title: Unplanned excision of soft tissue sarcoma: the impact of the referring hospital.
abstract: BACKGROUND
  Unplanned excision of soft tissue sarcoma (STS) remains a common problem performed at various levels of hospitals, where clinical characteristics may differ. However, there is little literature describing the impact of the referring hospital on patient characteristics and/or outcome in unplanned excision of STS. This study examined the possible different patient characteristics and prognoses according to the level of referring hospitals where unplanned excision was performed.
  
  
  METHODS
  Patients referred to our institute after unplanned excision of STS on their extremities were reviewed. Referring hospitals were categorized into two groups according to their referral grades; tertiary hospitals (general hospitals with tertiary [highest] referral grade, n = 42) and non-tertiary hospitals (others, n = 79).
  
  
  RESULTS
  Patients referred from tertiary hospitals had significantly larger number of high-grade tumors (p = 0.019) but lower chance of finding a residual tumor at re-excision (p = 0.020) than non-tertiary hospitals. For oncological outcomes, referral from tertiary hospital was an independent factor for better local control (hazard ratio, 0.211; 95% confidence interval, 0.061-0.730). However, there was no difference in disease-specific death (p = 0.729) or metastasis (p = 0.978) between the two groups.
  
  
  CONCLUSIONS
  Despite having worse clinicopathologic characteristics, patients referred from tertiary hospitals had fewer local recurrences than patients from non-tertiary hospitals. The impact of the referring hospital on patient outcome and disease characteristics needs to be considered in unplanned excision of STS.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110-744, Republic of Korea. ziozio79@daum.net
authors.forename: Seungcheol
authors.initials: S
authors.lastname: Kang
authors.forename: Ilkyu
authors.initials: I
authors.lastname: Han
authors.forename: Sang A
authors.initials: SA
authors.lastname: Lee
authors.forename: Hwan Seong
authors.initials: HS
authors.lastname: Cho
authors.forename: Han-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D006801:Humans; D012017:Referral and Consultation; D012509:Sarcoma / Q000601:surgery*