Angerame Marc R, Holst David C, Phocas Alexandria, Williams Michael A, Dennis Douglas A, Jennings Jason M
Illinois Bone and Joint Institute, Barrington, IL, USA.
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Arthroplast Today. 2021 Jan 30;7:136-142. doi: 10.1016/j.artd.2020.12.001. eCollection 2021 Feb.
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.
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.
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 ( = .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.
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.
全髋关节置换术（THA）和全膝关节置换术（TKA）术前和术后通常会进行实验室检查。本研究评估了围手术期常规实验室检查的必要性，并确定了与实验室相关干预措施的风险因素。
这项回顾性研究评估了在一家机构18个月期间连续安排进行初次单侧TKA（n = 593）或THA（n = 374）的967例患者。记录术前凝血酶原时间（PT）和国际标准化比值（INR）、全血细胞计数（CBC）、全代谢指标（CMP），以及术后CBC和基本代谢指标（BMP），以及任何与实验室相关的干预措施。患者的人口统计学特征和合并症确定了异常或可采取行动的实验室检查的风险因素。
术前，PT/INR、CMP和CBC的可采取行动率分别为0.3%、1.4%和0.5%。血管疾病、肾脏疾病和免疫疾病是CBC可采取行动的风险因素。CMP可采取行动的风险因素包括心律失常和糖尿病。PT/INR可采取行动没有风险因素。术后，只有1.5%的BMP和1.5%的CBC是可采取行动的。充血性心力衰竭、肾脏疾病、血管疾病或癌症病史（P = .030）是CBC可采取行动的风险因素。BMP可采取行动没有风险因素。术前实验室检查异常的患者术后实验室检查可采取行动的可能性高2.4倍。术前实验室检查可采取行动的患者术后实验室检查可采取行动的可能性高11.3倍。
对于所有接受TKA或THA的患者，术前和术后常规实验室检查可能并非必要。合并症风险因素以及术前CMP和CBC异常或可采取行动，有助于确定术后实验室评估的有用性。
