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J Surg Res. 2019 Jul;239:125-135. doi: 10.1016/j.jss.2019.01.055. Epub 2019 Feb 27.

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

Author information

1
Division of Surgical Oncology, Department of Surgery, University of California (UC), Davis Medical Center, Sacramento, California.
2
Center for Healthcare Policy and Research, UC Davis, Sacramento, California.
3
Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California.
4
Division of Surgical Oncology, Department of Surgery, University of California (UC), Davis Medical Center, Sacramento, California. Electronic address: rjcanter@ucdavis.edu.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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 < 0.0001). There was no difference in disease-specific survival or overall survival between groups (P > 0.05). Planned excisions were associated with increased Medicare costs (P < 0.05), with the first resection contributing to the majority of costs. Subgroup analyses by histologic grade and tumor size revealed similar results.

CONCLUSIONS:

Survival was comparable with greater health care costs in elderly patients undergoing planned STS excision. Although unplanned excisions remain a quality of care issue with high re-excision rates, these data have important implications for the surgical management of STS in the elderly.

KEYWORDS:

Biopsy; Cost; MRI; Sarcoma; Survival

PMID:
30825757
PMCID:
PMC6488355
[Available on 2020-07-01]
DOI:
10.1016/j.jss.2019.01.055

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