Koss Justin, Goyette David, Patel Jay, Harrington Colin J, Mazzei Christopher, Wittig James C, Dundon John
Orthopedics, Morristown Medical Center, Morristown, USA.
Orthopedics, Walter Reed National Military Medical Center, Bethesda, USA.
Cureus. 2021 Jan 30;13(1):e13005. doi: 10.7759/cureus.13005.
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.
背景 在许多机构，全关节置换术（TJA）中对骨标本进行常规分析是必不可少的。本研究的目的是确定强制性的常规TJA标本分析是否会改变患者的治疗方案，或者它们是否代表不必要的医疗支出。方法 对2015年10月至2017年12月在本机构接受初次TJA的所有患者进行回顾性研究。审查病理结果以确定一致、不符和不一致结果的数量。如果术前和病理诊断匹配，则诊断为一致；如果术前和病理诊断不同但患者的护理计划没有改变，则为不符；如果术前和病理诊断不同并导致患者的护理计划改变，则为不一致。结果 3670例全髋关节置换术（THA）和全膝关节置换术（TKA）手术（3613例患者）符合纳入标准并纳入本研究。所有3670个标本的诊断均一致；不符诊断和不一致诊断均为零。在研究期间，本机构病理学家对TJA标本进行常规分析花费了67246.88美元，术后患者护理计划没有任何改变。结论 在捆绑支付报销模式以及医院试图减少不必要支出的情况下，本研究进一步证明，由于患者护理管理改变的发生率较低，常规分析的成本效益有限。病理分析的决定应由外科医生自行决定，以最大限度地提高TJA手术的成本效益。
