Northwell, New Hyde Park, NY, USA.
Department of Orthopaedic Surgery at Huntington Hospital, Huntington, NY, USA.
Foot Ankle Int. 2024 Oct;45(10):1139-1144. doi: 10.1177/10711007241262999. Epub 2024 Aug 7.
Routine histopathologic examination of orthopaedic surgical specimens is a standard practice at many institutions. Previous studies have demonstrated that this practice seldom altered patient management for several orthopaedic procedures. As a result, the value of such practices has come into question. The purpose of this study is to determine the cost-effectiveness of routine histopathologic analysis of specimens obtained during total ankle arthroplasty (TAA).
A retrospective analysis was performed of patients who underwent uncomplicated primary TAA at a large, academic, health system between January 2015 and December 2021. The postoperative histopathologic diagnoses were compared with the respective patient's preoperative clinical and intraoperative diagnoses. The prevalence of concordant, discrepant, and discordant diagnoses was determined. Cost-effectiveness analysis was conducted to assess the financial implications of obtaining routine specimens for histopathologic examination for TAA.
A total of 85 TAAs were identified in 85 individual patients and were included in the present study. A total of 172 specimens were sent for routine histopathologic review. On histopathologic analysis, a final diagnosis was confirmed in 82 (96.5%) of the total specimens reviewed. A discrepant diagnosis was discovered in 3 (3.5%; 2 cases of gout/pseudogout and 1 case of osteonecrosis) cases and 0 (0%) discordant diagnoses were discovered, corresponding to positive and negative predictive values of 97% and 100%, respectively The total estimate of costs incurred for the routine analysis of all specimens included in the study was between $12 299.20 and 17 846.00. The estimated cost to establish each discrepant diagnosis ranged between $4099.73 and $5948.67, and the cost for a discordant diagnosis was unable to be established.
Routine histopathologic analysis of specimens obtained during TAA rarely revealed a discordant diagnosis and resulted in no alterations to patients' plan of care. Furthermore, the additional costs of routine histopathologic examination are significant. As such, it is recommended that such interventions in TAA should be performed on a per-case basis at the operating surgeon's discretion.
在许多机构中，对骨科手术标本进行常规组织病理学检查是一种标准做法。先前的研究表明，这种做法很少改变几种骨科手术的患者管理方式。因此，这种做法的价值受到了质疑。本研究旨在确定全踝关节置换术（TAA）中获得的标本进行常规组织病理学分析的成本效益。
对 2015 年 1 月至 2021 年 12 月期间在一家大型学术医疗系统中接受单纯初次 TAA 的患者进行了回顾性分析。比较了术后组织病理学诊断与患者术前临床和术中诊断的一致性。确定了一致、不一致和不一致诊断的患病率。进行成本效益分析，以评估为 TAA 获取常规标本进行组织病理学检查的财务影响。
共确定了 85 名患者的 85 例 TAA，并纳入本研究。总共发送了 172 个标本进行常规组织病理学复查。在组织病理学分析中，在所审查的 172 个总标本中，有 82 个（96.5%）得到了最终诊断。在 3 个（3.5%；2 例痛风/假性痛风和 1 例骨坏死）病例中发现了不一致的诊断，未发现不一致的诊断，对应的阳性和阴性预测值分别为 97%和 100%。本研究中包括的所有标本常规分析的总成本估计在 12299.20 美元至 17846.00 美元之间。建立每个不一致诊断的估计成本在 4099.73 美元至 5948.67 美元之间，而不一致诊断的成本无法确定。
TAA 中获得的标本的常规组织病理学分析很少发现不一致的诊断，也不会改变患者的护理计划。此外，常规组织病理学检查的额外成本是显著的。因此，建议 TAA 中的此类干预措施应根据手术医生的判断逐案进行。
