Comparison of Postoperative Rehabilitation in Cancer Patients Undergoing Internal and External Hemipelvectomy

Guo Y, Fu J, Palmer JL, Hanohano J, Cote C, Bruera E. Comparison of postoperative rehabilitation in cancer patients undergoing internal and external hemipelvectomy.ObjectiveTo compare postoperative rehabilitation, functional outcome, and pain management in cancer patients who underwent an internal hemipelvectomy versus an external hemipelvectomy.DesignRetrospective study.SettingTertiary cancer center.ParticipantsPatients (N=60) who underwent a hemipelvectomy between February 1996 and November 2005 were included in this study (30 internal hemipelvectomy patients and 30 external hemipelvectomy patients).InterventionsNot applicable.Main Outcome MeasuresHospital and rehabilitation length of stay (LOS), percentage of physiatrist consultation and inpatient rehabilitation, functional status of transfers and ambulation, and pain medication utilization.ResultsThe rate of physiatrist consultation and acute rehabilitation admission were 15 (50%) of 30 and 13 (43%) of 30 for internal hemipelvectomy patients, and 16 (53%) of 30 and 16 (53%) of 30 for external hemipelvectomy patients. Median hospital LOS for external hemipelvectomy patients (37d) was significantly longer than for internal hemipelvectomy patients (19d) (P=0.004); median rehabilitation LOS was similar in both groups (20d for external hemipelvectomy patients versus 22 for internal hemipelvectomy patients; P=0.83). On discharge, 14 (47%) of 30 internal hemipelvectomy patients could ambulate without assistance, whereas only 5 (17%) of 30 external hemipelvectomy patients could do so (P=0.013). The median morphine equivalent daily dose at discharge for external hemipelvectomy patients (150mg) was significantly higher than that for internal hemipelvectomy patients (45mg) (P=0.032).ConclusionsA similar percentage of internal hemipelvectomy and external hemipelvectomy patients were admitted to inpatient rehabilitation. External hemipelvectomy patients had longer hospital LOS, less favorable functional outcome, and required more intense treatment for pain.