Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients?

Abstract

Background: Laboratory studies are routinely obtained preoperatively and postoperatively for total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study evaluates the necessity of routine, perioperative laboratory tests and identifies risk factors for laboratory-associated interventions. Methods: This retrospective review evaluated 967 consecutive patients scheduled for primary, unilateral TKAs (n ¼ 593) or THAs (n ¼ 374) over an 18-month period at a single institution. Preoperative prothrombin time (PT) and International Normalized Ratio (INR), complete blood count (CBC), complete metabolic panel (CMP), and postoperative CBC and basic metabolic panel (BMP) were recorded along with any laboratory-associated intervention. Patient demographics and comorbidities identified risk factors for abnormal or actionable laboratory studies. Results: Preoperatively, the actionable rates for PT/INR, CMP, and CBC were 0.3%, 1.4%, and 0.5%, respectively. Vascular, renal, and immunologic diseases were risk factors for an actionable CBC. Risk factors for an actionable CMP include cardiac arrhythmia and diabetes. There were no risk factors for an actionable PT/INR. Postoperatively, only 1.5% of BMPs and 1.5% of CBCs were actionable. Congestive heart failure, renal disease vascular disease, or history of cancer (P ¼ .030) were risk factors for an actionable CBC. There were no risk factors for an actionable BMP. Patients with an abnormal preoperative lab were 2.4 times more likely to have an actionable postoperative lab. Patients with an actionable preoperative lab were 11.3 times more likely to have an actionable postoperative lab. Conclusion: Routine preoperative and postoperative labs may not be necessary on all patients undergoing a TKA or THA. Comorbid risk factors and abnormal or actionable preoperative CMPs and CBCs can help determine the usefulness of postoperative laboratory assessments.

Abnormal preoperative leukocyte counts and postoperative complications following total shoulder arthroplasty

“…Angerame et al concluded that medical comorbidities and abnormal preoperative lab tests should guide the decision to obtain postoperative lab testing. 3 However, their conclusion was solely based on whether abnormal labs led to actionable medical interventions. Hence, their study does acknowledge that abnormal preoperative labs can still predict adverse outcomes.…”

Are postoperative blood tests always required after lower limb arthroplasty?

“…Other studies have found specific comorbidities that could also guide postoperative blood tests. 35 The routine use of postoperative blood tests is a significant financial burden to healthcare providers, 36 and previous studies have suggested that this is not a cost-effective practice. 37 It is also essential that patients with these risk factors be managed and optimized preoperatively to avoid postoperative interventions.…”

Preoperative Laboratory Values Predicting Periprosthetic Joint Infection in Morbidly Obese Patients Undergoing Total Hip or Knee Arthroplasty

“…The study included preoperative neutrophil, monocyte, total lymphocyte, leukocyte, and platelet counts; albumin level; albuminglobulin ratio (A/G ratio); hemoglobin level; and HbA1c. These values are commonly utilized as screening metrics for patients undergoing TJA and have previously been identified as predictors of postoperative complications following TJA [21][22][23][24]26,27,[43][44][45][46][47][48][49][50][51][52] . The NLR, MLR, PLR, and SII were included to investigate their preoperative utility to predict PJI due to their proven function as diagnostic markers of PJI and as preoperative predictors of complications in other surgical specialties [53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] .…”

“…Preoperative risk stratification and medical optimization remain paramount to mitigate the risk of complications in this high-risk population. Preoperative laboratory values, including a complete blood-cell count (CBC) and albumin level, are routinely obtained and have demonstrated utility in predicting complications following total joint arthroplasty (TJA) [21][22][23][24][25][26][27] . Additionally, there is a growing interest in CBC-based ratios (CBRs), including the platelet-lymphocyte ratio (PLR), neutrophillymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII), which serve as markers of systemic inflammation.…”