Naathan Habillan, Ilo Kevin, Berber Reshid, Matar Hosam E, Bloch Benjamin
Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Bone Jt Open. 2023 May 17;4(5):357-362. doi: 10.1302/2633-1462.45.BJO-2022-0124.R1.
It is common practice for patients to have postoperative blood tests after total joint replacement (TJR). However, there have been significant improvements in perioperative care with arthroplasty surgery, and a drive to reduce the length of stay (LOS) and move towards day-case TJR. We should reconsider whether this intervention is necessary for all patients.
This retrospective study included all patients who underwent a primary unilateral TJR at a single tertiary arthroplasty centre during a one-year period. Electronic medical records of 1,402 patients were reviewed for patient demographics, LOS, and American Society of Anesthesiologists (ASA) grade. Blood tests were examined to investigate the incidence of postoperative anaemia, electrolyte abnormalities, and incidence of acute kidney injury (AKI).
For total knee arthroplasties, preoperative ( = -0.22) and postoperative haemoglobin ( = 0.2) levels were both negatively correlated with LOS (p < 0.001). For all patients who had undergone a TJR, 19 patients (0.014%) required a blood transfusion postoperatively due to symptomatic anaemia. Risk factors identified were age, preoperative anaemia, and long-term aspirin use. Significant abnormal sodium levels were found in123 patients (8.7%). However, only 36 patients (2.6%) required intervening treatment. Risk factors identified were age, preoperative abnormal sodium level, and long-term use of non-steroidal anti-inflammatory drugs, angiotensin receptor blockers, and corticosteroids. Similarly, abnormal potassium levels were evident in 53 patients (3.8%), and only 18 patients (1.3%) required intervening treatment. Risk factors identified were preoperative abnormal potassium level, and long-term use of angiotensin-converting enzyme inhibitors and diuretics. The incidence of AKI was 4.4% (61 patients). Risk factors identified were age, increased ASA grade, preoperative abnormal sodium, and creatinine level.
Routine blood tests after primary TJR is unnecessary for most patients. Blood tests should only be performed on those with identifiable risk factors such as preoperative anaemia and electrolyte abnormalities, haematological conditions, long-term aspirin use, and electrolyte-altering medications.
全关节置换术（TJR）后对患者进行术后血液检查是常见做法。然而，关节置换手术的围手术期护理有了显著改善，并且有减少住院时间（LOS）并朝着日间手术TJR发展的趋势。我们应该重新考虑这种干预措施是否对所有患者都必要。
这项回顾性研究纳入了在一个单一的三级关节置换中心在一年内接受初次单侧TJR的所有患者。查阅了1402例患者的电子病历，以了解患者的人口统计学信息、住院时间和美国麻醉医师协会（ASA）分级。检查血液检查结果以调查术后贫血、电解质异常的发生率以及急性肾损伤（AKI）的发生率。
对于全膝关节置换术，术前（=-0.22）和术后血红蛋白（=0.2）水平均与住院时间呈负相关（p<0.001）。在所有接受TJR的患者中，19例（0.014%）因症状性贫血术后需要输血。确定的危险因素为年龄、术前贫血和长期使用阿司匹林。123例患者（8.7%）发现有显著的钠水平异常。然而，只有36例患者（2.6%）需要进行干预治疗。确定的危险因素为年龄、术前钠水平异常以及长期使用非甾体抗炎药、血管紧张素受体阻滞剂和皮质类固醇。同样，53例患者（3.8%）有明显的钾水平异常，只有18例患者（1.3%）需要进行干预治疗。确定的危险因素为术前钾水平异常以及长期使用血管紧张素转换酶抑制剂和利尿剂。AKI的发生率为4.4%（61例患者）。确定的危险因素为年龄、ASA分级增加、术前钠异常和肌酐水平。
对于大多数患者，初次TJR后进行常规血液检查是不必要的。血液检查仅应在具有可识别危险因素的患者中进行，如术前贫血和电解质异常、血液系统疾病、长期使用阿司匹林以及使用改变电解质的药物。
