215 - National Patterns and Determinants of Limb Salvage versus Amputation in Pediatric Osteosarcoma: Insights from the HCUP Kids’ Inpatient Database

Publication Number: 1204.215

Helen Xie, Icahn School of Medicine at Mount Sinai, New York City, NY, United States; Sheena Ranade, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Ryan G.. Smolarsky, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: Limb-salvage surgery (LSS) has largely replaced amputation in osteosarcoma management, but pediatric-specific national data on hospital characteristics, regional variation, and socioeconomic factors influencing surgical choice remain limited. Existing registry studies lack information on hospital type, cost, and geography, preventing a health-systems understanding of surgical disparities.

Objective: To evaluate national trends and determinants of LSS versus amputation among pediatric osteosarcoma hospitalizations.

Design/Methods: A retrospective cross-sectional analysis of the 2016-2022 Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) identified patients aged ≤20 years with a primary diagnosis of osteosarcoma undergoing amputation (ICD-10-PCS 0Y6*) or LSS (0QB*, 0QR*, 0SR*, 0SG*). Race, primary payer, and ZIP-code income quartile were used as SES proxies; hospital-level variables included region, bed size, teaching status, and children's hospital designation. Weighted chi-squared and t-tests compared covariates. Multivariable logistic regression determined independent predictors of LSS, reporting adjusted odds ratios (aOR) and 95% confidence intervals (CI); p< 0.05 was considered significant.

Results: Among 2,100 weighted pediatric osteosarcoma hospitalizations, 1,812 (88.6%) underwent LSS and 233 (11.4%) amputation. LSS patients had higher mean hospital charges ($223,429 vs $119,567, p< 0.001) but similar length of stay (7.8 vs 6.6 days, p=0.92). LSS utilization was highest in the Northeast (94.3%) and lowest in the Midwest (84.8%, p=0.032). In adjusted analysis, higher household income predicted LSS (aOR 1.29, 95% CI 1.09-1.53, p=0.003), while treatment in the South was associated with lower odds (aOR 0.86, 95% CI 0.76-0.97, p=0.017). No independent racial or payer disparities were observed. Among LSS cases, resection-only (45.2%) and prosthetic replacement (23.8%) were the most frequent subtypes, differing significantly by hospital type (p=0.003).

Conclusion(s): LSS utilization predominates in pediatric osteosarcoma; however, socioeconomic disparities persist. Patients from higher-income areas had significantly greater odds of receiving limb-salvage procedures, highlighting continued inequities in access to advanced surgical care.

Individual characteristics of patients undergoing limb salvage surgery (LSS) versus amputation, 2016-2022


Characteristics of hospitals performing limb salvage surgery (LSS) versus amputation, 2016-2022


Multivariable logistic regression model identifying socioeconomic and institutional predictors of limb salvage surgery (LSS) utilization versus amputation
Covariates in the multivariable analysis included age, sex, LOS, and total hospital charges.
P value > 0.05 indicates statistical significance.