Clinical Outcomes and Costs Following Unplanned Excisions of Soft Tissue Sarcomas in the Elderly

Surgical guidelines for soft tissue sarcoma (STS) emphasize pretreatment evaluation and reports of the perils of unplanned excision exist. Given the paucity of population-based data on this topic, our objective was to analyze clinical outcomes and costs of planned versus unplanned STS excisions in t...

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Bibliographic Details
Published in:The Journal of surgical research 2019-07, Vol.239, p.125-135
Main Authors: Bateni, Sarah B., Gingrich, Alicia A., Jeon, Sun Y., Hoch, Jeffrey S., Thorpe, Steven W., Kirane, Amanda R., Bold, Richard J., Canter, Robert J.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biopsy
Biopsy - economics
Biopsy - statistics & numerical data
Cost
Cost-Benefit Analysis
Female
Health Care Costs - statistics & numerical data
Humans
Magnetic Resonance Imaging - economics
Magnetic Resonance Imaging - statistics & numerical data
Male
Margins of Excision
Medicare - economics
Medicare - statistics & numerical data
MRI
Postoperative Complications - economics
Postoperative Complications - epidemiology
Preoperative Care - economics
Preoperative Care - statistics & numerical data
Reoperation - economics
Reoperation - statistics & numerical data
Retrospective Studies
Sarcoma
Sarcoma - diagnostic imaging
Sarcoma - mortality
Sarcoma - surgery
SEER Program - statistics & numerical data
Survival
Survival Analysis
Treatment Outcome
United States - epidemiology
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Summary:Surgical guidelines for soft tissue sarcoma (STS) emphasize pretreatment evaluation and reports of the perils of unplanned excision exist. Given the paucity of population-based data on this topic, our objective was to analyze clinical outcomes and costs of planned versus unplanned STS excisions in the Medicare population. We analyzed 3913 surgical patients with STS ≥66 y old from 1992 to 2011 using the Surveillance, Epidemiology, and End Results–Medicare datafiles. Planned excisions were classified based on preoperative MRI and/or biopsy, whereas unplanned excisions were classified by excision as the first procedure. Inverse probability of treatment weighting with propensity scores was used to adjust for clinicopathologic differences. Re-excisions, complications, and Medicare payments were compared with multivariate models. Overall survival and disease-specific survival were analyzed using Cox proportional hazards and competing risk models. Before the first excision, 24.3% had an MRI and biopsy, 27.3% had an MRI, 11.4% had a biopsy, and 36.9% were unplanned. Re-excision rates were highest for unplanned excisions: 46.3% compared to 18.1%, 36.4%, and 29.7% for other groups (P  0.05). Planned excisions were associated with increased Medicare costs (P 
ISSN:0022-4804
1095-8673
1095-8673
DOI:10.1016/j.jss.2019.01.055