Orfanos Georgios, Nantha Kumar Nakulan, Redfern Daniel, Burston Ben, Banerjee Robin, Thomas Geraint
The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK.
Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
Bone Jt Open. 2023 Nov 24;4(11):899-905. doi: 10.1302/2633-1462.411.BJO-2023-0137.R1.
We aim to evaluate the usefulness of postoperative blood tests by investigating the incidence of abnormal results following total joint replacement (TJR), as well as identifying preoperative risk factors for abnormal blood test results postoperatively, especially pertaining to anaemia and acute kidney injury (AKI).
This is a retrospective cohort study of patients who had elective TJR between January and December 2019 at a tertiary centre. Data gathered included age at time of surgery, sex, BMI, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative laboratory test results, haemoglobin (Hgb), white blood count (WBC), haematocrit (Hct), platelets (Plts), sodium (Na), potassium (K), creatinine (Cr), estimated glomerular filtration rate (eGFR), and Ferritin (ug/l). Abnormal blood tests, AKI, electrolyte imbalance, anaemia, transfusion, reoperation, and readmission within one year were reported.
The study included 2,721 patients with a mean age of 69 years, of whom 1,266 (46.6%) were male. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥ 65 years), female sex, and ASA grade ≥ III as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dl) and packed cell volume (≤ 0.395 l/l) were noted to be significant risk factors for postoperative anaemia, and potassium (≤ 3.7 mmol/l) was noted to be a significant risk factor for AKI.
The costs outweigh the benefits of ordering routine postoperative blood tests in TJR patients. Clinicians should risk-stratify their patients and have a lower threshold for ordering blood tests in patients with abnormal preoperative haemoglobin (≤ 127 g/l), blood loss > 300 ml, chronic kidney disease, ASA grade ≥ III, and clinical concern.
我们旨在通过调查全关节置换术（TJR）后异常结果的发生率，评估术后血液检查的实用性，并确定术后血液检查结果异常的术前危险因素，特别是与贫血和急性肾损伤（AKI）相关的因素。
这是一项对2019年1月至12月在一家三级中心接受择期TJR的患者进行的回顾性队列研究。收集的数据包括手术时的年龄、性别、体重指数、美国麻醉医师协会（ASA）分级、术前和术后实验室检查结果、血红蛋白（Hgb）、白细胞计数（WBC）、血细胞比容（Hct）、血小板（Plts）、钠（Na）、钾（K）、肌酐（Cr）、估算肾小球滤过率（eGFR）和铁蛋白（微克/升）。报告了异常血液检查、AKI、电解质失衡、贫血、输血、再次手术和一年内再次入院的情况。
该研究纳入了2721例平均年龄为69岁的患者，其中1266例（46.6%）为男性。444例（16.3%）患者术后血液检查异常。我们确定年龄（≥65岁）、女性和ASA分级≥III为术后血液检查异常的危险因素。术前血红蛋白（≤127克/分升）和红细胞压积（≤0.395升/升）被认为是术后贫血的重要危险因素，钾（≤3.7毫摩尔/升）被认为是AKI的重要危险因素。
在TJR患者中，常规术后血液检查的成本超过了其益处。临床医生应对患者进行风险分层，对于术前血红蛋白异常（≤127克/升）、失血>300毫升、慢性肾病、ASA分级≥III以及存在临床担忧的患者，进行血液检查的阈值应更低。
