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Cost-benefit value of microscopic examination of intervertebral discs
D M Grzybicki1, E J Callaghan, S S Raab
1School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania 15282-0001, USA.
Object:
Given the virtual absence of histologically detected, clinically unsuspected disease in intervertebral disc specimens, some authors have advocated that histological examination be discontinued. However, the examination of intervertebral disc specimens remains common practice in most pathology laboratories. No cost-benefit analysis of this practice has been made; therefore, the authors' goal in this study was perform such an analysis.
Methods:
Using the University of Iowa surgical pathology database, 1109 patients who had undergone a laminectomy were identified retrospectively. These cases were classified into four categories based on the patients' preoperative clinical diagnosis and final histopathological diagnosis: insignificant clinical diagnosis/insignificant pathological diagnosis (ICIP), significant clinical diagnosis/insignificant pathological diagnosis (SCIP), significant clinical diagnosis/significant pathological diagnosis (SCSP), and insignificant clinical diagnosis/significant pathological diagnosis (ICSP). A significant clinical diagnosis was defined as one other than a benign, noninfectious indication for laminectomy. A significant pathological diagnosis was a diagnosis other than degenerative changes. The cost-benefit value of performing a histological examination in cases with significant or insignificant clinical diagnoses was examined. The cases were classified as: 1068 ICIP, 17 SCIP, 21 SCSP, and three ICSP. On chart review, in all three cases of ICSP an epidural abscess was identified perioperatively and the subsequent histological diagnosis did not affect patient care. The costs per case of identifying a significant pathological diagnosis with a significant and an insignificant clinical diagnosis were $44.79 and $8811, respectively.
Conclusions:
Histological examination of intervertebral disc specimens is cost beneficial only if there is a significant preoperative clinical diagnosis.
Insights
Histological examination of intervertebral disc specimens is cost-effective only when a significant preoperative clinical diagnosis is present. This analysis evaluated the cost-benefit of routine disc examination in laminectomy patients.
Area of Science:
- Pathology
- Surgical Pathology
- Health Economics
Background:
- Histological examination of intervertebral disc specimens is common practice.
- Previous literature suggests a low yield of clinically unsuspected disease.
- A cost-benefit analysis of this practice has been lacking.
Purpose of the Study:
- To perform a cost-benefit analysis of histological examination of intervertebral disc specimens.
- To determine the conditions under which disc examination is cost-effective.
Main Methods:
- Retrospective review of 1109 laminectomy cases from the University of Iowa surgical pathology database.
- Classification of cases based on preoperative clinical diagnosis and final histopathological diagnosis (ICIP, SCIP, SCSP, ICSP).
- Calculation of cost-benefit based on significant vs. insignificant clinical diagnoses.
Main Results:
- The cost per case of identifying a significant pathological diagnosis was $44.79 with a significant clinical diagnosis and $8811 with an insignificant clinical diagnosis.
- In cases with an insignificant clinical diagnosis and significant pathological diagnosis (ICSP), an epidural abscess was identified perioperatively, and histology did not alter patient care.
- The vast majority of cases were insignificant clinical/insignificant pathological (ICIP).
Conclusions:
- Histological examination of intervertebral disc specimens is cost-beneficial only when a significant preoperative clinical diagnosis is present.
- Routine histological examination of intervertebral discs may not be cost-effective in all cases.
- Clinical information is crucial in determining the utility of disc specimen examination.