Socioeconomic Disparities in Reception of Limb-Sparing Surgery Versus Amputation for Lower Extremity Sarcoma

• Published in: Journal of plastic, reconstructive & aesthetic surgery
• Main Authors: Kim, Dylan K., Kuonqui, Kevin, Dugue, David, Tyler, Wakenda K., Bogue, Jarrod T.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.10.2024
• Subjects: Amputation; Disparities; Limb salvage; Plastic surgery; Sarcoma; SEER; Plastic surgery; SEER; Disparities; Limb salvage; Sarcoma; Amputation
• ISSN: 1748-6815
• DOI: 10.1016/j.bjps.2024.10.005

In lower extremity sarcoma treatment, limb salvage approaches present superior alternatives to amputation due to reduced postoperative morbidity and improved quality of life. This study provides a novel analysis of socioeconomic disparities that may affect reception of limb-sparing surgery. Lower extremity bone or soft tissue sarcoma patients who received either limb-sparing surgery or amputation from 2007-2021 were identified in the Surveillance, Epidemiology and End Results (SEER) database. Demographic, socioeconomic, and oncologic variables were collected for each patient. Multivariate binary logistic regression was conducted to assess preoperative demographic and oncologic risk factors for amputation (p<0.05). 6,465 patients were identified in the final cohort, 586 (9.1%) of whom received amputation. After controlling for tumor size, stage, and neoadjuvant therapy administration, non-Hispanic American Indian/Alaskan Native race/ethnicity predicted the highest odds of amputation (OR: 1.78, 95% CI: 1.12-2.85, p=0.015). Non-metropolitan residence (OR: 1.69, 95% CI: 1.43-2.00, p<0.001) also conferred higher risk of amputation compared to residence in a large metropolitan area. Overall, amputation was associated with a higher risk of ten-year cancer-specific mortality (p<0.001) even when controlled by sociodemographic and clinical characteristics. There are significant disparities in limb-sparing surgery and amputation rates in lower extremity sarcoma management, even when accounting for differences in baseline oncologic characteristics. Further study into socioeconomic drivers of these trends will allow the development of initiatives that improve disparities in reconstructive outcomes.