Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy
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Le résumé fourni par la source
OBJECTIVE: To investigate the oncological safety and potential cost savings of selective histopathological examination after appendectomy. BACKGROUND: The necessity of routine histopathological examination after appendectomy has been questioned, but prospective studies investigating the safety of a selective policy are lacking. METHODS: In this multicenter, prospective, cross-sectional study, inspection and palpation of the (meso)appendix was performed by the surgeon in patients with suspected appendicitis. The surgeon's opinion on additional value of histopathological examination was reported before sending all specimens to the pathologist. Main outcomes were the number of hypothetically missed appendiceal neoplasms with clinical consequences benefiting the patient (upper limit two-sided 95% confidence interval below 3:1000 considered oncologically safe) and potential cost savings after selective histopathological examination. RESULTS: Seven thousand three hundred thirty-nine patients were included. After a selective policy, 4966/7339 (67.7%) specimens would have been refrained from histopathological examination. Appendiceal neoplasms with clinical consequences would have been missed in 22/4966 patients. In 5/22, residual disease was completely resected during additional surgery. Hence, an appendiceal neoplasm with clinical consequences benefiting the patient would have been missed in 1.01:1000 patients (upper limit 95% confidence interval 1.61:1000). In contrast, twice as many patients (10/22) would not have been exposed to potential harm due to re-resections without clear benefit, whereas consequences were neither beneficial nor harmful in the remaining seven. Estimated cost savings established by replacing routine for selective histopathological examination were €725,400 per 10,000 patients. CONCLUSIONS: Selective histopathological examination after appendectomy for suspected appendicitis is oncologically safe and will likely result in a reduction of pathologists' workload, less costs, and fewer re-resections without clear benefit.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Oncological Safety and Potential Cost Savings of Routine vs Selective Histopathological Examination After Appendectomy
- Date Crossref
- 05/10/2021
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Amsterdam University Medical Centers pays non établi dans la noticeÉtablissement de santé
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University of Amsterdam Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
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Tergooi Department of Surgery pays non établi dans la noticeÉtablissement de santé
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Radboud University Nijmegen pays non établi dans la noticeUniversité ou école supérieure
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Máxima Medisch Centrum pays non établi dans la noticeÉtablissement de santé
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Radboud University Medical Center Department of Surgery pays non établi dans la noticeOrganisme public
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Albert Schweitzer Ziekenhuis pays non établi dans la noticeÉtablissement de santé
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Medisch Centrum Haaglanden pays non établi dans la noticeÉtablissement de santé
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De Kinderkliniek pays non établi dans la noticeÉtablissement de santé
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Amsterdam Neuroscience pays non établi dans la noticeStructure de recherche
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Amsterdam University of Applied Sciences pays non établi dans la noticeUniversité ou école supérieure
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Maasstad Ziekenhuis pays non établi dans la noticeÉtablissement de santé
Amsterdam University Medical Centers, Department of Surgery — University of Amsterdam et Department of Surgery — Tergooi, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.