Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients?
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 interventio...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-02-01
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| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344120302399 |
| _version_ | 1818870428286844928 |
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| author | Marc R. Angerame, MD David C. Holst, MD Alexandria Phocas, BS Michael A. Williams, MD Douglas A. Dennis, MD Jason M. Jennings, MD DPT |
| author_facet | Marc R. Angerame, MD David C. Holst, MD Alexandria Phocas, BS Michael A. Williams, MD Douglas A. Dennis, MD Jason M. Jennings, MD DPT |
| author_sort | Marc R. Angerame, MD |
| collection | DOAJ |
| description | 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 = 593) or THAs (n = 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 = .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. |
| first_indexed | 2024-12-19T12:06:52Z |
| format | Article |
| id | doaj.art-d4d0daf802e44ce0b98ffd51fb0c1be5 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-19T12:06:52Z |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-d4d0daf802e44ce0b98ffd51fb0c1be52022-12-21T20:22:20ZengElsevierArthroplasty Today2352-34412021-02-017136142Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients?Marc R. Angerame, MD0David C. Holst, MD1Alexandria Phocas, BS2Michael A. Williams, MD3Douglas A. Dennis, MD4Jason M. Jennings, MD DPT5Illinois Bone and Joint Institute, Barrington, IL, USADepartment of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USAColorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USAPorter Adventist Hospital, Denver, CO, USAColorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA; Department of Mechanical and Materials Engineering, Denver University, Denver, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USAColorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA; Department of Mechanical and Materials Engineering, Denver University, Denver, CO, USA; Corresponding author. Colorado Joint Replacement, 2535 S Downing Street Suite 100, Denver, CO 80210, USA. Tel.: +1 720 524 1367.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 = 593) or THAs (n = 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 = .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.http://www.sciencedirect.com/science/article/pii/S2352344120302399Preoperative labsPostoperative labsPT/INRComplete metabolic panelBasic metabolic panelTotal joint replacement |
| spellingShingle | Marc R. Angerame, MD David C. Holst, MD Alexandria Phocas, BS Michael A. Williams, MD Douglas A. Dennis, MD Jason M. Jennings, MD DPT Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients? Arthroplasty Today Preoperative labs Postoperative labs PT/INR Complete metabolic panel Basic metabolic panel Total joint replacement |
| title | Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients? |
| title_full | Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients? |
| title_fullStr | Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients? |
| title_full_unstemmed | Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients? |
| title_short | Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients? |
| title_sort | usefulness of perioperative laboratory tests in total hip and knee arthroplasty are they necessary for all patients |
| topic | Preoperative labs Postoperative labs PT/INR Complete metabolic panel Basic metabolic panel Total joint replacement |
| url | http://www.sciencedirect.com/science/article/pii/S2352344120302399 |
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