Indications for routine pathologic examination of specimens removed during trauma operations.

BACKGROUND

Surgical specimens removed during trauma operations are routinely submitted for examination by pathology. This practice has not been systematically evaluated and the incidence of abnormal results from these examinations remains unknown. The objective of this study was to identify the incidence and management implications of abnormal findings at pathology review of trauma specimens.

METHODS

This is a retrospective chart and pathology review of all surgical specimens obtained during laparotomy or thoracotomy for trauma between January 1, 1993 and December 31, 2005. Reports were assessed for significant abnormal findings, including malignancy, infectious processes, and chronic inflammation. Additional clinical and demographic data were obtained. The main outcome measure was any change in management due to the pathology result.

RESULTS

A total of 1686 specimens were obtained from 1307 trauma patients. Ten patients (0.8%) were identified as having clinically significant abnormal findings on pathology. Six findings (0.5%) were evidence of malignancy. The pathology reports did not alter care in any patients. In all instances malignancy was known or highly suspected prior to specimen examination based on other diagnostic modalities or gross examination during surgery. Patients with an abnormal finding were significantly older than the patients with normal pathology reports (70.5 vs. 30.4, P < 0.0001).

CONCLUSIONS

The routine pathology review of specimens obtained during trauma operations did not alter patient care and should not continue. In all instances of abnormal pathology, preoperative imaging or gross intraoperative findings led to increased suspicion of occult disease. The suggestion of abnormalities on imaging or intraoperatively warrants pathologic examination, especially in older patients.