Introduction: Surgical treatment for soft tissue sarcoma has evolved significantly. Historically, extremities with sarcomas were amputated. Aggressive tumor resection with wide margins is now routinely performed as reconstructive microsurgery has made limb preservation a reality. Occasionally, resection eliminates crucial limb functions such as joint motion, elbow, wrist, or ankle extension/flexion that then requires functional reconstruction with innervated muscles, tendon transfers, or alloplastic joint replacement. In this study, the costs associated with functional restoration surgery were compared to those surgeries requiring only soft tissue replacement.

Methods: Between December 1998 and July 2002, 69 patients underwent limb-preservation surgery for extremity sarcomas at our medical center (48 lower extremity, 23 upper extremity). 15 patients required functional restoration in 15 limbs (8 upper, 7 lower extremity), and 54 limbs required only soft tissue replacement. We analyzed the lengths of stay (ICU and hospital) and the charges associated with their illness and surgeries (total charges, routine charges, hospital, operating room, pharmacy, radiology, laboratory, medial supplies, physical therapy, and other miscellaneous services). Complexity level adjustment was performed to minimize population differences between the two groups.

Results: There was an increased cost associated with functional restoration surgery for both the upper and lower extremities. The total cost associated with upper extremity functional restoration surgery was $10,357.00 more than soft tissue-only reconstruction ($21,055.38 vs. $10,698.38). Similarly, the total cost associated with lower extremity functional restoration was $8,271.05 higher: ($27,372.71 vs. $19,101.66). In the upper extremity subgroup, statistical significance was seen in the length of stay, postoperative days, total charges, routine charges, OR charges, lab charges, supply charges, therapy charges and other charges. In the lower extremity subgroup, statistical significance was seen in the total charges, supply charges and therapy charges. Analysis of their function using the Toronto Extremity Salvage Score showed a score of 0.83 (0= impossible to do, 1=no difficulty), indicating only a little difficulty with their activities of daily living.

Conclusion: This study demonstrates that costs are higher with functional restoration surgery. For the upper extremity reconstruction, this was due to the increased lengths of stay, routine charges, operating room charges, lab charges, supplies, and therapy charges. For the lower extremity reconstruction, this was due to increased supply and physical therapy charges. Despite being more costly, we feel that functional restoration is an important component in limb preservation surgery for extremity sarcomas and should be performed whenever necessary.