title: The financial burden of reexcising incompletely excised soft tissue sarcomas: a cost analysis.
abstract: BACKGROUND
  Although survival outcomes have been evaluated between those undergoing a planned primary excision and those undergoing a reexcision following an unplanned resection, the financial implications associated with a reexcision have yet to be elucidated.
  
  
  METHODS
  A query for financial data (professional, technical, indirect charges) for soft tissue sarcoma excisions from 2005 to 2008 was performed. A total of 304 patients (200 primary excisions and 104 reexcisions) were identified. Wilcoxon rank sum tests and χ2 or Fisher's exact tests were used to compare differences in demographics and tumor characteristics. Multivariable linear regression analyses were performed with bootstrapping techniques.
  
  
  RESULTS
  The average professional charge for a primary excision was $9,694 and $12,896 for a reexcision (p<.001). After adjusting for tumor size, American Society of Anesthesiologists status, grade, and site, patients undergoing reexcision saw an increase of $3,699 in professional charges more than those with a primary excision (p<.001). Although every 1-cm increase in size of the tumor results in an increase of $148 for a primary excision (p=.006), size was not an independent factor in affecting reexcision charges. The grade of the tumor was positively associated with professional charges of both groups such that higher-grade tumors resulted in higher charges compared to lower-grade tumors (p<.05).
  
  
  CONCLUSIONS
  Reexcision of an incompletely excised sarcoma results in significantly higher professional charges when compared to a single, planned complete excision. Additionally, when the cost of the primary unplanned surgery is considered, the financial burden nearly doubles.
authors: Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
authors: Vignesh K
authors: VK
authors: Alamanda
authors: Gadini O
authors: GO
authors: Delisca
authors: Shannon L
authors: SL
authors: Mathis
authors: Kristin R
authors: KR
authors: Archer
authors: Jesse M
authors: JM
authors: Ehrenfeld
authors: Mark W
authors: MW
authors: Miller
authors: Kelly C
authors: KC
authors: Homlar
authors: Jennifer L
authors: JL
authors: Halpern
authors: Herbert S
authors: HS
authors: Schwartz
authors: Ginger E
authors: GE
authors: Holt
mesh_terms: D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D012086:Reoperation / Q000191:economics*; D012189:Retrospective Studies; D012509:Sarcoma / Q000191:economics* / Q000473:pathology / Q000601:surgery*