A Temporal Analysis of Trends in Intraoperative Consultation in a Large Academic Center
Jennifer A Bennett, Michelle Walls, Henry S Crist, Haresh Mani. Penn State Hershey Medical Center, Hershey, PA
Background: Evaluation of trends in utilization of laboratory services is important for quality assurance, planning and education. We undertook a temporal analysis of the utilization of pathology intraoperative consultation (IOC) services in a large academic center, to look for changing trends, if any.
Design: The pathology database was searched to identify all cases that had IOC over two different periods (2002-2003 and 2010-2011). Results were tabulated by specialty, reason for consultation (diagnosis, margins, or both), deferral rates, and discordance, and trends were evaluated.
Results: Overall, IOC utilization remained comparable between the two periods analyzed (4.2% of all surgical cases for 2002-2003 and 3.6% for 2010-2011, p 0.14). IOC increased significantly in 2010-2011 for breast cases (1.0% vs 8.6%, p < 0.01), due to increase in sentinel node evaluations. There was also an increase for pancreatohepatobiliary (7.3% vs 12.3%, p 0.07), genitourinary (6.9% vs 10.6%, p 0.11) and skin (2.6% vs 5.6%, p 0.18) cases. IOC decreased for gynecologic (17.5% vs 2.4%, p 0.04) and neurological (12.6% vs 8.0%, p 0.05) cases, and remained similar for pulmonary (6.3% vs 8.7%, p 0.31), musculoskeletal (16.1% vs 11.9%, p 0.33), ENT (18.1% vs 20.1%, p 0.4) and gastrointestinal (7.2% vs 8.1%, p 0.4) cases. Although the primary reason for requesting IOC was for a diagnosis in both periods studied, the relative frequency of cases requiring diagnosis significantly decreased in 2010-2011 (84% vs 67.2%, p 0.02). This was due to an increase in number of cases requiring margin evaluation (12.9% vs 26.6%, p 0.04). The number of parts per case increased in 2010-2011 (1.7 vs 2.3, p 0.05), with multi-part cases primarily seen in ENT and skin resections due to multiple margins requiring frozen sections. Margins were also requested more frequently in nephrectomies and esophagogastrectomies. The deferral rate was comparable (9.4% vs 7.8%, p 0.16) between the two periods, with similar specimens being deferred (thyroid follicular neoplasms, glial neoplasms, and lymphoid/spindle cell proliferations). The number of discordant diagnoses also remained comparable (3.0% vs 4.8%, p 0.26).
Conclusions: Although the rate of IOC has remained relatively constant over the past 10 years, there are significant differences in specimen types, with margin evaluation becoming more frequent. These changes likely reflect changes in surgical management paradigms over the past decade. Similar studies at other institutions could provide a benchmark to help plan for resource allocation and training needs.
Category: Quality Assurance
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 268, Tuesday Morning