INDICATIONS AND IMMEDIATE PATIENT OUTCOMES OF PATHOLOGY INTRAOPERATIVE CONSULTATIONS - A COLLEGE-OF-AMERICAN-PATHOLOGISTS CENTERS-FOR-DISEASE-CONTROL AND PREVENTION OUTCOMES WORKING GROUP-STUDY

Objective.-To evaluate the reasons (indications) for and immediate int raoperative surgical results (outcomes) associated with pathology intr aoperative consultation. Design.-ln 1992 and 1993, surgeons collaborat ed with pathologists in 472 voluntarily participating institutions fro m the United States (462), Canada (7), Australia (2), and New Zealand (1) in a study jointly sponsored by the College of American Pathologis ts and the Centers for Disease Control and Prevention. Pathologists se lected 20 consecutive intraoperative consultations and assembled a cov er letter, a checklist questionnaire, and a copy of the corresponding surgical pathology report, all of which were sent to the surgeon(s) fo r retrospective evaluation. Participants.-The study was distributed to participants in the College of American Pathologists voluntary Q-Prob es quality improvement and Surgical Pathology Performance Improvement programs and to Canadian and Australian hospitals with more than 200 b eds. Results.-Evaluation of 9164 cases established the five most commo n indications for intraoperative consultation: (1) establish or confir m diagnosis to determine type or extent of operation (51%), (2) confir m adequacy of margins (16%), (3) confirm nature of tissue to direct sa mpling for immediate culture or other laboratory study (10%), (4) expe dite obtaining diagnosis to inform family or patient (8%), and (5) con firm sufficient tissue submitted to secure diagnosis in permanent sect ion (8%). The information provided by the intraoperative consultation resulted in changed surgical procedures that were either modified, ter minated, or newly initiated in 47%, 30%, 6%, 9%, and 28% of cases, cor responding respectively to each of the above five common indications. Rarely cited reasons for intraoperative consultation were to expedite obtaining diagnosis for surgeon's knowledge (3%), to facilitate patien t management, other professional communication or discharge planning p rior to permanent section availability (3%), academic protocol (<1%), and consultation not needed or no reason for request (<1%). Conclusion s.-This multi-institutional, interdisciplinary database confirms that pathology intraoperative consultations, regardless of the initial indi cations, influence immediate patient care decisions, resulting in chan ged surgical procedures in an average of 39% of all operative cases.