Patient characteristics, outcomes, and trends in extremity sarcoma management by surgeon specialty

Abstract

BackgroundExtremity soft tissue sarcoma is managed by oncological trained general or orthopedic surgeons, but limited data exist comparing patient characteristics and outcomes between the 2 specialties. MethodsPatients were identified from the 2008 to 2017 National Surgical Quality Improvement Program who underwent limb-sparing resection of extremity soft tissue sarcoma by either general surgeons or orthopedic surgeons. Multivariable logistic regression analysis identified factors associated with general surgeons compared with OS. Length of stay was assessed using Poisson regression. Procedure annual percent change was analyzed using Joinpoint Regression. ResultsThe majority of extremity soft tissue sarcoma cases were performed by general surgeons (N = 304, 69.4%), but general surgeons’ resections significantly decreased (35.2%) over the study period (annual percent change –5.8, P < .0001). General surgeons’ patients were less likely to receive neoadjuvant chemotherapy (2.0% vs 3.7%, P < .01), and more likely to receive neoadjuvant radiation (9.9% vs 5.2%, P < .01) and have normal preoperative white blood cell counts (77.0% vs. 66.4%, P = .02). Orthopedic surgeons’ cases were more often performed under regional anesthesia (9.7% vs. 2.3%, P = .01), and orthopedic patients were more likely to receive postoperative transfusions (5.2% vs 0.3%, P < .01) and had a longer median length of stay (2 vs 1 days, P < .01). Thirty-day overall morbidity (7.2% general surgeon vs 9.7% orthopedic surgeon, P = .38) and all-cause mortality (0.3% general surgeon vs 0% orthopedic surgeon, P = .51) did not differ by specialty. ConclusionAlthough postoperative outcomes for extremity soft tissue sarcoma are comparable between general and orthopedic surgeons, treatment and perioperative management differences exist. Future investigation focused on understanding these differences in perioperative management across specialties may help identify areas for quality improvement in care of patients with extremity soft tissue sarcoma.