title: Histologic examinations of arthroplasty specimens are not cost-effective: a retrospective cohort study.
abstract: BACKGROUND
  Many hospitals require all operative specimens be sent to pathologists for routine examination. Although previous studies indicate this practice increases medical cost, it remains unclear whether it alters patient management and whether it is cost-effective.
  
  
  OBJECTIVE
  We therefore (1) determined the rate of discordance between clinical and histologic examinations of routine operative specimens during elective primary arthroplasties, (2) determined the cost of routine histologic screening, and (3) estimated its cost-effectiveness in terms of cost per quality-adjusted life year gained, as compared with gross examination or no examination.
  
  
  METHODS
  We retrospectively reviewed medical records of 1247 patients who underwent 1363 routine elective primary total joint arthroplasties between January 18, 2006 and March 15, 2010. We compared preoperative, postoperative, and histologic diagnoses for each patient and categorized them into three classes: concordant (clinical and histologic diagnoses agreed), discrepant (diagnoses differed but with no resultant change in treatment), and discordant (diagnoses differed with resultant change in treatment). Medicare reimbursements were determined through the pathology department's administrative office.
  
  
  RESULTS
  In 1363 cases, 1335 (97.9%) clinical and histologic diagnoses were concordant, 28 (2.1%) were discrepant, and none were discordant. Total reimbursement for routine pathological examination was $139,532, or $102.37 per specimen. The average cost to identify each discrepant case was $4983.29. Routine histologic examination did not alter patient management, and there was no direct gain in quality-adjusted life years.
  
  
  CONCLUSIONS
  Our observations show routine histologic examinations of routine operative specimens during elective primary arthroplasties increase medical cost but rarely alter patient management and are not cost-effective.
  
  
  METHODS
  Level I, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA.
authors: Michael M
authors: MM
authors: Lin
authors: Jeffrey D
authors: JD
authors: Goldsmith
authors: Stephen C
authors: SC
authors: Resch
authors: Joseph P
authors: JP
authors: DeAngelis
authors: Arun J
authors: AJ
authors: Ramappa
mesh_terms: D019643:Arthroplasty, Replacement / Q000191:economics*; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D006652:Histological Techniques / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007596:Joints / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies