Costs and benefits of routine histopathological examination of hammertoe specimens. Academic Article uri icon

Overview

MeSH

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid
  • Comorbidity
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteomyelitis
  • Reconstructive Surgical Procedures
  • Tenotomy

MeSH Major

  • Cost of Illness
  • Hammer Toe Syndrome

abstract

  • 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. 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). 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. 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.

publication date

  • April 2013

has subject area

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid
  • Comorbidity
  • Cost of Illness
  • Cost-Benefit Analysis
  • Female
  • Hammer Toe Syndrome
  • Humans
  • Male
  • Middle Aged
  • Osteomyelitis
  • Reconstructive Surgical Procedures
  • Tenotomy

Research

keywords

  • Journal Article

Identity

Language

  • eng

Digital Object Identifier (DOI)

  • 10.1177/1071100712467781

PubMed ID

  • 23559613

Additional Document Info

start page

  • 530

end page

  • 533

volume

  • 34

number

  • 4