Study Urges No Routine Histological Exam in Orthopedic Surgeries
Substantial cost savings could be achieved by eliminating the practice of routine histological examinations of knee arthroscopy tissue, according to a study published in the June issue of the Journal of Bone and Joint Surgery. These routine pathological examinations are of limited cost-effectiveness because of the low prevalence of findings that altered patient management. As […]
Substantial cost savings could be achieved by eliminating the practice of routine histological examinations of knee arthroscopy tissue, according to a study published in the June issue of the Journal of Bone and Joint Surgery. These routine pathological examinations are of limited cost-effectiveness because of the low prevalence of findings that altered patient management. As a result, the authors suggest that gross and histological examinations should be performed only at the discretion of the orthopedic surgeon. There are more than 1 million knee arthroscopies performed annually in the United States, making it the most common orthopedic surgical procedure performed. Pathological evaluation is commonly performed as routine practice on samples acquired during this procedure, due to a lack of exemption from accreditation guidelines (the College of American Pathologists and the Joint Commission). In the present study, medical records were reviewed for 3,797 consecutive knee arthroscopies (partial meniscectomies and anterior cruciate ligament [ACL] reconstructions) performed by two surgeons (from 2004 to 2013). Pathology reports were reviewed to determine if the results altered patient care and the total costs of histological examination were estimated in 2012-adjusted U.S. dollars. The researchers found that the prevalence of concordant diagnoses was 99.3 percent, the prevalence of discrepant diagnoses was 0.7 percent (n = 270), and there was one case of discordant diagnoses, which was refuted with further testing. Two patients were diagnosed with benign neoplasms. Neither diagnosis resulted in changes in care management. Across the 23 abnormal histological diagnoses, intraoperative findings were consistent with the histological diagnosis. The total cost of histological examinations was estimated to be $371,810, and the total cost of the pathology cost per discrepant diagnosis was $13,771, and the cost per discordant diagnosis was $371,810. “We believe that hospitals and health-care institutions should revise their surgical policies to exclude specimens removed during arthroscopic ACL reconstruction and partial meniscectomy from mandatory gross and/or histological examination,” write the authors, led by Joseph W. Greene, M.D., from the Insall Scott Kelly Institute for Orthopedics and Sports Medicine in New York. “Patients with intra-articular tumors, synovial disease, or atypical appearances who are undergoing knee arthroscopy would benefit from histological examination, but this could be determined by the orthopedist during surgery.” Takeaway: As hospitals look for opportunities for savings through elimination of unnecessary care, pathological examination of tissues from orthopedic procedures may be one source of cost savings, as studies show the exams rarely yield results that affect patient care.