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

Marc R. Angerame, MD; David C. Holst, MD; Alexandria Phocas, BS; Michael A. Williams, MD; Douglas A. Dennis, MD; Jason M. Jennings, MD DPT

Arthroplasty Today (Feb 2021)

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

Marc R. Angerame, MD,
David C. Holst, MD,
Alexandria Phocas, BS,
Michael A. Williams, MD,
Douglas A. Dennis, MD,
Jason M. Jennings, MD DPT

Affiliations

Marc R. Angerame, MD: Illinois Bone and Joint Institute, Barrington, IL, USA
David C. Holst, MD: Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
Alexandria Phocas, BS: Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA
Michael A. Williams, MD: Porter Adventist Hospital, Denver, CO, USA
Douglas A. Dennis, MD: Colorado 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, USA
Jason M. Jennings, MD DPT: Colorado 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.

Journal volume & issue: Vol. 7
pp. 136 – 142

Abstract

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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.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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Abstract

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