Use of Routine Pathologic Evaluation of Nonmalignant Lesions in Hand Surgery: A National Study.

Abstract:

BACKGROUND:Most lesions of the upper extremity are common and benign, and many have questioned the need for routine pathologic evaluation of these specimens. The authors aim to examine the national use of routine pathologic examination of nonmalignant hand lesions to help guide health care policy and practice patterns. METHODS:The authors used a national level MarketScan database to form a cohort of adult patients who underwent excision of nonmalignant upper extremity lesions. The authors calculated the rate of submission for each surgical procedure and separately for each diagnosis. The authors also investigated demographic and clinical characteristics associated with the submission of surgical specimens using a multivariable logistic regression model. The authors calculated the total cost of routine pathologic evaluation. RESULTS:The final study cohort included 222,947 patients and 182,962 specimens from 153,518 cases. The mean rate of submission was 69 percent. Older age, Northeast region, and high comorbidity scores showed significant correlation with the odds of having a specimen submitted for pathologic evaluation. Excision of primary wrist ganglion was the most performed procedure, and benign lesions larger than 4.0 cm were most frequently submitted for pathologic evaluation. The mean cost of routine pathologic examination was $133 per specimen, and the annual expenditure was $5 million. CONCLUSIONS:The routine pathologic examination of benign hand lesions is used frequently but provides limited clinical benefit at a cost. To increase efficiency and improve quality of care, surgeons should be aware of the low value of routine pathologic evaluation and be more selective for cases for which diagnostic testing will change management.

journal_name

Plast Reconstr Surg

authors

Cho HE,Kelley B,Zhong L,Chung KC

doi

10.1097/PRS.0000000000004592

subject

Has Abstract

pub_date

2018-08-01 00:00:00

pages

160e-168e

issue

2

eissn

0032-1052

issn

1529-4242

pii

00006534-201808000-00024

journal_volume

142

pub_type

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