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Is There Value in Pathology Specimens in Routine Total Hip and Knee Arthroplasty?

Background Routine analysis of bone specimens in total joint arthroplasty (TJA) is mandatory at many institutions. The purpose of this study was to determine if mandatory routine TJA specimen analysis alters patient care or if they represent an unnecessary healthcare expenditure. Methods A retrospec...

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Autores principales: Koss, Justin, Goyette, David, Patel, Jay, Harrington, Colin J, Mazzei, Christopher, Wittig, James C, Dundon, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919613/
https://www.ncbi.nlm.nih.gov/pubmed/33659136
http://dx.doi.org/10.7759/cureus.13005
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author Koss, Justin
Goyette, David
Patel, Jay
Harrington, Colin J
Mazzei, Christopher
Wittig, James C
Dundon, John
author_facet Koss, Justin
Goyette, David
Patel, Jay
Harrington, Colin J
Mazzei, Christopher
Wittig, James C
Dundon, John
author_sort Koss, Justin
collection PubMed
description Background Routine analysis of bone specimens in total joint arthroplasty (TJA) is mandatory at many institutions. The purpose of this study was to determine if mandatory routine TJA specimen analysis alters patient care or if they represent an unnecessary healthcare expenditure. Methods A retrospective review was performed of all primary TJA patients between October 2015 and December 2017 at our institution. Pathology results were reviewed to ascertain the number of concordant, discrepant, and discordant results. A diagnosis was considered concordant if the preoperative and pathologic diagnosis matched, discrepant if the preoperative and pathological diagnosis differed but no change in the patient’s plan of care occurred, and discordant if the preoperative and pathologic diagnosis differed and resulted in a change in the patient’s plan of care.  Results 3,670 total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures (3,613 patients) met the inclusion criteria and were included in this study. All 3,670 specimens had a concordant diagnosis; there were zero discrepant and zero discordant diagnoses. During the study period, our institution spent $67,246.88 in routine analysis of TJA specimens by a pathologist, with no change in any postoperative patient care plans. Conclusion With bundled payment reimbursement models and hospitals trying to decrease unnecessary expenditures, the present study helps further demonstrate that routine analysis has limited cost-effectiveness due to the low prevalence of alteration in the management of patient care. The decision for pathological analysis should be left at the discretion of the surgeon in order to maximize the cost-efficiency of TJA procedures.
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spelling pubmed-79196132021-03-02 Is There Value in Pathology Specimens in Routine Total Hip and Knee Arthroplasty? Koss, Justin Goyette, David Patel, Jay Harrington, Colin J Mazzei, Christopher Wittig, James C Dundon, John Cureus Pathology Background Routine analysis of bone specimens in total joint arthroplasty (TJA) is mandatory at many institutions. The purpose of this study was to determine if mandatory routine TJA specimen analysis alters patient care or if they represent an unnecessary healthcare expenditure. Methods A retrospective review was performed of all primary TJA patients between October 2015 and December 2017 at our institution. Pathology results were reviewed to ascertain the number of concordant, discrepant, and discordant results. A diagnosis was considered concordant if the preoperative and pathologic diagnosis matched, discrepant if the preoperative and pathological diagnosis differed but no change in the patient’s plan of care occurred, and discordant if the preoperative and pathologic diagnosis differed and resulted in a change in the patient’s plan of care.  Results 3,670 total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures (3,613 patients) met the inclusion criteria and were included in this study. All 3,670 specimens had a concordant diagnosis; there were zero discrepant and zero discordant diagnoses. During the study period, our institution spent $67,246.88 in routine analysis of TJA specimens by a pathologist, with no change in any postoperative patient care plans. Conclusion With bundled payment reimbursement models and hospitals trying to decrease unnecessary expenditures, the present study helps further demonstrate that routine analysis has limited cost-effectiveness due to the low prevalence of alteration in the management of patient care. The decision for pathological analysis should be left at the discretion of the surgeon in order to maximize the cost-efficiency of TJA procedures. Cureus 2021-01-30 /pmc/articles/PMC7919613/ /pubmed/33659136 http://dx.doi.org/10.7759/cureus.13005 Text en Copyright © 2021, Koss et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Pathology
Koss, Justin
Goyette, David
Patel, Jay
Harrington, Colin J
Mazzei, Christopher
Wittig, James C
Dundon, John
Is There Value in Pathology Specimens in Routine Total Hip and Knee Arthroplasty?
title Is There Value in Pathology Specimens in Routine Total Hip and Knee Arthroplasty?
title_full Is There Value in Pathology Specimens in Routine Total Hip and Knee Arthroplasty?
title_fullStr Is There Value in Pathology Specimens in Routine Total Hip and Knee Arthroplasty?
title_full_unstemmed Is There Value in Pathology Specimens in Routine Total Hip and Knee Arthroplasty?
title_short Is There Value in Pathology Specimens in Routine Total Hip and Knee Arthroplasty?
title_sort is there value in pathology specimens in routine total hip and knee arthroplasty?
topic Pathology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919613/
https://www.ncbi.nlm.nih.gov/pubmed/33659136
http://dx.doi.org/10.7759/cureus.13005
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