Routine Postoperative Chemistry Panels Are Not Necessary for Most Total Joint Arthroplasty Patients

Tischler, Eric H.; Restrepo, Camilo; Ponzio, Danielle Y.; Austin, Matthew S.

doi:10.2106/jbjs.20.01530

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…Previous studies have shown that abnormal preoperative laboratory results and certain medications are risk factors for postoperative electrolyte disturbance. 26 Patients are also at risk of AKI after major surgery. However, postoperative AKI was found in only 61 (4.4%) of all patients in this study.…”

Section: Discussionmentioning

confidence: 99%

Are postoperative blood tests always required after lower limb arthroplasty?

et al. 2023

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AimsIt is common practice for patients to have postoperative blood tests after total joint replacement (TJR). However, there have been significant improvements in perioperative care with arthroplasty surgery, and a drive to reduce the length of stay (LOS) and move towards day-case TJR. We should reconsider whether this intervention is necessary for all patients.MethodsThis retrospective study included all patients who underwent a primary unilateral TJR at a single tertiary arthroplasty centre during a one-year period. Electronic medical records of 1,402 patients were reviewed for patient demographics, LOS, and American Society of Anesthesiologists (ASA) grade. Blood tests were examined to investigate the incidence of postoperative anaemia, electrolyte abnormalities, and incidence of acute kidney injury (AKI).ResultsFor total knee arthroplasties, preoperative (R = −0.22) and postoperative haemoglobin (R = 0.2) levels were both negatively correlated with LOS (p < 0.001). For all patients who had undergone a TJR, 19 patients (0.014%) required a blood transfusion postoperatively due to symptomatic anaemia. Risk factors identified were age, preoperative anaemia, and long-term aspirin use. Significant abnormal sodium levels were found in123 patients (8.7%). However, only 36 patients (2.6%) required intervening treatment. Risk factors identified were age, preoperative abnormal sodium level, and long-term use of non-steroidal anti-inflammatory drugs, angiotensin receptor blockers, and corticosteroids. Similarly, abnormal potassium levels were evident in 53 patients (3.8%), and only 18 patients (1.3%) required intervening treatment. Risk factors identified were preoperative abnormal potassium level, and long-term use of angiotensin-converting enzyme inhibitors and diuretics. The incidence of AKI was 4.4% (61 patients). Risk factors identified were age, increased ASA grade, preoperative abnormal sodium, and creatinine level.ConclusionRoutine blood tests after primary TJR is unnecessary for most patients. Blood tests should only be performed on those with identifiable risk factors such as preoperative anaemia and electrolyte abnormalities, haematological conditions, long-term aspirin use, and electrolyte-altering medications.Cite this article: Bone Jt Open 2023;4(5):357–362.

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Section: Discussionmentioning

confidence: 99%