Purpose: Patients with soft tissue sarcomas (STS) of the extremity require ongoing follow-up to detect treatment failures. There is a significant variation in follow-up schemes among sarcoma specialists due to a lack of evidence. Methods: A retrospective single-center review was performed on all patients with a minimum 1-year follow-up after resection of a localized STS, utilizing a prospectively collected database. Kaplan-Meier curves were used to calculate the incidence of local recurrence and metastases on an annual basis over 10 years. Results: There were 407 patients who met the inclusion criteria. Considering the annual incidence of local recurrence and distant metastasis per STS size and grade, patients with small, low-grade STS should be followed yearly for 10 years. Patients with small, intermediate/high-grade STS and those with large, low-grade STS should be followed every 6 months for the first 2 years and then yearly until 10 years postoperatively. Patients with large, intermediate/high-grade STS should be followed every 3 months for the first 2 years and then every 6 months thereafter until 10 years postoperatively. Conclusion Compared to National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines, our proposed scheme has the potential to reduce hospital visits, mainly for patients with small intermediate and high-grade tumors. This protocol validates the previously published scheme, despite being relatively more conservative.

STUDY DESIGN: Retrospective cohort study. PURPOSE: The purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect on complication rates. OVERVIEW OF LITERATURE: Cervical spine fusions have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion from 2010 to 2013. Multivariate regression analysis was used to determine postoperative complications associated with transfusion and cervical fusion. RESULTS: We identified 11,588 patients who had cervical fusion between 2010 and 2013. The rate of blood transfusion following cervical fusion found to be 1.47%. All transfused patients were found to have increased risk of venous thromboembolism (TBE) (odds ratio [OR], 3.19; 95% confidence interval [95% CI], 1.16–8.77), myocardial infarction (MI) (OR, 9.12; 95% CI, 2.53–32.8), increased length of stay (LOS) (OR, 28.03; 95% CI, 14.28–55.01) and mortality (OR, 4.14; 95% CI, 1.44–11.93). Single level fusion had increased risk of TBE (OR, 3.37; 95% CI, 1.01–11.33), MI (OR, 10.5; 95% CI, 1.88–59.89), and LOS (OR, 14.79; 95% CI, 8.2–26.67). Multilevel fusion had increased risk of TBE (OR, 5.64; 95% CI, 1.15–27.6), surgical site infection (OR, 16.29; 95% CI, 3.34–79.49), MI (OR, 10.84; 95% CI, 2.01–58.55), LOS (OR, 26.56; 95% CI, 11.8–59.78), and mortality (OR, 10.24; 95% CI, 2.45–42.71). Patients who had anterior cervical discectomy and fusion surgery and received a transfusion had an increased risk of TBE (OR, 4.87; 95% CI, 1.04–22.82), surgical site infection (OR, 9.73; 95% CI, 2.14–44.1), MI (OR, 9.88; 95% CI, 1.87–52.2), increased LOS of more than 2 days (OR, 28.34; 95% CI, 13.79–58.21) and increase in mortality (OR, 6.3; 95% CI, 1.76–22.48). While, transfused patients who had posterior fusion surgery had increased risk of MI (OR, 10.45; 95% CI, 1.42–77.12) and increased LOS of more than 6 days (OR, 4.42; 95% CI, 2.68–7.29). CONCLUSIONS: Our results demonstrate that although cervical fusions can be done as outpatient procedures special precautions and investigations should be done for patients who receive transfusion after cervical fusion. These patients are demonstrated to have higher rate of MI, TBE, wound infection and mortality when compared to those who do not receive transfusion.
Blood Transfusion ; Cohort Studies ; Diskectomy ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Outpatients ; Postoperative Complications ; Prevalence* ; Quality Improvement* ; Retrospective Studies ; Spine* ; Surgeons* ; Surgical Wound Infection ; Venous Thromboembolism ; Wound Infection