Department of Orthopaedics, Augusta University Medical Center, Augusta, GA, USA.
Department of Orthopaedics, Augusta University Medical Center, Augusta, GA, USA.
J Shoulder Elbow Surg. 2020 Aug;29(8):1656-1664. doi: 10.1016/j.jse.2019.12.023. Epub 2020 Mar 16.
Obtaining postoperative laboratory studies after primary reverse shoulder arthroplasty (RSA) is a common practice. However, justification of this practice remains unclear. This study assesses the utility of routine postoperative laboratory studies in RSA.
The electronic medical records of 369 patients who underwent RSA over 10 years were retrospectively reviewed. A total of 213 patients qualified for analysis. Primary outcomes were intervention related to abnormal laboratory values, length of stay, and 90-day emergency department visits/readmissions. Multivariate logistic regression analysis was performed to identify risk factors associated with abnormal laboratory values and postoperative visits/readmissions.
Of 213 patients analyzed, 188 (88.7%) had abnormal postoperative laboratory values: 69% had an abnormal hemoglobin (Hgb) or hematocrit level, but only 12% underwent interventions. Lower preoperative Hgb was a significant predictor of receiving a transfusion. A significant association existed between abnormal postoperative electrolyte and creatinine levels with lower body mass index (BMI) and higher Charlson Comorbidity Index (CCI). Only 4 patients (1.8%) received non-transfusion related intervention. Emergency department visits were not statistically different between patients with positive or negative laboratory tests (P = .73).
Because 87.3% of laboratory studies did not influence patient management, we recommend against routine testing for primary RSA. This study demonstrates that the practice of obtaining routine postoperative laboratory studies is not justified. We recommend selectively obtaining a postoperative basic metabolic profile in patients with increased American Society of Anesthesiologists classification and/or CCI with a lower BMI. We also recommend selectively ordering postoperative complete blood count in patients with a lower preoperative Hgb.
在初次反肩关节置换术（RSA）后获取术后实验室研究结果是一种常见做法。然而，这种做法的合理性仍不清楚。本研究评估 RSA 后常规术后实验室研究的效用。
回顾性分析了 10 年间行 RSA 的 369 例患者的电子病历。共有 213 例患者符合分析条件。主要结果是与异常实验室值、住院时间和 90 天急诊就诊/再入院相关的干预。采用多变量逻辑回归分析确定与异常实验室值和术后就诊/再入院相关的危险因素。
在分析的 213 例患者中，188 例（88.7%）的术后实验室值异常：69%的血红蛋白（Hgb）或血细胞比容水平异常，但只有 12%的患者接受了干预。术前 Hgb 较低是接受输血的显著预测因素。术后电解质和肌酐水平异常与较低的体重指数（BMI）和较高的 Charlson 合并症指数（CCI）显著相关。只有 4 例（1.8%）患者接受了非输血相关的干预。实验室检查阳性和阴性患者的急诊就诊率无统计学差异（P=0.73）。
由于 87.3%的实验室检查结果并未影响患者的管理，我们建议不要对 RSA 进行常规检测。本研究表明，获得常规术后实验室研究结果的做法是不合理的。我们建议在具有更高的美国麻醉医师协会分类和/或 CCI 且 BMI 较低的患者中选择性地获得术后基本代谢谱。我们还建议在术前 Hgb 较低的患者中选择性地进行术后全血细胞计数。
