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Is it Effective and Cost-saving to Send all Tonsillectomy Specimens for Histopathological Examinations?
Mohammad Faramarzi1, Mohsen Ghaffari Darab2, Abdosaleh Jafari3
1Otolaryngology Research Centre, Department of Otolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Routine pathological examination of tonsillectomy specimens is unnecessary. Limiting pathology requests to non-routine cases can significantly reduce healthcare costs and optimize resource allocation for tonsillectomies.
Area of Science:
- Otolaryngology
- Pathology
- Health Economics
Background:
- Tonsillectomy is a common surgical procedure.
- Current practices often involve routine pathological examination of all tonsillectomy specimens.
- This study evaluates the necessity and economic impact of this practice.
Purpose of the Study:
- To determine the necessity of routine pathological examination for tonsillectomy specimens.
- To analyze the rate of malignancies and other significant findings.
- To assess potential cost savings and prevention strategies.
Main Methods:
- Retrospective analysis of 18,437 tonsillectomy specimens (2004-2018).
- Data collection included demographics, clinical information, and costs (public and private sectors).
- Calculation of financial burden and cost-saving rates.
Main Results:
- Only 0.64% of specimens showed unusual diagnoses (malignancies, benign tumors, infections).
- Malignant tumors accounted for 56% of unusual findings.
- Significant annual cost savings were identified in both public ($87,919) and private ($179,530) sectors.
Conclusions:
- Routine pathological examination of tonsillectomy specimens is not cost-effective.
- Selective examination of non-routine specimens is recommended.
- This approach offers economic and clinical benefits.
Introduction:
The present study aimed to investigate the necessity or unnecessity of sending all tonsillectomy specimens for pathological examinations in Shiraz, Iran; moreover, it examined malignancies, cost-saving, causes, and the ways to prevent sending all specimens.
Materials And Methods:
In the first retrospective phase of the study, a checklist was used to gather demographic, clinical, and cost information of 18,437 tonsillectomy specimens during 2004-2018 in Shiraz, Iran. In order to estimate the cost of each pathology specimen, the cost components, including human resources costs and consumables, were collected in the private and public sectors separately and divided by the number of cases performed. Finally, the financial burden resulting from these services (in the study centers) was calculated by multiplying each item's cost by the total number of these services.
Results:
Out of the total 18,437 histopathology specimens examined, only 118 (0.64%) samples were identified with unusual diagnoses, of which 66 (56%) cases had malignant tumors, and the remaining 52 (44%) samples included benign tumors (n=41), infections (n=2), and other problems (n=9). The second phase results also indicated that according to the ear, nose, and throat experts, the rules and regulations governing the country's health system and the suspicion of tumors were the main reasons for sending tonsil specimens for pathological examinations. Generally, the annual cost-saving rates in the studied public and private centers were $87,919 and $179,530 purchasing power parity, respectively.
Conclusions:
According to the results, sending tonsillectomy specimens should only be limited to nonroutine ones for economic-clinical reasons.
