Yeovil District Hospital, UK.
Ann R Coll Surg Engl. 2021 Nov;103(10):757-761. doi: 10.1308/rcsann.2020.7111.
Routine blood tests following total shoulder arthroplasty (TSA) cost the British national health system over £65,000 in 2018 without definite evidence of their impact on patients' outcomes. This study aimed to ascertain whether routine laboratory tests are necessary after elective TSA.
A retrospective review of electronic records was completed for 274 patients that underwent TSA in the past six years. In total, 216 patients were eligible for analysis. The primary outcome was intervention rate for abnormal postoperative blood tests. Secondary outcomes were hospital length of stay (LOS), and readmissions at 30 and 90 days.
In total, 193 patients underwent 216 TSAs; 72% were female, and the mean cohort age was 78 ± 7.2 years. Overall, 136 patients (63%) had an abnormal postoperative blood test, however; only 8 (3.7%) required intervention. The average postoperative drop in haemoglobin (Hb) was 19g/l. In four patients (1.8%) Hb levels dropped to < 80g/l; however, only two (0.9%) were symptomatic and received a red blood cell transfusion. Six patients (2.8%) developed acute kidney injury and did not require haemofiltration. The mean LOS was 3.2 ± 2.9 days. Five patients (2.3%) were readmitted within 30 days and six patients (2.8%) within 90 days. Univariate analysis only showed association between patients with abnormal creatinine and LOS (< 0.05), and all of these patients had raised preoperative creatinine levels.
Routine postoperative blood tests are not required as they did not change the clinical outcome in this cohort or the readmission rate, causing unnecessary costs. It is recommended to request postoperative blood tests for patients with raised preoperative creatinine levels.
2018 年，全肩关节置换术（TSA）后常规血液检查给英国国家医疗服务体系带来了超过 65000 英镑的费用，但没有明确证据表明这些检查会对患者的治疗结果产生影响。本研究旨在确定在择期 TSA 后是否需要进行常规实验室检查。
对过去六年中进行 TSA 的 274 例患者的电子病历进行回顾性分析。共有 216 例患者符合分析条件。主要结果是术后异常血液检查的干预率。次要结果是住院时间（LOS）和术后 30 天和 90 天的再入院率。
共有 193 例患者进行了 216 次 TSA；72%为女性，平均年龄为 78±7.2 岁。总的来说，136 例患者（63%）术后血液检查异常，但仅 8 例（3.7%）需要干预。术后平均血红蛋白（Hb）下降 19g/L。4 例（1.8%）Hb 水平降至<80g/L，但仅有 2 例（0.9%）出现症状并接受了红细胞输注。6 例（2.8%）发生急性肾损伤，无需血液滤过。平均 LOS 为 3.2±2.9 天。5 例（2.3%）患者术后 30 天内再次入院，6 例（2.8%）患者术后 90 天内再次入院。单因素分析仅显示异常肌酐患者与 LOS 之间存在关联（<0.05），所有这些患者术前肌酐水平升高。
术后常规血液检查不需要，因为它们没有改变本队列患者的临床结果或再入院率，造成了不必要的成本。建议对术前肌酐水平升高的患者进行术后血液检查。
