Sacral tumor resection: the effect of surgical staging on patient outcomes, resource management, and hospital cost.
METHODS
Single-institution retrospective study.


OBJECTIVE
To assess the effect surgical staging (i.e., sequencing) has on clinical and economic outcomes for patients undergoing sacropelvic tumor resection requiring lumbopelvic stabilization.


BACKGROUND
Sacral corpectomy with lumbopelvic stabilization is an extensive surgical procedure that can be performed in either a single episode or multiple episodes of care on different days. The impact of varied sequencing of surgical episodes of care on patient, resource, and financial outcomes is unknown.


METHODS
This single-center retrospective case series identified all cases of sacropelvic tumor resection requiring lumbopelvic stabilization over an 8-year period. We assessed and compared clinical and economic outcomes for patients whose anterior exposure and posterior resection were separated into two distinct surgical episodes of care (staged) versus patients whose anterior exposure and posterior resection occurred in a single encounter (nonstaged procedures). Primary endpoints included procedural outcomes (operative and after-hours surgical time), resuscitative requirements, adverse perioperative events, mortality, and direct medical costs (hospital and physician) associated with the surgical episodes of interest.


RESULTS
From January 1, 2000, to July 15, 2008, a total of 25 patients were identified. Eight patients had their procedure staged. Surgical staging was associated with a significant increase in intensive care unit free days (P = 0.03), ventilator free days (P < 0.01), and reduced morbidity (P < 0.01). Surgical staging significantly reduced postoperative red blood cell (P = 0.03), and after-hours red blood cell (P < 0.01) and component requirements (P = 0.04). Mean total inpatient costs were $89,132 lower for patients undergoing the staged procedure (95% confidence interval of mean cost difference = -$178,899 to -$4661).


CONCLUSIONS
Separating the anterior exposure and posterior resection phases of complex sacral tumor resection into two separate surgical episodes of care is associated with improved clinical outcomes and reduced inpatient cost.
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. brown.michael3@mayo.edu
Michael J
MJ
Brown
Daryl J
DJ
Kor
Timothy B
TB
Curry
Matthew A
MA
Warner
Eduardo S
ES
Rodrigues
Steven H
SH
Rose
Mark B
MB
Dekutoski
James P
JP
Moriarty
Kirsten Hall
KH
Long
Peter S
PS
Rose
D000328:Adult; D003362:Cost-Benefit Analysis; D004906:Erythrocyte Count; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019637:Orthopedic Procedures / Q000191:economics* / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010388:Pelvis / Q000601:surgery; D012189:Retrospective Studies; D012447:Sacrum / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult