F. Hebal1, M. Browne2, P. Chou1,3, N. Wadhwani1,3, M. Reynolds1,3 1Ann & Robert H Lurie Children’s Hospital Of Chicago,Pediatric Surgery,Chicago, IL, USA 2Lehigh Valley Children’s Hospital,Pediatric Surgery,Allentown, PA, USA 3Northwestern University,Feinberg School Of Medicine,Chicago, IL, USA
Introduction: Frozen Section (FS) is an essential tool that can guide intraoperative decisions directly affecting the methods and endpoint of an operation. FS analysis, however, is a multistep process prone to technical error and errors in communication. Given the technical quality of FS compared to permanent section, discordance rates between FS and final diagnosis reported in previous studies ranges from 1.4-12.9%. The potential consequences to surgical care warrants review of intraoperative FS an important component of an institution’s quality assurance process. The purposes of this study were to assess FS utilization and attitudes regarding FS of pediatric surgeons and pathologists at a stand-alone pediatric tertiary care center.
Methods: We queried hospital EMR to identify FS ordered between June 2013 and June 2014 for patients of any age. Patient medical records were reviewed to identify operative surgeons and pathologists surveyed to assess attitudes regarding FS utilization, discordance between FS and permanent section results, and communication between pathologist and surgeon. Cohen's κ was run to determine agreement between pathologist and surgeon responses.
Results: A total of 217 FS (205 patients) were identified. Of these, 20 mislabeled FS in query, and 12 incomplete surveys were excluded, leaving 185 FS (174 patients) for analysis. Of these, the majority were in Neurosurgery 77(42%) and Pediatric Surgery 76(41%), with remaining specialties accounting for 32(17%). Pathologists felt FS a) did not impact surgical procedure in 63(34%), b) differed from final pathology in 3(2%), and c) was unnecessary in 46(25%) of cases. Surgeons felt FS a) did not impact surgical procedure in 67(36%), b) differed from final pathology in 55(30%), and c) was unnecessary in 61(33%). Analysis showed minimal-to-no agreement between pathologist and surgeon responses. Additionally, surgeons felt FS did not affect outcome in 95(51%), and verbal FS results differed from written FS results in 25(14%) of cases. Survey and analysis summarized in Table 1.
Conclusion: Effective communication and consensus between pathologist and surgeon is crucial to successful FS use in the course of surgical care. Our study demonstrates marked difference between pathologist and surgeon attitudes regarding utilization, reported results, and necessity of FS. Intraoperative FS results given verbally in OR may have contributed to discrepancy between final pathology (as perceived by surgeons) and FS (as reported by pathologists). Notably, a 21% decrease in FS orders in the year following this study may suggest a practice change in surgeon participants. Further investigation is necessary to address these findings and impact on patient outcomes.
