Orthopaedic Associates of Michigan, Grand Rapids, MI.
Florida Orthopaedic Institutue, Temple Terrace, FL.
J Arthroplasty. 2021 Apr;36(4):1257-1261. doi: 10.1016/j.arth.2020.10.047. Epub 2020 Oct 29.
Routine postoperative complete blood count tests are commonplace after total joint arthroplasty. The goal of this study was to identify if these result in any clinically meaningful action and if it would be safe to forego this testing in a population without known risk factors for transfusion.
A retrospective review of 1060 patients undergoing a total knee or total hip arthroplasty at a single institution was performed. Data points including patient demographics, preoperative and postoperative laboratory results, tranexamic acid use, preoperative and postoperative medication for venous thromboembolism prophylaxis and anticoagulation, as well as 90-day readmission related to anemia were collected.
The transfusion rate for all patients was 0.66% (7/1060) and there was only one transfusion for a patient with a preoperative hemoglobin (Hb) greater than 12 g/dL (1/976; 0.1%). There was no difference in the change from preoperative to postoperative day 1 Hb levels in patients treated with aspirin compared with those on direct oral anticoagulation (P = .73). There were no 90-day readmissions related to acute blood loss anemia.
This study demonstrates that routine postoperative complete blood count testing is not absolutely necessary and does not provide additional value in the vast majority of patients with preoperative Hb levels equal to or greater than 12 g/dL when tranexamic acid is administered. This could avoid unnecessary testing in patients and increased savings to the health care system.
Level 3, retrospective cohort.
全关节置换术后常规进行术后全血细胞计数检查较为常见。本研究旨在确定这些检查是否具有任何临床意义，以及在没有已知输血风险因素的人群中是否可以安全地避免这种检查。
对一家医疗机构的 1060 例全膝关节或全髋关节置换术患者进行回顾性研究。收集的数据点包括患者人口统计学特征、术前和术后实验室结果、氨甲环酸的使用情况、术前和术后预防静脉血栓栓塞和抗凝的药物，以及与贫血相关的 90 天再入院情况。
所有患者的输血率为 0.66%（7/1060），仅有 1 例术前血红蛋白（Hb）大于 12 g/dL（1/976；0.1%）的患者接受输血。与使用阿司匹林的患者相比，接受直接口服抗凝剂治疗的患者术后第 1 天 Hb 水平从术前到术后的变化无差异（P =.73）。没有与急性失血性贫血相关的 90 天再入院。
本研究表明，在术前 Hb 水平等于或大于 12 g/dL 且使用氨甲环酸的情况下，常规进行术后全血细胞计数检查并非绝对必要，并且在绝大多数患者中并未提供额外价值。这可以避免对患者进行不必要的检查，并为医疗保健系统节省开支。
3 级，回顾性队列。
