The Financial burden of reexcising incompletely excised soft tissue sarcomas: A cost analysis

Vignesh K. Alamanda, Gadini O. Delisca, Shannon L. Mathis, Kristin R. Archer, Jesse M. Ehrenfeld, Mark W. Miller, Kelly Cornett Homlar, Jennifer L. Halpern, Herbert S. Schwartz, Ginger E. Holt

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20 Citations (Scopus)

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 χ 2 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.

Original languageEnglish (US)
Pages (from-to)2808-2814
Number of pages7
JournalAnnals of Surgical Oncology
Volume20
Issue number9
DOIs
StatePublished - Sep 1 2013

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Sarcoma
Costs and Cost Analysis
Neoplasms
Nonparametric Statistics
Linear Models
Regression Analysis
Demography
Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Alamanda, V. K., Delisca, G. O., Mathis, S. L., Archer, K. R., Ehrenfeld, J. M., Miller, M. W., ... Holt, G. E. (2013). The Financial burden of reexcising incompletely excised soft tissue sarcomas: A cost analysis. Annals of Surgical Oncology, 20(9), 2808-2814. https://doi.org/10.1245/s10434-013-2995-5

The Financial burden of reexcising incompletely excised soft tissue sarcomas : A cost analysis. / Alamanda, Vignesh K.; Delisca, Gadini O.; Mathis, Shannon L.; Archer, Kristin R.; Ehrenfeld, Jesse M.; Miller, Mark W.; Homlar, Kelly Cornett; Halpern, Jennifer L.; Schwartz, Herbert S.; Holt, Ginger E.

In: Annals of Surgical Oncology, Vol. 20, No. 9, 01.09.2013, p. 2808-2814.

Research output: Contribution to journalArticle

Alamanda, VK, Delisca, GO, Mathis, SL, Archer, KR, Ehrenfeld, JM, Miller, MW, Homlar, KC, Halpern, JL, Schwartz, HS & Holt, GE 2013, 'The Financial burden of reexcising incompletely excised soft tissue sarcomas: A cost analysis', Annals of Surgical Oncology, vol. 20, no. 9, pp. 2808-2814. https://doi.org/10.1245/s10434-013-2995-5
Alamanda VK, Delisca GO, Mathis SL, Archer KR, Ehrenfeld JM, Miller MW et al. The Financial burden of reexcising incompletely excised soft tissue sarcomas: A cost analysis. Annals of Surgical Oncology. 2013 Sep 1;20(9):2808-2814. https://doi.org/10.1245/s10434-013-2995-5
Alamanda, Vignesh K. ; Delisca, Gadini O. ; Mathis, Shannon L. ; Archer, Kristin R. ; Ehrenfeld, Jesse M. ; Miller, Mark W. ; Homlar, Kelly Cornett ; Halpern, Jennifer L. ; Schwartz, Herbert S. ; Holt, Ginger E. / The Financial burden of reexcising incompletely excised soft tissue sarcomas : A cost analysis. In: Annals of Surgical Oncology. 2013 ; Vol. 20, No. 9. pp. 2808-2814.
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AU - Alamanda, Vignesh K.

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AU - Mathis, Shannon L.

AU - Archer, Kristin R.

AU - Ehrenfeld, Jesse M.

AU - Miller, Mark W.

AU - Homlar, Kelly Cornett

AU - Halpern, Jennifer L.

AU - Schwartz, Herbert S.

AU - Holt, Ginger E.

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N2 - 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 χ 2 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.

AB - 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 χ 2 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.

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