title: Pathological review of turbinate tissue from functional nasal surgery: incurring costs without adding quality.
abstract: OBJECTIVE
  Inferior turbinate surgery for nasal obstruction can be performed in a variety of ways. Only a few of these methods produce tissue that can be sent for pathologic analysis. According to the College of American Pathologists, turbinate tissues are not exempt from requisite pathologic evaluation. Our objectives were to evaluate the clinical value and cost implications of routine pathological examination of turbinate specimens.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic tertiary care medical center.
  
  
  METHODS
  Charts of patients who underwent an inferior turbinate procedure for nasal obstruction between January 2008 and August 2011 were reviewed.
  
  
  RESULTS
  Thirteen hundred consecutive cases from 17 surgeons were identified. Among these patients, 223 (17%) underwent an isolated turbinate reduction procedure and 779 (59%) underwent a reduction procedure in conjunction with a septoplasty. The remaining patients had a turbinate procedure in addition to another head and neck procedure. Only 591 (45%) turbinate reduction procedures were performed by methods that were tissue producing, and of these, 137 (23%) were sent for pathologic analysis. All submitted specimens received a gross examination and 123 (90%) also underwent histologic analysis. No abnormalities were reported.
  
  
  CONCLUSIONS
  At our institution, most surgeons did not submit turbinate tissues for pathologic examination even when a specimen was produced. Of the specimens sent, no abnormal pathologic results were identified. Our results suggest that routine pathologic evaluation of inferior turbinate specimens may not contribute to patient care and perhaps represents an unnecessary cost.
authors.affiliation: Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Rajasekaran
authors.affiliation: Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Haffey
authors.affiliation: Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Halderman
authors.affiliation: Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Hoschar
authors.affiliation: Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA sindwar@ccf.org.
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000473:pathology* / Q000601:surgery*; D009300:Nasal Septum / Q000473:pathology / Q000601:surgery*; D059747:Nasal Surgical Procedures / Q000191:economics / Q000379:methods; D058996:Quality Improvement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014420:Turbinates / Q000473:pathology* / Q000601:surgery*; D014481:United States
keywords: financial analysis; nasal obstruction; septoturbinoplasty; submucosal resection of turbinates; turbinate pathology; turbinate reduction; turbinate specimen; turbinoplasty