title: Costs and benefits of routine histopathological examination of hammertoe specimens.
abstract: BACKGROUND
  The purpose of this study was to evaluate the cost and benefit of routinely submitting hammertoe specimens for histopathological examination. We hypothesized that such examination rarely shows a new diagnosis and seldom alters postoperative care.
  
  
  METHODS
  Three hundred and fourteen proximal interphalangeal (PIP) joint and 37 extensor tendon specimens from 187 consecutive hammertoe correction surgeries were submitted by 2 surgeons for histopathological examination between January 2009 and December 2011. Each patient's chart was reviewed to determine whether the histopathological examination revealed a diagnosis other than degenerative joint or degenerative tendon and whether subsequent patient management was altered. The total reimbursements for professional charges were calculated using the average reimbursement from common insurance providers for two Current Procedural Terminology (CPT) codes: 88304 (soft tissue examination) and 88311 (decalcification).
  
  
  RESULTS
  Almost all of the specimens were diagnosed as degenerative: 97.5% (307/314) of the PIP specimens and all (37/37) of the tendon specimens. Seven PIP specimens (2.2%, 7/314) from 5 patients (2.7%, 5/187) and no tendon specimens had other diagnoses. These diagnoses were rheumatoid arthritis (5/314, 1.6%), osteomyelitis (1/314, 0.3%), and pigmented villonodular synovitis (PVNS) (1/314, 0.3%). Only the PVNS was a new diagnosis. A total of $56,750 was spent to determine 1 new diagnosis.
  
  
  CONCLUSIONS
  The routine submission of hammertoe specimens for pathological evaluation was not cost-efficient. Our analysis showed that new diagnoses were rarely found and patient management was not affected.
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY 10021, USA. malzberga@hss.edu
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Malzberg
authors.forename: Ettore
authors.initials: E
authors.lastname: Vulcano
authors.forename: Martin J
authors.initials: MJ
authors.lastname: O'Malley
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Deland
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D037801:Hammer Toe Syndrome / Q000191:economics* / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000191:economics; D058971:Tenotomy / Q000191:economics