Identifying Modifiable and Non-modifiable Risk Factors of Readmission and Short-Term Mortality in Chondrosarcoma: A National Cancer Database Study

Abstract

Limited data are available to inform the risk of readmission and short-term mortality in musculoskeletal oncology. The goal of this study was to identify factors independently associated with 30-day readmission and 90-day mortality following surgical resection of chondrosarcoma. We retrospectively reviewed 6653 patients following surgical resection of primary chondrosarcoma in the National Cancer Database (2004-2017). Both demographic and clinicopathologic variables were assessed for correlation with readmission and short-term mortality utilizing univariate and multivariate logistic regression modeling. Of 220 readmissions (3.26%), risk factors independently associated with an increased risk of unplanned 30-day readmission included Charlson-Deyo Comorbidity Index (CDCC) (odds ratio [OR] 1.31; p=0.027), increasing American Joint Committee on Cancer (AJCC) stage (OR 1.31; p=0.004), undergoing major amputation (OR 2.38; p=0.001), and axial skeletal location (OR 1.51; p=0.028). A total of 137 patients died within 90days of surgery (2.25%). Risk factors associated with increased mortality included the CDCC (OR 1.60; p=0.001), increasing age (OR 1.06; p<0.001), having Medicaid insurance status (OR 3.453; p=0.005), living in a zip code with a higher educational attainment (OR 1.59; p=0.003), increasing AJCC stage (OR 2.32; p<0.001), longer postoperative length of stay (OR 1.015; p=0.033), and positive surgical margins (OR 2.75; p=0.001). Although a majority of the cohort did not receive radiation therapy (88.8%), receiving radiotherapy (OR 0.132; p=0.010) was associated with a decreased risk of short-term mortality. Several tumor, treatment, and patient factors can help inform the risk of readmission and short-term mortality in patients with surgically treated chondrosarcoma.