title: Level-adjusted perioperative risk of sacral amputations.
abstract: OBJECTIVE
  Sacral amputations above the S2 body often involve increased surgical complexity leading to long-term morbidity. The purpose of this study was to determine whether proximal sacral amputations have substantially higher perioperative morbidity compared with more distal sacral amputations.
  
  
  METHODS
  We evaluated the effect of sacral amputation level on perioperative outcomes within 90 days of surgery. Outcome measures included blood loss, intensive care unit (ICU) and hospital stay, hospital cost, and incidence of a major and minor morbidity. Survival analyses were adjusted for the level of resection and histological appearance.
  
  
  RESULTS
  Thirteen proximal and 14 distal resections were performed. In comparing proximal versus distal resections, median estimated blood loss was 4 L versus 1 L (P < 0.001), ICU stay was 4 days versus 0 days (P = 0.012), hospital stay was 19 days versus 8 days (P = 0.001), hospital cost was 28,800 dollars versus 7,500 dollars (P = 0.003), with one or more major complications in 85% versus 29% (P = 0.011). Survival analysis demonstrated that the sacral resection level did not influence survival (P = 0.936), whereas the type of tumor did influence survival (P = 0.012).
  
  
  CONCLUSIONS
  Tumor resections above S2 demonstrate increased perioperative morbidity, suggesting that proximal osteotomies be reserved for patients with a realistic cure potential.
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8774, USA.
authors.forename: Clinton
authors.initials: C
authors.lastname: Devin
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Chong
authors.forename: Ginger E
authors.initials: GE
authors.lastname: Holt
authors.forename: Irene
authors.initials: I
authors.lastname: Feurer
authors.forename: Adriana
authors.initials: A
authors.lastname: Gonzalez
authors.forename: Nipun
authors.initials: N
authors.lastname: Merchant
authors.forename: Herbert S
authors.initials: HS
authors.lastname: Schwartz
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002817:Chordoma / Q000473:pathology / Q000601:surgery; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009361:Neoplasm Invasiveness; D010027:Osteotomy / Q000379:methods; D012306:Risk; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome