Cargando…

Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy

BACKGROUND: Routine submission of pathologic specimens for histologic analysis following orthopedic surgery is a common and often required practice in the United States. Prior orthopedic studies have determined that these histologic examinations are of limited cost effectiveness and low clinical val...

Descripción completa

Detalles Bibliográficos
Autores principales: Burgess, Colin, Petrone, Brandon, Matai, Prashant, Cohn, Randy, Bitterman, Adam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697194/
https://www.ncbi.nlm.nih.gov/pubmed/35097363
http://dx.doi.org/10.1177/2473011419900882
_version_ 1784619994541195264
author Burgess, Colin
Petrone, Brandon
Matai, Prashant
Cohn, Randy
Bitterman, Adam
author_facet Burgess, Colin
Petrone, Brandon
Matai, Prashant
Cohn, Randy
Bitterman, Adam
author_sort Burgess, Colin
collection PubMed
description BACKGROUND: Routine submission of pathologic specimens for histologic analysis following orthopedic surgery is a common and often required practice in the United States. Prior orthopedic studies have determined that these histologic examinations are of limited cost effectiveness and low clinical value because rarely do the pathology findings alter patient management. The purpose of this study was to evaluate the cost effectiveness and clinical significance of routine histologic examination of tissue specimens removed during ankle arthroscopy. METHODS: Between 2014 and 2018, 408 patients underwent ankle arthroscopy at a multi-center hospital system by 16 different orthopedic surgeons. The available pathology reports from these cases were retrospectively reviewed to determine if the routine histologic examination altered patient care. We compared the preoperative diagnosis to both the postoperative and histologic diagnoses. The total cost for these histologic examinations was estimated using 2017 Medicare physician fees released by the College of American Pathologists. Cost-effectiveness was estimated in 2017 US dollars by cost per discrepant and discordant diagnosis. RESULTS: Of the 408 patients who underwent ankle arthroscopy, 361 pathology reports were available for review. The prevalence of concordant diagnosis was 98.9% (357/361); the prevalence of discrepant diagnoses was 1.0% (4/361). There were no cases identified with a discordant diagnosis. Total estimated cost for all pathology specimens was $46 381 in 2017 US dollars. Cost per discrepant diagnosis was $11 595. CONCLUSION: In our study, histologic examination of surgical specimens following ankle arthroscopy had no effect on patient management, yet it increased costs. Routine examination of these pathologic specimens had a low rate of discrepant and/or discordant diagnoses. Based on our results, routine pathologic examination of ankle arthroscopy tissue specimens should be sent solely at the discretion of the orthopedic surgeon as opposed to being a mandated policy. LEVEL OF EVIDENCE: Level IV, case series.
format Online
Article
Text
id pubmed-8697194
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-86971942022-01-28 Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy Burgess, Colin Petrone, Brandon Matai, Prashant Cohn, Randy Bitterman, Adam Foot Ankle Orthop Article BACKGROUND: Routine submission of pathologic specimens for histologic analysis following orthopedic surgery is a common and often required practice in the United States. Prior orthopedic studies have determined that these histologic examinations are of limited cost effectiveness and low clinical value because rarely do the pathology findings alter patient management. The purpose of this study was to evaluate the cost effectiveness and clinical significance of routine histologic examination of tissue specimens removed during ankle arthroscopy. METHODS: Between 2014 and 2018, 408 patients underwent ankle arthroscopy at a multi-center hospital system by 16 different orthopedic surgeons. The available pathology reports from these cases were retrospectively reviewed to determine if the routine histologic examination altered patient care. We compared the preoperative diagnosis to both the postoperative and histologic diagnoses. The total cost for these histologic examinations was estimated using 2017 Medicare physician fees released by the College of American Pathologists. Cost-effectiveness was estimated in 2017 US dollars by cost per discrepant and discordant diagnosis. RESULTS: Of the 408 patients who underwent ankle arthroscopy, 361 pathology reports were available for review. The prevalence of concordant diagnosis was 98.9% (357/361); the prevalence of discrepant diagnoses was 1.0% (4/361). There were no cases identified with a discordant diagnosis. Total estimated cost for all pathology specimens was $46 381 in 2017 US dollars. Cost per discrepant diagnosis was $11 595. CONCLUSION: In our study, histologic examination of surgical specimens following ankle arthroscopy had no effect on patient management, yet it increased costs. Routine examination of these pathologic specimens had a low rate of discrepant and/or discordant diagnoses. Based on our results, routine pathologic examination of ankle arthroscopy tissue specimens should be sent solely at the discretion of the orthopedic surgeon as opposed to being a mandated policy. LEVEL OF EVIDENCE: Level IV, case series. SAGE Publications 2020-01-30 /pmc/articles/PMC8697194/ /pubmed/35097363 http://dx.doi.org/10.1177/2473011419900882 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Burgess, Colin
Petrone, Brandon
Matai, Prashant
Cohn, Randy
Bitterman, Adam
Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy
title Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy
title_full Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy
title_fullStr Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy
title_full_unstemmed Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy
title_short Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy
title_sort cost analysis of routine examination of pathology specimens following ankle arthroscopy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697194/
https://www.ncbi.nlm.nih.gov/pubmed/35097363
http://dx.doi.org/10.1177/2473011419900882
work_keys_str_mv AT burgesscolin costanalysisofroutineexaminationofpathologyspecimensfollowinganklearthroscopy
AT petronebrandon costanalysisofroutineexaminationofpathologyspecimensfollowinganklearthroscopy
AT mataiprashant costanalysisofroutineexaminationofpathologyspecimensfollowinganklearthroscopy
AT cohnrandy costanalysisofroutineexaminationofpathologyspecimensfollowinganklearthroscopy
AT bittermanadam costanalysisofroutineexaminationofpathologyspecimensfollowinganklearthroscopy