Routine histopathologic evaluation in hallux valgus surgery.
BACKGROUND
Anecdotal evidence suggests that specimens submitted for histopathologic assessment during hallux valgus surgery most commonly reveal degenerative changes. The purpose of this study was to evaluate the cost effectiveness of routine examination of tissue from hallux valgus procedures. We hypothesized that such examination rarely diagnoses a new condition and does not alter postoperative management.


METHODS
Specimens from 315 consecutive primary hallux valgus reconstructions performed between November 1995 and August 2002 were retrospectively analyzed. Patient charts were reviewed to determine the number of cases in which new diagnoses were made or treatment altered based upon histopathologic examination. Cost effectiveness was assessed by identifying the reimbursement for professional fees charged for these analyses. The total reimbursement per new diagnosis made and per alteration of treatment were calculated.


RESULTS
Degenerative changes were diagnosed in the majority of speciments (97.5%, 307 of 315). Other diagnoses included rheumatoid arthritis (1.3%, four of 315), gouty arthritis (1.0%, three of 315), and pseudogout (0.3%, one of 315). A new diagnosis was made only in the one patient (0.3%, one of 315) with pseudogout. Postoperative management was unchanged in every case.


CONCLUSIONS
Routine submission of specimens obtained during hallux valgus surgery is not cost effective. New diagnoses are very rare and postoperative management did not change.
Oh
Irvin C
IC
Hospital for Special Surgery, New York, NY 10021, USA.
Ellis
Scott J
SJ
O'Malley
Martin J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003951:Diagnostic Errors; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D006215:Hallux Valgus / Q000473:pathology* / Q000601:surgery*; D006652:Histological Techniques / Q000191:economics; D006801:Humans; D007430:Intraoperative Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult