Preoperative albumin is associated with unplanned readmission following soft tissue sarcoma resection

Introduction: Treatment of soft tissue sarcomas (STS) revolves around surgical resection. Post-operative readmission is common and is associated with patient morbidity and increased healthcare costs. This study sought to identify risk factors for unplanned readmission and quantify the cost of such events. Experimental Procedures: Extremity STS patients who underwent resection from 2018 to 2022 at a tertiary referral center were included. Demographics, comorbidities, tumor characteristics, treatment, and surgical findings were collected. Postoperative complications, readmissions, local recurrence, reoperations, and disease-specific survival were also obtained. Risk factors for readmission were evaluated via Pearson correlation testing. Binomial logistic regression modeling was subsequently utilized for variables with p-values < 0.2. Results: Among 131 patients (mean follow-up 21 ± 10 months), overall postoperative complication rate was 36%, local recurrence rate was 9%, reoperation rate was 20%, and disease-specific survival rate was 96%. Unplanned readmission occurred in 32% of patients at a mean of 19 days after discharge (Range: 6-121). ASA class, preoperative hemoglobin, preoperative albumin, and complications during the index hospitalization were significantly associated with readmission. After multivariate analysis, preoperative serum albumin remained independently associated with unplanned readmission (OR = 0.077; 95% CI = 0.005, 0.15). Mean readmission cost was $76,605.39 (Standard Deviation: $101,981.78). Conclusions: Unplanned readmission after STS resection is common and is associated with substantial financial burden. Low preoperative serum albumin is associated with increased readmission risk, underscoring the potential value of preoperative nutritional optimization and intervention. Studies with larger patient cohorts and additional nutritional markers are needed. Patient Characteristics and their Associations with Unplanned Readmission Demographics and Comorbidities P-value Age (years), Mean (SD) 61 (16) 0.92 Male, n (%) 61 (54) 0.21 BMI (kg/m 2 ), Mean (SD) 28 (6.4) 0.19 Diabetes Mellitus, n (%) 21 (19) 0.10 COPD, n (%) 10 (9.2) 0.14 Osteoporosis, n (%) 10 (9.2) 0.26 ASA Class, Mean (SD) 2.6 (0.6) 0.0009 Preoperative Serum and Tumor Metrics P-value Hemoglobin (g/dL), Mean (SD) 12.7 (1.79) 0.03 Albumin (g/dL), Mean (SD) 4.02 (0.681) 0.001 Tumor Location - Proximal Lower Extremity, n (%) 73 (64) 0.16 FNCLCC Grade (1/2/3), n (%) 15 (13)/34 (30)/63 (57) 0.25 Tumor Size (cm), Mean (SD) 10.0 (1.5-40) 0.01 Treatment and Surgical Metrics P-value Preoperative Radiation, n (%) 61 (54) 0.14 OR Time (minutes), Mean (SD) 468 (306) 0.05 Estimated Blood Loss (mL), Mean (SD) 172 (516) 0.05 Hospital LOS (days), Mean (SD) 4.3 (5.6) 0.05 Complications During Operative Hospitalization, n (%) 17 (15) 0.03 Independent Risk Factors of Unplanned Readmission Following Multivariate Analysis OR (95% CI) P-value Preoperative Serum Albumin 0.077 (0.005, 0.15) 0.03 Diabetes Mellitus 1.4 (0.70, 2.1) 0.12 Preoperative Radiation 9 (0.98, 17.02) 0.07