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Published on: November 6, 2019
Pathologic evaluation of routine pediatric tonsillectomy specimens: analysis of cost-effectiveness
Marc E Nelson1, T J Gernon, Joseph C Taylor
1Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Michigan, Ann Arbor, MI 48109- 5241, USA.
Summary
Mandatory gross pathologic analysis of routine pediatric tonsillectomy specimens rarely identifies unsuspected pathology. This practice is not cost-effective, with microscopic examination reserved for specific cases.
Area of Science:
- Pathology
- Pediatric Surgery
- Health Economics
Background:
- Routine pathologic analysis of tonsillectomy specimens in children is common practice.
- The utility and cost-effectiveness of this practice require evaluation.
Purpose of the Study:
- To evaluate the diagnostic yield of mandatory gross or pathologic analysis of routine pediatric tonsillectomy specimens.
- To explore the cost-effectiveness of this practice.
Main Methods:
- Retrospective case series of 5235 pediatric tonsillectomy specimens from 1996-2008.
- Evaluation of results from routine and non-routine specimen analysis.
- Economic analysis of alternative specimen handling methods.
Main Results:
- Zero cases of unsuspected pathology found in 4186 routine gross evaluations (prevalence 0-0.00088).
- Positive findings on microscopic analysis (1066 specimens) were limited to post-transplant patients (10/63) and surgeon-suspicion cases (8/78).
- Estimated cost: $766,500 per unsuspected lymphoma case identified via microscopic evaluation.
Conclusions:
- Gross pathologic analysis of routine pediatric tonsillectomy specimens has a very low yield for unsuspected pathology.
- The practice is not a cost-effective use of healthcare resources.
- Microscopic examination is appropriate for post-transplant patients and when surgeon suspicion exists.
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