Utilization of Routine Pathology Evaluation of Non-Malignant Lesions in Hand Surgery – A National Study

Background: Most lesions of the upper extremity are common and benign, and many have questioned the need for routine pathology evaluation of these specimens. We aim to examine the national utilization of routine pathology examination of non-malignant hand lesions to help guide healthcare policy and practice patterns. Methods: We used a national level Marketscan database to form a cohort of adult patients who underwent excision of non-malignant upper extremity lesions. We calculated the rate of submission for each surgical procedure and separately for each diagnosis. We also investigated demographic and clinical characteristics associated with the submission of surgical specimens using a multivariable logistic regression model. We calculated total cost of routine pathology evaluation. Results: The final study cohort included 222,947 patients and 182,962 specimens from 153,518 cases. The mean rate of submission was 69%. Older age, Northeast region, and high comorbidity scores showed significant correlation with the odds of having a specimen submitted for pathology evaluation. Excision of primary wrist ganglion was the most performed procedure, and benign lesions over 4.0cm in size were most frequently submitted for pathology. The mean cost of routine pathology exam was $133 per specimen and annual expenditure of $5 million. Conclusions: The routine pathology examination of benign hand lesions is utilized frequently while providing limited clinical benefit at a cost. To increase efficiency and improve quality of care, surgeons should be aware of the low value of routine pathology evaluation and be more selective for cases for which diagnostic testing will change management. Funding: Funding for this work was supported by a Midcareer Investigator Award (2 K24-AR053120-06) to Dr. Kevin Chung from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. Acknowledgements: We thank Melissa Shauver, MPH for her contribution in proofreading the manuscript. Corresponding Author: Kevin C. Chung, MD, MS, Section of Plastic Surgery, The University of Michigan Health System, 1500 E. Medical Center Drive , 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, Phone: 734-936-5885, Fax: 734-763-5354, E-mail: kecchung@med.umich.edu ©2018American Society of Plastic Surgeons

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