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The Journal of Bone and Joint Surgery 82:1531 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Cost and Effectiveness of Routine Pathological Examination of Operative Specimens Obtained During Primary Total Hip and Knee Replacement in Patients with Osteoarthritis*

Mininder S. Kocher, M.D.M.P.H.{dagger}, Greg Erens, M.D.{ddagger}, Thomas S. Thornhill, M.D.{ddagger} and John E. Ready, M.D.{ddagger}

Investigation performed at the Department of Orthopaedic Surgery, Brigham and Women's Hospital, and the Harvard School of Public Health, Boston, Massachusetts
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was an American Academy of Orthopaedic Surgeons/Orthopaedic Research and Education Foundation Health Services Research Fellowship Grant (M. S. K.).
{dagger}Department of Orthopaedic Surgery, Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115. E-mail address: kocher_m{at}a1.tch.harvard.edu
{ddagger}Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.

Background: The challenge of cost-efficiency is maintaining the quality of medical care while reducing costs and eliminating unnecessary practices. The purpose of this investigation was to evaluate the cost and effectiveness of routine pathological examination of surgical specimens from patients undergoing primary total hip or knee replacement for the treatment of osteoarthritis.

Methods: Effectiveness was assessed by comparing clinical and pathological diagnoses associated with 1234 consecutive primary total joint replacements (471 hip and 763 knee replacements) performed between 1992 and 1995 in one hospital in patients with the clinical diagnosis of osteoarthritis. Clinical and pathological diagnoses were considered concordant if they agreed, discrepant if they differed without a resultant change in patient management, and discordant if they differed with a resultant change in patient management. Cost identification was performed by determining charges, reimbursement, and costs in 1998-adjusted American dollars for both total hip and total knee replacement. The cost per health-effect was determined by calculating the cost per discrepant and discordant diagnosis.

Results: The prevalence of concordant diagnoses was 97.6 percent (1205 of 1234) (95 percent confidence interval, 96.6 to 98.4 percent), the prevalence of discrepant diagnoses was 2.3 percent (twenty-eight of 1234) (95 percent confidence interval, 1.4 to 3.1 percent), and the prevalence of discordant diagnoses was 0.1 percent (one of 1234) (95 percent confidence interval, 0.1 to 0.3 percent). The cost per discrepant diagnosis was $4383, and the cost per discordant diagnosis was $122,728.

Conclusions: Routine pathological examination of surgical specimens from patients undergoing primary total hip or knee replacement because of the clinical diagnosis of osteoarthritis had limited cost-effectiveness at our hospital due to the low prevalence of findings that altered patient management.


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