extremities, we found a thirty-day mortality rate of 0.4% [25]. When our pediatric sarcoma cohort is partitioned by tumor location, axial tumors had a 2.1% thirty-day mortality rate and there were no deaths in the appendicular tumor group.…”

“…Our thirty-day wound dehiscence and infectious complication rate of 7.8% is significant, but higher rates in studies with longer follow-ups make it clear that infectious complications continue to be a concern well beyond the early postoperative recovery period. Of note, the wound dehiscence rate and surgical site infection rate are higher in the pediatric population compared with our adult sarcoma cohort, 7.8% vs 5.6%, respectively [25]. Potentially, this is related to pressure from the medical oncologists to get patients back on chemotherapy as soon as possible.…”

“…NSQIP has been used to characterize patient characteristics and outcomes after surgical management of primary and metastatic tumors of the spine [22,23]. Our research team has also used NSQIP to study outcomes after surgical management of primary bone and soft tissue sarcomas and metastatic bone tumors of the extremities [24,25].…”

What are the predictors of emergency department utilization and readmission following extremity bone sarcoma resection?

“…A recent study reported the unplanned readmission rate following a bone sarcoma to be 7.1% 30 ; lower than the 18% observed in the current series. In the series by Gallaway et al, 30 The results of this study should be interpreted in light of certain limitations. The data was collected from a large database, and although it is a large sample size, it lacks the clinical details of the ED presentations and also the exact indications for readmission.…”

Effect of Resident and Fellow Involvement on Outcomes of Sarcoma Surgery: A NSQIP Database Cross-Sectional Study

“…For multivariate regression, a multiple logistic regression was performed for the outcome of “any complication.” The following variables were identified from clinical expertise and the literature as being prognostic and/or potential confounders [ 15 ] for complications in orthopedic oncology surgery: older age, hematologic comorbidity, preoperative chemotherapy or radiation, higher American Society of Anesthesiologists (ASA) class, total work relative value units (wRVUs), [ 16 ] and lower extremity surgery (including the pelvis) [ 8 , 17 ]. Penalized maximum likelihood using the Firth method was utilized in order to reduce small-sample bias and avoid problems related to data separation [ 18 ].…”