COMPLICATIONS AND COST ANALYSIS OF HEMIPELVECTOMY FOR THE TREATMENT OF PELVIC TUMORS

ABSTRACT Objective: Hemipelvectomy is a complex surgery with a high complication rate. Here, we aimed to identify factors related to the onset of complications and calculate their impacts on hospital costs. Methods: We evaluated 31 consecutive patients who underwent hemipelvectomy between 1999 and 2015. We assessed the clinical and radiographic data to determine the patients’ demographic factors, tumor and surgical characteristics, and complications. The individual hospital stays and financial balances were assessed up to 6 months following the index surgery. Results: The overall complication rate was 61% (19/31). Infection was the most prevalent complication (36%). Immediate postoperative death occurred in 5/31 patients (16%); another 5 (16%) died after hospital discharge due to disease progression. Histological grade, previous surgery, and previous radiotherapy were not associated with complications or infection. Acetabular resections, bone reconstruction, and longer operative times were associated with infection, whereas older age, pelvic organ involvement, and comorbidities were associated with immediate postoperative death. Complications and infection were associated with 4.8- and 5.9-fold increases in hospital costs, respectively. Conclusions: Acetabular resection and bone reconstruction are important factors that increase short-term complication rates, infection rates, and hospital costs. Mortality was associated with older age and adjacent pelvic tumor progression. Level of Evidence: IV, case series.摘要 研究目的：半骨盆切除术是一类操作复杂的手术，术后并发症发生率较高。本研究旨在明确与并发症发生相关的影响因素，并量化其对住院费用的影响。方法：本研究回顾性分析了1999年至2015年间接受半骨盆切除术的31例连续病例。通过梳理患者的临床及影像学资料，对其人口统计学特征、肿瘤与手术相关特征以及并发症发生情况进行评估；同时追踪随访至首次术后6个月，统计患者单次住院时长及财务收支情况。结果：本研究队列总并发症发生率为61%（19/31），其中感染为最常见的并发症（占比36%）。31例患者中5例（16%）发生术后即刻死亡，另有5例（16%）在出院后因疾病进展死亡。组织学分级、既往手术史及既往放疗史与并发症或感染的发生均无显著关联。髋臼切除术、骨重建术及更长的手术时长与感染发生相关；而高龄、盆腔脏器受累及合并症则与术后即刻死亡风险升高相关。并发症及感染分别使住院费用升高4.8倍和5.9倍。结论：髋臼切除术与骨重建术是提升短期并发症发生率、感染发生率及住院费用的重要危险因素。患者死亡风险与高龄及盆腔邻近肿瘤进展相关。证据等级：IV级，病例系列研究。