title: Incomplete excisions of extremity soft tissue sarcomas are unaffected by insurance status or distance from a sarcoma center.
abstract: BACKGROUND
  Soft tissue sarcomas (STS) continue to be excised inappropriately without proper preoperative planning. The reasons for this remain elusive. The role of insurance status and patient distance from sarcoma center in influencing such inappropriate excisions were examined in this study.
  
  
  METHODS
  This retrospective review of a single institution prospective database evaluated 400 patients treated for STS of the extremities between January 2000 and December 2008. Two hundred fifty three patients had a primary excision while 147 patients underwent re-excision. Wilcoxon rank sum test and either χ(2) or Fisher's exact were used to compare variables. Multivariable regression analyses were used to take into account potential confounders and identify variables that affected excision status.
  
  
  RESULTS
  Tumor size, site, depth, stage, margins, and histology were significantly different between the primary excision and re-excision groups; P < 0.05. Insurance status and patient distance from the treatment center were not statistically different between the two groups. Large and deep tumors and certain histology types predicted appropriate referral.
  
  
  CONCLUSIONS
  Inappropriate excision of STS is not influenced by patient distance from a sarcoma center or by a patient's insurance status. In this study, tumor size, depth, and certain histology types predicted the appropriate referral of a STS to a sarcoma center.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Vignesh K
authors.initials: VK
authors.lastname: Alamanda
authors.forename: Gadini O
authors.initials: GO
authors.lastname: Delisca
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.forename: Yanna
authors.initials: Y
authors.lastname: Song
authors.forename: Herbert S
authors.initials: HS
authors.lastname: Schwartz
authors.forename: Ginger E
authors.initials: GE
authors.lastname: Holt
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000473:pathology / Q000601:surgery; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007866:Leg / Q000473:pathology / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D014481:United States
keywords: insurance status; patient distance; soft tissue sarcoma; unplanned excision and incomplete excision of STS