Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

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.

Issues With Big Data: Variability in Reported Demographics and Complications Associated With Posterior Spinal Fusion in Pediatric Patients

“…There is a role for database studies in pediatric orthopaedic surgery; however, it is important to consider these differences when interpreting study results, generalizing data to other populations, and selecting databases for future research. (14,16) 16 (15,17) 16.5 (15.5, 17) 0.06…”

“…The availability of data for pediatric patients is more limited since pediatric patients are often treated at specialized centers and commonly have public insurance 1,2. The most commonly used databases in pediatric orthopaedic research include the National Surgical Quality Improvement Program (NSQIP), the Healthcare Cost and Utilization Project (HCUP), and the Pediatric Health Information System (PHIS) 13–19. However, their patient populations and procedures for data collection and validation are distinct and slightly different 3,20…”

Development of an Enhanced Recovery Program in Pediatric, Adolescent, and Young Adult Surgical Oncology Patients

“…The lack of ERAS-based protocols for pediatric cancer patients is an opportunity for improvement, considering the presence of surgical complications in this population. Gallaway et al found that 1 in 11 pediatric bone and soft tissue sarcoma surgical patients experienced complications within 30 days post-surgery, including wound dehiscence, surgical site infections, pneumonia, urinary tract infections, C. diff colitis, and unplanned readmissions related to the surgical procedure [ 10 ]. Additionally, 24% of patients in this study required blood transfusions due to excessive bleeding.…”

Investigating readmission rates for patients undergoing oncologic resection and endoprosthetic reconstruction for primary sarcomas and tumors involving bone

“…Investigations into this subject matter are lacking. Existing studies have relied upon national registries and claims databases 16–18 . While these sources allow for general implications, they lack the granularity necessary to parse out the nuances of readmission in this patient group 16–18 …”