Cost effectiveness of routine histology for haemorrhoidectomy specimens

Henry K. Watter; Guat Shi Ng; Sasikaran Nalliah

doi:10.18203/2349-2902.isj20215127

Authors

Henry K. Watter Department of General Surgery, Hervey Bay Hospital, Hervey Bay, Queensland, Australia http://orcid.org/0000-0002-8311-6812
Guat Shi Ng Department of General Surgery, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
Sasikaran Nalliah Department of General Surgery, Hervey Bay Hospital, Hervey Bay, Queensland, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20215127

Keywords:

Anal, Cancer, Cost, Haemorrhoid, Histology, Value

Abstract

Background: Routine histology for haemorrhoidectomy specimens remains commonplace in clinical practice, as a method of detecting incidental anal cancer. However, its utility and cost-effectiveness is unclear in the literature. This study aimed to determine the cost-effectiveness of routine histology for haemorrhoidectomy specimens in a regional Australian hospital. The secondary aim was to determine the proportion of specimens sent for histology, and whether individual surgeons had a statistically significant preference for whether to send for histology.

Methods: This was a retrospective cohort study of patients who received haemorrhoidectomies at Hervey Bay Hospital between March 2012 and May 2020. Cost effectiveness of routine histology was investigated by weighing the number of incidental anal cancers detected against the cost of analysis. The proportion sent for histology was determined, both as a whole and by individual consultant surgeons.

Results: Routine histology was ordered in 65% of patients who received haemorrhoidectomies over the study period (n=119), costing $13,623 AUD ($1,651 AUD per year). No cases of incidental anal dysplasia or neoplasia were found. Only 1 of the 8 most prolific surgeons over the study period demonstrated a statistically significant preference for whether to send for histology.

Conclusions: Our study does not support routine histology for haemorrhoidectomy specimens as a cost-effective practice for detecting incidental anal cancer. Most individual surgeons did not display a clear preference for whether to send for histology.

Metrics

Metrics Loading ...

References

Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009-17.

Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist’s view. World J Gastroenterol. 2015;21(31):9245-52.

Mascagni P, Eberspacher C, Saraceno F, Felli E, Sileri P, Fralleone L, et al. Routine pathology examination in the era of value-based healthcare: the case of haemorrhoids specimens. Updates Surg. 2020;72:83-8.

Cataldo PA, MacKeigan JM. The necessity of routine pathologic evaluation of hemorrhoidectomy specimens. Surg Gynecol Obstet. 1992;174(4):302-4.

Christensen A, Solstad K. Routine microscopic examination of excised hemorrhoids. Ugeskr Laeger. 1983;145(31):2369-70.

Fenger C, Nielsen VT. Dysplastic changes in the anal canal epithelium in minor surgical specimens. Acta Pathol Microbiol Immunol Scand A. 1981;89(6):463-5.

Grodsky L. Unsuspected carcinoma found histologically after minor anorectal operations. Calif Med. 1967;106(1):44-8.

Lemarchand N, Tanne F, Aubert M, Benfredj P, Denis J, Dubois-Arnous N, et al. Is routine pathologic evaluation of hemorrhoidectomy specimens necessary? Gastroenterol Clin Biol. 2005;29(2):659-61.

Foust RL, Dean PJ, Stoler MH, Moinuddin SM. Intraepithelial neoplasia of the anal canal in hemorrhoidal tissue: a study of 19 cases. Hum Pathol. 1991;22(6):528-34.

Luca N, Valentina A, Federico S, Renato P. Unexpected anal squamous cells carcinoma after open hemorrhoidectomy. Case Rep Surg. 2015;2015:616274.

Parab S, Bhalerao S. Choosing statistical test. Int J Ayurveda Res. 2010;1(3):187-91.

Salati SA, Al Kadi A. Anal cancer- a review. Int J Health Sci (Qassim). 2012;6(2):206-30.