Routine Laboratory Tests are not Necessary After Primary Total Joint Arthroplasty: A Prospective Study Utilizing a Selective Algorithmic Approach

Phillips, Jessica; Fillingham, Yale A.; Mitchell, William; Nimoityn, Philip; Restrepo, Camilo; Sherman, Matthew; Austin, Matthew S.

doi:10.1016/j.arth.2022.04.004

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…When controlling for confounding variables, primary TJA patients with postoperative sodium of ‡135 mEq/L were less likely to undergo non-home discharge or experience in-hospital complications than those with a value of <130 mEq/L. With advancements in perioperative protocols and the push toward less frequent laboratory evaluation 13 , it is important to identify individuals who are at risk for electrolyte disturbances following TJA. Previous studies have identified several risk factors for postoperative hyponatremia, including older age, lower preoperative sodium levels, the use of diuretics, longer operative time, greater blood loss, and greater comorbidities 5,6,10,17 .…”

Section: Discussionmentioning

confidence: 99%

“…With advancements in perioperative protocols and the push toward less frequent laboratory evaluation 13 , it is important to identify individuals who are at risk for electrolyte disturbances following TJA. Previous studies have identified several risk factors for postoperative hyponatremia, including older age, lower preoperative sodium levels, the use of diuretics, longer operative time, greater blood loss, and greater comorbidities 5,6,10,17 .…”

Section: Discussionmentioning

confidence: 99%

“…Relatively few studies have investigated the effects of perioperative sodium status in TJA patients. Although there has been a recent push to limit the routine use of laboratory tests in arthroplasty patients 13 , metabolic panels that include sodium levels are nonetheless commonly ordered at most institutions. Several factors have been found to be associated with the development of postoperative hyponatremia, including age, preoperative hyponatremia, the use of thiazide diuretics, and diabetes mellitus 4,9,10,14 .…”

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confidence: 99%

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Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty

Baker

Goh

Tarabichi

et al. 2023

Journal of Bone and Joint Surgery

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Background:Hyponatremia is a common electrolyte abnormality in arthroplasty patients. This issue, underrecognized by surgeons, can impact the postoperative course of patients. There are, however, little data on the implications of sodium disturbances following total joint arthroplasty (TJA). The primary aims of this study were to (1) report the rate of hyponatremia following TJA, and (2) examine the impact of hyponatremia on the perioperative course of TJA patients.Methods:This was a retrospective analysis of 3,071 primary and revision TJAs performed between 2015 and 2017. Based on preoperative and postoperative sodium values (pre-post), patients were classified into 4 groups: normonatremic-normonatremic (Group 1), normonatremic-hyponatremic (Group 2), hyponatremic-normonatremic (Group 3), and hyponatremic-hyponatremic (Group 4). Primary end points were length of stay (LOS), postoperative discharge, in-hospital complications, and 90-day readmissions.Results:The distribution of cases was 84.6% Group 1, 9.4% Group 2, 2.1% Group 3, and 3.8% Group 4. Overall, 13.2% of patients had hyponatremia after TJA. Older age, hip arthroplasty, general anesthesia, higher Charlson Comorbidity Index, congestive heart failure, revision surgery, and history of stroke, liver disease, and chronic kidney disease were risk factors for postoperative hyponatremia. Patients with postoperative hyponatremia (Groups 2 and 4) had greater likelihoods of having a 90-day complication and non-home discharge and greater LOS.Conclusions:Postoperative hyponatremia was a relatively common occurrence in patients undergoing TJA, and was associated with greater LOS, complications, and non-home discharge. Surgeons should identify patients at risk for developing sodium abnormalities in order to optimize these patients and avoid increased resource utilization.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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