Article Text

Review of pathology and cost benefit analysis of hernia sacs processed over a 19-year period
1. Arshia Kazerouni,
2. Klaudia M Nowak,
3. Stefano Serra,
4. Rajkumar Vajpeyi,
5. Kenny Chieu,
6. Runjan Chetty
1. Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
1. Correspondence to Professor Runjan Chetty, Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, M5G 2C4, Canada; runjan.chetty{at}gmail.com

## Abstract

Aim Hernia sacs with pathological evaluation over a 19-year period were analysed with regards to pathological diagnoses, full costing and the impact on patient management.

Materials and methods The database of the Department of Pathology were searched over the study period (2001 to 2019 inclusive) for hernia sacs. The total cost of complete pathology examination was calculated on average numbers and rates of pay that existed over the study period.

Results A total of 3619 hernia sacs from the abdominal, hiatus/diaphragmatic, inguinal and femoral hernias were retrieved. Of these 3592 cases (99.25%) had sections taken for histological evaluation. A total of 3437 cases representing 95.7% of all hernia sacs did not show any pathological abnormality. If non-neoplastic clinically insignificant lesions seen in hernia sacs is included, then 3552 of 3592 (98.9%) hernia sacs underwent full pathological evaluation for no patient benefit.

On average two blocks or tissue sections per case were processed incurring a technical cost of $53 175.00. The total pathologist cost in reporting the 3592 cases was approximately$39 870.00 and rose to $40 410.00 when interpretation of ancillary tests was factored in.$95 328.90 (average $26.90 per specimen with a yearly average total cost of$5 017.31) was spent over the 19-year period in full pathological examination of 3592 hernia sacs.

Conclusion Given the low return on investment and the difficult to quantify time savings and reallocation, we do not advocate the routine sampling of hernia sacs. Gross examination will suffice in 99% of the cases. Selective cases may be sampled if clinically indicated.

• audit
• clinical audit
• costing & pricing
• histopathology

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## Footnotes

• Handling editor Dhirendra Govender.

• Contributors Author contributorship statement: AK and KN were responsible for data extraction, pathology report review and collating all information. KC was responsible for the financial costing. RC was responsible for the concept and execution. All authors contributed to the writing, editing and direction of the manuscript.

• Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

• Competing interests None declared.

• Patient consent for publication Not required.

• Ethics approval Institutional research ethics board approval was obtained: CAPCR ID: 17–5578.

• Provenance and peer review Not commissioned; externally peer reviewed.

• Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.