title: Cost analysis of functional restoration surgery for extremity soft-tissue sarcoma.
abstract: BACKGROUND
  Limb-sparing surgery, consisting of wide-margin tumor resection and preoperative or postoperative radiotherapy/chemotherapy, has become the surgical treatment of choice for extremity sarcomas. However, adequate tumor resection can sometimes compromise crucial limb function, necessitating functional restoration surgery. The purpose of this study was to determine the cost impact and functional outcomes of such procedures.
  
  
  METHODS
  Patients receiving either functional restoration surgery or soft-tissue-only reconstruction following extremity soft-tissue sarcoma excision were identified. Patients were then compared along several dimensions: overall length of stay and its subdivisions, surgical time, and total charges and its subdivisions. Patients' functional outcomes were assessed with the Toronto Extremity Salvage Score.
  
  
  RESULTS
  Sixty-seven patients who underwent 69 limb-sparing procedures were identified. Fifteen of these procedures (eight upper extremity, seven lower extremity) required functional restoration surgery; 54 of these procedures (13 upper extremity, 41 lower extremity) required only soft-tissue coverage. In the upper extremity, there was a statistically significant increase in overall length of stay (2.8 days) and its subdivisions, surgical time (3.7 hours), and total charges (12,484 dollars) and its subdivisions associated with performing functional restoration surgery. In lower extremity cases, statistically significant increases were determined in only the total charges (9190 dollars) and medical supply charges (13,204 dollars) following functional restoration. Patients who underwent functional restoration surgery had better postoperative function (mean Toronto Extremity Salvage Score, 82 versus 80), but this difference was not statistically significant.
  
  
  CONCLUSIONS
  Although functional restoration surgery is more costly than soft-tissue reconstruction alone, the authors believe that the associated better functional outcome justifies its performance.
authors.affiliation: Division of Plastic Surgery, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nelson
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Frassica
authors.forename: Toby A
authors.initials: TA
authors.lastname: Gordon
authors.forename: E Gene
authors.initials: EG
authors.lastname: Deune
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005121:Extremities; D005260:Female; D018219:Histiocytoma, Benign Fibrous / Q000601:surgery; D006801:Humans; D007890:Leiomyosarcoma / Q000601:surgery; D007902:Length of Stay; D008080:Liposarcoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D020127:Recovery of Function; D012509:Sarcoma / Q000191:economics / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000191:economics / Q000601:surgery*; D013524:Surgical Flaps / Q000191:economics*; D014481:United States