Abstract
Background Pediatric bone and soft tissue sarcomas are rare; therefore, national registries are essential tools for orthopedic oncology research. Past studies provide excellent data on long-term prognosis and survival trends but fail to examine treatment-specific morbidity. The aim of this study is to use a national registry to describe patient demographics, comorbidities, and adverse events in the first thirty days following surgical management of pediatric bone and soft tissue sarcomas. Methods A retrospective review of patients in the American College of Surgeons National Surgical Quality Improvement Program—Pediatrics database (NSQIP-P) was performed. The cohort was partitioned by tumor origin (bone versus soft tissue) and tumor location (axial versus appendicular). Results One-hundred ninety-two patients were identified. Bone sarcomas were more common (71.9%) and predominately appendicular (62.3%), while soft tissue sarcomas were predominately axial (77.8%). The overall complication rate was 8.9%. The most frequent etiologies were wound dehiscence (3.6%) and infectious complications such as surgical site infections (2.6%), pneumonia (1.6%), urinary tract infections (1.6%), and C. diff colitis (1.0%). Twenty-four percent of patients experienced bleeding requiring transfusion. The unplanned readmission rate was 12.5% (3.6% related to principle procedure), and the unplanned reoperation rate was 4.7% (4.2% related to principle procedure). The mortality rate was 1.0%. Neoadjuvant chemotherapy was associated with higher rates of wound dehiscence and infectious complications. There were no differences in adverse events with respect to tumor origin or location. Conclusion Approximately 1 in 11 pediatric patients will experience a complication in the first thirty days following surgery. However, perioperative mortality remains low. This study represents the first comprehensive review of pediatric bone and soft tissue sarcoma surgery in the NSQIP-P database. As the case volume of NSQIP-P continues to grow, NSQIP-P has the potential to become a powerful tool for pediatric orthopedic oncology research.
Highlights
Pediatric bone and soft tissue sarcomas are rare tumors associated with significant morbidity and long-term sequelae. e most common pediatric sarcomas are osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma with a combined age-adjusted incidence of 2.7 cases per 100,000 children ages 0 to 19 in the United States [1]
National Surgical Quality Improvement Program—Pediatrics database (NSQIP-P) has not been used to characterize outcomes after pediatric orthopedic oncology procedures. e aim of this study is to describe patient demographics, comorbidities, surgical parameters, and adverse events in the first thirty days following surgical management of pediatric bone and soft tissue sarcomas
Comorbidities, surgical parameters, and adverse events were extracted. e cohort was partitioned by tumor origin and tumor location to determine if there were any significant differences between these groups
Summary
Pediatric bone and soft tissue sarcomas are rare tumors associated with significant morbidity and long-term sequelae. e most common pediatric sarcomas are osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma with a combined age-adjusted incidence of 2.7 cases per 100,000 children ages 0 to 19 in the United States [1]. Due to the rare incidence of these tumors, past research has frequently been limited to case series and small sample sizes [5,6,7,8,9] International collaborations such as the European and American Osteosarcoma Study (EURAMOS-1) and national cancer registries such as the Surveillance, Epidemiology, and End Results program (SEER) have become essential research tools illustrating trends in epidemiology and survival in bone and soft tissue sarcomas [10,11,12,13,14,15]. E aim of this study is to use a national registry to describe patient demographics, comorbidities, and adverse events in the first thirty days following surgical management of pediatric bone and soft tissue sarcomas. As the case volume of NSQIP-P continues to grow, NSQIP-P has the potential to become a powerful tool for pediatric orthopedic oncology research
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