TITLE:
Mortality and Morbidity Following Surgery for Primary Malignant Musculoskeletal Tumors in the Pelvis and Limbs: A Retrospective Analysis Using the Japanese Diagnosis Procedure Combination Database
AUTHORS:
Toru Akiyama, Kazuo Saita, Hirotaka Chikuda, Hiromasa Horiguchi, Kiyohide Fushimi, Hideo Yasunaga
KEYWORDS:
Musculoskeletal Tumor Resection, Sarcoma, Pelvic Tumor, Postoperative Complication, Japanese Diagnosis Procedure Combination Database
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.4,
April
28,
2016
ABSTRACT: Introduction: Resection of malignant pelvic tumors has long been
considered to be associated with higher postoperative mortality and morbidity
than resection of malignant limb tumors. We compared the postoperative adverse
events of pelvic tumor surgery and limb tumor surgery using a national
inpatient database. Methods: We identified patients who underwent surgery for
primary musculoskeletal malignant tumors of the pelvis or limbs between July
and December in 2007- 2010 using the Japanese Diagnosis Procedure Combination
inpatient database. We calculated the risk-adjusted odds ratio for the occurrence
of postoperative complications following pelvic tumor surgery with reference to
limb tumor surgery using a multivariable logistic regression analysis. Results:
Of 3255 eligible patients, 3116 underwent limb tumor surgery and 139 underwent
pelvic tumor surgery. In-hospital mortality was 0.6% and 0.7% and postoperative
complication rates were 8.2% and 18.7%, respectively. The rate of blood
transfusion and duration of anesthesia over 480 min were higher in the pelvic
tumor group. Blood transfusion volume and duration of anesthesia were
independently associated with worse outcomes, but there was no significant
association between tumor location and occurrence of postoperative
complications (odds ratio 1.18, 95% confidence interval 0.73 - 1.88, p = 0.502).
Conclusions: Blood transfusion volume and duration of anesthesia were
significant predictors of outcome. Our data demonstrate that the higher morbidity
rate after pelvic tumor resection could result from the larger blood
transfusion volume and longer anesthesia duration.