Related Experiment Video
Updated: Dec 31, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Indiscriminate Pathologic Examination of Pediatric Supraglottoplasty Specimens: An Evidence-Based Approach toward
Alhasan N Elghouche1, Mohamedkazim M Alwani1, Bruce H Matt1
1Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Objective:
The primary aim of this study was to demonstrate that indiscriminate pathologic evaluation of supraglottoplasty specimens is unnecessary and does not influence postoperative management. The secondary objective was to determine the costs associated with pathologic evaluation of supraglottoplasty specimens.
Methods:
A planned chart review was conducted to evaluate data from consecutive patients undergoing supraglottoplasty. Demographic data were extracted and pathology reports were reviewed. Projected cost savings were estimated based on 2018 Centers for Medicare & Medicaid Services reimbursement rates for Current Procedural Terminology code 88304 (surgical pathology, gross and microscopic examination).
Results:
A total of 1417 consecutive patients were identified. All specimens underwent gross and microscopic examination. Pathologic outcomes were categorized into 3 major categories: no diagnostic abnormality (n = 1069), chronic inflammation (n = 346), and other (n = 2). Pathologic evaluation did not alter postoperative management in any patient. Projected yearly and 5-year cost- savings totaled $11,818.08 and $59,173.92, respectively.
Discussion:
These findings demonstrate that pathologic examination of supraglottoplasty specimens adds no value to patient management. A more selective approach to pathologic examination of certain surgical specimens is an improvement opportunity to enhance the value of patient care by eliminating direct financial costs and "hidden costs" associated with unnecessarily increased workload.
Implications For Practice:
Addressing inappropriate, indiscriminate pathologic examination of certain surgical specimens is a potential quality improvement opportunity that has a meaningful impact on the value of patient care and reduces strains on the workload of surgical and pathology department personnel.
Insights
Pathologic evaluation of supraglottoplasty specimens is unnecessary and does not impact patient care. Eliminating this practice can save significant healthcare costs and reduce workload.
Area of Science:
- Otolaryngology
- Surgical Pathology
Background:
- Supraglottoplasty is a surgical procedure to treat upper airway obstruction in infants.
- Pathologic evaluation of surgical specimens is standard practice, but its necessity varies by procedure.
- The value of routine pathologic examination of supraglottoplasty specimens is questioned.
Purpose of the Study:
- To determine if routine pathologic evaluation of supraglottoplasty specimens influences postoperative management.
- To assess the financial costs associated with the pathologic evaluation of these specimens.
Main Methods:
- A retrospective chart review of 1417 patients undergoing supraglottoplasty.
- Analysis of demographic data and pathology reports.
- Estimation of cost savings using Medicare reimbursement rates for surgical pathology.
Main Results:
- Pathologic examination did not alter postoperative management in any of the 1417 patients.
- The majority of specimens showed no diagnostic abnormality (n=1069) or chronic inflammation (n=346).
- Projected cost savings from eliminating routine evaluation are substantial, totaling over $59,000 in 5 years.
Conclusions:
- Pathologic examination of supraglottoplasty specimens provides no additional value to patient management.
- A selective approach to specimen evaluation can improve healthcare value by reducing costs and workload.
- Implementing this change represents a quality improvement opportunity for surgical and pathology departments.
