Department of Pathology and Laboratory Medicine, University of California Irvine, CA, 92868 USA.
California University of Science and Medicine, Colton, CA, 92324 USA.
Hum Pathol. 2023 Nov;141:1-5. doi: 10.1016/j.humpath.2023.08.002. Epub 2023 Aug 12.
Rising healthcare costs have been linked to overtreatment and overuse of available resources. Identifying and eliminating low-value services is vital for reducing such costs. At many institutions, including ours, all ileostomy and colostomy specimens are sent for pathological evaluation. It is estimated that approximately 120,000 ileostomy/colostomy procedures are done every year, and at least 1 million patients have stomas at any given time in North America. Hence, we decided to analyze the pathological findings and cost-benefit of undertaking the pathological evaluation of these colostomy and ileostomy specimens. The pathology database of our department was searched for all ileostomy and colostomy specimens received between 2000 and 2020, resulting in a total of 2762 cases (1944 ileostomy and 818 colostomy). We performed a cost-benefit analysis and pathologic review of these cases. The results of our study show that 99.38% of these specimens did not show any significant pathological abnormality, and non-neoplastic pathologic findings accounted for 99.63% of cases. Less than 1% of our cases showed any clinically significant pathological findings. All 10 cases that showed a neoplastic or malignant diagnosis showed some abnormal finding that was appreciated at the time of gross examination. We conclude that microscopic evaluation of ileostomy and colostomy specimens incurs significant costs and provides no clear value or relevant information for patient care. The results of our study provide support for ileostomy and colostomy specimens to be triaged by gross-only pathological examination in the first instance for the vast majority of cases.
不断上涨的医疗保健成本与过度治疗和过度使用现有资源有关。确定和消除低价值服务对于降低此类成本至关重要。在包括我们医院在内的许多机构中，所有的回肠造口和结肠造口标本都要进行病理评估。据估计，每年大约有 12 万例回肠造口/结肠造口术，在北美任何时候都至少有 100 万名患者有造口。因此，我们决定分析这些结肠造口和回肠造口标本进行病理评估的病理发现和成本效益。我们科室的病理数据库搜索了 2000 年至 2020 年期间收到的所有回肠造口和结肠造口标本，共 2762 例（1944 例回肠造口和 818 例结肠造口）。我们对这些病例进行了成本效益分析和病理复查。研究结果表明，这些标本中 99.38%没有显示任何明显的病理异常，非肿瘤性病理发现占病例的 99.63%。不到 1%的病例显示出任何有临床意义的病理发现。所有 10 例显示肿瘤或恶性诊断的病例都显示出一些在大体检查时就已被注意到的异常发现。我们得出结论，回肠造口和结肠造口标本的显微镜评估会产生显著的成本，但对患者护理没有提供明确的价值或相关信息。我们的研究结果支持对绝大多数病例的回肠造口和结肠造口标本进行仅通过大体检查进行初步分类。
