(117) Cost-benefit Analysis of Routine Histopathologic Examination of Tissue Post Adenotonsillectomy

Introduction: This study aims to analyze the cost of routine histopathological analysis of Tonsillectomy and Adenoidectomy (T&A) specimens at a tertiary-care level hospital, common indications for T&A, and incidence of unexpected histological findings.

Methods: 2500 pathology reports of T&A in patients aged 0 -18 from April of 2017-2022 were reviewed as a retrospective chart review. Hospital’s fee for gross and microscopic (G&M) examination of surgical pathology, cost of special histological stains, and diagnostic tools were obtained to calculate the overall cost.

Results: Albany Medical Center charges $209 for a routine G&M examination of T&A tissue. Use of special stains and flow cytometry incurs an additional charge of $62 and $141 respectively. Identification of actinomyces costs $34. Of the 2500 cases Actinomyces was identified in 10 specimens, special stain was used 4 times and multiparametric flow cytometry was utilized twice, making the total cost of routine T&A analysis $523,370. Pathology reports further demonstrated that there were only 3 cases with granulomatous inflammation (0.12%), 10 with actinomyces-related acute tonsillitis (0.4%), and 9 with crypt neutrophilic exudates (0.36%). Rest of the cases (n=2478) were cleared as “mucosa-associated lymphoid tissue with follicular hyperplasia” (99.1 %). There were 0 malignant findings. Most common indication for surgery was tonsillar hypertrophy with 403 cases out of 2500 having multiple indications. Previous research has identified actinomyces and crypt neutrophilic exudates as a common cause of tonsillar hypertrophy, thus our study demonstrated only 3 uncommon pathological findings for every $523,370 spent.

Conclusions: Even in patients who had multiple indications for T&A, the probability of the tissue sample containing malignancy or granulomatous inflammation were zero and 0.12% respectively, yet the cost of routine specimen examination amounted to $523,370. This leads us to believe that eliminating routine T&A specimen analysis, in pediatric patients who demonstrate no clinical signs of malignancy, may effectively cut excess healthcare costs.