Bookman Jared S, Romanelli Filippo, Hutzler Lorraine, Bosco Joseph A, Lajam Claudette
Bull Hosp Jt Dis (2013). 2019 Mar;77(2):132-135.
Routine immediate postoperative laboratory studies, including metabolic panels and hematologic profiles, are commonly ordered after arthroplasty procedures. However, their values only occasionally influence management. This study investigated the clinical utility and value of these tests.
A large retrospective cohort study of 18,935 patients spanning a 6-year period from 2008 to 2013 from a single high-volume institution was evaluated. Only immediate postoperative labs drawn on postoperative day 0 in the recovery room were included in the study. Complete blood counts (CBC) and basic metabolic panels (BMP) were reviewed, and ranges of abnormal were set for each lab test based on values significant enough to impact patient management. Cost effectiveness calculations were made based on current cost of the laboratory tests.
Actionably low hemoglobin values ( < 8 g/dL) were found in 1.44% of the overall cohort. Unilateral primary total knee arthroplasty was associated with the fewest hemoglobin abnormalities at 0.59%. Primary unilateral total hip arthroplasty was associated with abnormal hemoglobin values in 1.81% of cases. Significant electrolyte abnormalities were far less common, with hyperkalemia (> 6.5 mEq/L) in 0.19%, hyponatremia ( < 120 mEq/L) in 0.01% and elevated creatinine (> 2.0 mg/dL) was found in 0.25%. Hemoglobin values were calculated at a cost of $1,710 to detect a single significantly abnormal result. The cost to detect a single actionably abnormal BMP value was $1,000.
Routine immediate postoperative laboratory tests represent a high institutional cost and are seldom abnormal enough to warrant a change in patient management. The routine use of these tests can likely be safely eliminated in uncomplicated primary unilateral arthroplasty procedures.
关节置换术后通常会进行常规的术后即时实验室检查，包括代谢指标和血液学指标。然而，这些检查结果仅偶尔会影响治疗决策。本研究旨在探讨这些检查的临床实用性和价值。
对一家大型机构在2008年至2013年期间的18935例患者进行了一项为期6年的大型回顾性队列研究。本研究仅纳入在恢复室术后第0天采集的术后即时实验室检查结果。对全血细胞计数（CBC）和基本代谢指标（BMP）进行了评估，并根据足以影响患者治疗决策的数值为每项实验室检查设定了异常范围。根据当前实验室检查的成本进行了成本效益计算。
在整个队列中，有1.44%的患者血红蛋白值低至有临床意义（<8 g/dL）。单侧初次全膝关节置换术患者血红蛋白异常最少，为0.59%。初次单侧全髋关节置换术患者中有1.81%出现血红蛋白异常。明显的电解质异常则更为少见，高钾血症（>6.5 mEq/L）为0.19%，低钠血症（<120 mEq/L）为0.01%，肌酐升高（>2.0 mg/dL）为0.25%。计算得出，检测出一例明显异常的血红蛋白结果的成本为1710美元。检测出一例有临床意义的异常BMP值的成本为1000美元。
术后常规即时实验室检查成本高昂，且很少出现异常到足以改变患者治疗决策的情况。在无并发症的单侧初次关节置换手术中，可能可以安全地取消这些检查的常规使用。
