Clinical and economic value of routine pathological examination of hernia sacs and scheduled clinic follow-ups after inguinal hernia and hydrocele repair in a Canadian tertiary care children's hospital
Min Joon Lee, BA1, Jin K. Kim, MD1, Martha Pokarowski, MPH1, Mitchell Shiff, MSc1, Patricia Mitton, MBA2, Andreea Popescu, MBA2, Catherine Chung, MD3, Jacob Langer, MD4, Agostino Pierro, MD4, Joseph Milner, PhD2, Armando Lorenzo, MD1, Martin Koyle, MD, MSc1.
1Division of Urology, Hospital for Sick Children, Toronto, ON, Canada, 2Rotman School of Management, Toronto, ON, Canada, 3Division of Pathology, Hospital for Sick Children, Toronto, ON, Canada, 4Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, ON, Canada.
BACKGROUND: The clinical and economical value of routine submission of hernia sacs for pathological examination and scheduled clinic follow-ups after inguinal hernia and hydrocele repair have been questioned. Herein, we assessed the institutional variability in these routine practices. METHODS: We retrospectively reviewed patients who underwent unilateral or bilateral inguinal hernia and/or hydrocele repair, open or laparoscopically, at our institution from 2015 to 2018. RESULTS: 1181 patients were included (1074 inguinal hernias and 157 hydroceles). Of 531 specimens obtained from 446 (38%) patients, 515 (97%) were normal. 16 (3%) abnormal pathological findings included 7 with mesothelial hyperplasia, 5 with non-functional genital ductal remnants, 3 with ectopic adrenal cortical tissues, and 1 epidydimal structure which was not recognized at the time of surgery. 418 (35%) patients had scheduled clinic follow-ups 65 (IQR 46-94) days postoperatively. 44 (4%) patients with unexpected postoperative Emergency Department visits within 30 days of surgery were identified. Only one patient required inpatient treatment, and the rest did not require intervention or admission. The total direct cost of analyzing specimens during the study period was $30,798 CAD ($10,266/year). The average cost to detect a potentially significant finding was $1,924.88/specimen and $2,053.20/patient. CONCLUSIONS: Routine pathological examination of hernia sacs and scheduled clinic follow-ups were associated with significant costs and predominantly nonsignificant findings. They should therefore be reserved for patients with a high clinical suspicion of injuries/abnormalities or risk factors for potential complications.
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