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Clinical Orthopaedics and Related Research®

Published in:

01-05-2012 | Clinical Research

Histologic Examinations of Arthroplasty Specimens are not Cost-effective: A Retrospective Cohort Study

Authors: Michael M. Lin, AB, Jeffrey D. Goldsmith, MD, Stephen C. Resch, PhD, Joseph P. DeAngelis, MD, Arun J. Ramappa, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2012

Abstract

Background

Many hospitals require all operative specimens be sent to pathologists for routine examination. Although previous studies indicate this practice increases medical cost, it remains unclear whether it alters patient management and whether it is cost-effective.

Questions/purposes

We therefore (1) determined the rate of discordance between clinical and histologic examinations of routine operative specimens during elective primary arthroplasties, (2) determined the cost of routine histologic screening, and (3) estimated its cost-effectiveness in terms of cost per quality-adjusted life year gained, as compared with gross examination or no examination.

Methods

We retrospectively reviewed medical records of 1247 patients who underwent 1363 routine elective primary total joint arthroplasties between January 18, 2006 and March 15, 2010. We compared preoperative, postoperative, and histologic diagnoses for each patient and categorized them into three classes: concordant (clinical and histologic diagnoses agreed), discrepant (diagnoses differed but with no resultant change in treatment), and discordant (diagnoses differed with resultant change in treatment). Medicare reimbursements were determined through the pathology department’s administrative office.

Results

In 1363 cases, 1335 (97.9%) clinical and histologic diagnoses were concordant, 28 (2.1%) were discrepant, and none were discordant. Total reimbursement for routine pathological examination was $139,532, or $102.37 per specimen. The average cost to identify each discrepant case was $4983.29. Routine histologic examination did not alter patient management, and there was no direct gain in quality-adjusted life years.

Conclusions

Our observations show routine histologic examinations of routine operative specimens during elective primary arthroplasties increase medical cost but rarely alter patient management and are not cost-effective.

Level of evidence

Level I, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

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Title: Histologic Examinations of Arthroplasty Specimens are not Cost-effective: A Retrospective Cohort Study
Authors: Michael M. Lin, AB
Jeffrey D. Goldsmith, MD
Stephen C. Resch, PhD
Joseph P. DeAngelis, MD
Arun J. Ramappa, MD
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 5/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2149-7

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Springer Medicine

Histologic Examinations of Arthroplasty Specimens are not Cost-effective: A Retrospective Cohort Study

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of evidence

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