title: Cost-benefit analysis of routine pathology examination in primary shoulder arthroplasty.
abstract: BACKGROUND
  The annual number of shoulder arthroplasty procedures is continuing to increase. Specimens from shoulder arthroplasty cases are routinely sent for pathologic examination. This study sought to evaluate the clinical utility and associated costs of routine pathologic examination of tissue removed during primary shoulder arthroplasty cases and to determine cost-effectiveness of this practice.
  
  
  METHODS
  This is a retrospective review of primary shoulder arthroplasty cases. Patients whose humeral head was sent for routine pathologic examination were included. Cases were determined to have concordant, discrepant, or discordant diagnoses based on preoperative/postoperative diagnosis and pathology diagnosis. Costs were estimated in 2015 U.S. dollars, and cost-effectiveness was determined by the cost per discrepant diagnosis and cost per discordant diagnosis.
  
  
  RESULTS
  We identified 714 cases of primary shoulder arthroplasty in 646 patients who met inclusion criteria. The prevalence of concordant diagnoses was 94.1%, the prevalence of discrepant diagnoses was 5.9%, and no cases had discordant diagnoses. There were 172 cases that had biceps tendon specimens sent for pathology examination, and none led to a change in patient care. Total estimated costs were $77,309.34 in 2015 U.S. dollars. Cost per discrepant diagnosis for humeral head specimens was $1424.09, and cost per discordant diagnosis is at least $59,811.78.
  
  
  CONCLUSIONS
  Primary shoulder arthroplasty has a high rate of concordant diagnosis. Discrepant diagnoses were 5.9% in our study, and there were no discordant diagnoses. This study showed limited clinical utility in routinely sending specimens from primary shoulder arthroplasty cases for pathology examination, and calculation using a traditional life-year value of $50,000 showed that the standard for cost-effectiveness is not met.
authors.affiliation: Department of Orthopedic Surgery, Mount Sinai St. Luke's-Roosevelt Hospital, New York, NY, USA. Electronic address: daniel.r.howard28@gmail.com.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Howard
authors.affiliation: Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Namdar
authors.initials: N
authors.lastname: Kazemi
authors.affiliation: Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Rubenstein
authors.affiliation: Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hartwell
authors.affiliation: Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jashvant
authors.initials: J
authors.lastname: Poeran
authors.affiliation: Department of Orthopedic Surgery, Mount Sinai St. Luke's-Roosevelt Hospital, New York, NY, USA.
authors.forename: Andy L
authors.initials: AL
authors.lastname: Chang
authors.affiliation: Department of Orthopedic Surgery, Mount Sinai St. Luke's-Roosevelt Hospital, New York, NY, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Podolnick
authors.affiliation: Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Bradford O
authors.initials: BO
authors.lastname: Parsons
authors.affiliation: Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Leesa M
authors.initials: LM
authors.lastname: Galatz
authors.affiliation: Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Evan L
authors.initials: EL
authors.lastname: Flatow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D058430:Humeral Head / Q000473:pathology* / Q000601:surgery; D007592:Joint Diseases / Q000175:diagnosis* / Q000191:economics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010336:Pathology / Q000191:economics; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000473:pathology* / Q000601:surgery
keywords: Shoulder arthroplasty; biceps tendon; cost-benefit; humeral head; pathology; shoulder arthritis