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Lazarides AL, Flamant EM, Cullen MC, Ferlauto HR, Goltz DE, Cochrane NH, Visgauss JD, Brigman BE, Eward WC. Why Do Patients Undergoing Extremity Prosthetic Reconstruction for Metastatic Disease Get Readmitted? J Arthroplasty 2022; 37:232-237. [PMID: 34740789 DOI: 10.1016/j.arth.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/11/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Orthopedic oncology patients are particularly susceptible to increased readmission rates and poor surgical outcomes, yet little is known about readmission rates. The goal of this study is to identify factors independently associated with 90-day readmission for patients undergoing oncologic resection and subsequent prosthetic reconstruction for metastatic disease of the hip and knee. METHODS This is a retrospective comparative cohort study of all patients treated from 2013 to 2019 at a single tertiary care referral institution who underwent endoprosthetic reconstruction by an orthopedic oncologist for metastatic disease of the extremities. The primary outcome measure was unplanned 90-day readmission. RESULTS We identified 112 patients undergoing 127 endoprosthetic reconstruction surgeries. Metastatic disease was most commonly from renal (26.8%), lung (23.6%), and breast (13.4%) cancer. The most common type of skeletal reconstruction performed was simple arthroplasty (54%). There were 43 readmissions overall (33.9%). When controlling for confounding factors, body mass index >40, insurance status, peripheral vascular disease, and longer hospital length of stay were independently associated with risk of readmission (P ≤ .05). CONCLUSION Readmission rates for endoprosthetic reconstructions for metastatic disease are high. Although predicting readmission remains challenging, risk stratification presents a viable option for helping minimize unplanned readmissions. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Etienne M Flamant
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Mark C Cullen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Harrison R Ferlauto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Evans DR, Lazarides AL, Cullen MM, Somarelli JA, Blazer DG, Visguass JD, Brigman BE, Eward WC. Identifying Modifiable and Non-modifiable Risk Factors of Readmission and Short-Term Mortality in Chondrosarcoma: A National Cancer Database Study. Ann Surg Oncol 2021; 29:1392-1408. [PMID: 34570333 DOI: 10.1245/s10434-021-10802-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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 90 days 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. CONCLUSIONS Several tumor, treatment, and patient factors can help inform the risk of readmission and short-term mortality in patients with surgically treated chondrosarcoma.
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Affiliation(s)
| | | | | | - Jason A Somarelli
- Duke Cancer Institute, Duke University Hospital, Durham, NC, USA.,Department of Medicine, Duke University Hospital, Durham, NC, USA
| | - Dan G Blazer
- Duke Cancer Institute, Duke University Hospital, Durham, NC, USA.,Department of Surgery, Duke University Hospital, Durham, NC, USA
| | - Julia D Visguass
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.,Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.,Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.,Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
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