Cost-benefit analysis of routine pathology examination in primary shoulder arthroplasty
Section snippets
Clinical value
We performed a retrospective review of cases of primary total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), hemiarthroplasty (HHA), and resurfacing procedures at 2 centers. The cases from the first hospital were performed between 2002 and 2015, and the cases at the second hospital were performed between 2006 and 2015. Inclusion criteria were patients who underwent primary shoulder arthroplasty and had the resected humeral head sent for routine histologic examination.
Results
We identified 714 cases of primary shoulder arthroplasty in 646 patients who met inclusion criteria. Preoperative diagnoses included osteoarthritis, rotator cuff tear arthropathy, rheumatoid arthritis, psoriatic arthritis, avascular necrosis, massive irreparable rotator cuff tear, chronic dislocation, proximal humerus fracture, and post-traumatic arthritis (Table I). The mean age of patients was 69.4 years (range, 27.1-91.8 years); 39.8% of patients were male.
An additional 53 cases of primary
Discussion
Hospital pathology laboratories are required to perform histologic examination on human tissues removed during surgical procedures by the College of American Pathologists,17 although certain types of specimens may be excluded from routine examination by hospitals under College of American Pathologists standard ANP.10016.4 The Joint Commission9 also requires routine examination of specimens by a pathologist unless clinical staff and a pathologist together decide on exemptions, which should be
Conclusion
Our study found a high rate of concordance between clinical and pathologic diagnoses in primary shoulder arthroplasty cases in which routine pathologic examination was performed. Our rate of discrepant diagnoses (5.9%) was consistent with previous literature of routine pathologic examination of primary hip and knee arthroplastyspecimens, and we found no cases of discordant diagnoses. The cost per discrepant diagnosis was $1424.09, and the cost per discordant diagnosis was at least $59,811.78
Disclaimer
The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Approval was obtained from the Mount Sinai Health System Institutional Review Board: No. 15-0061.