Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients?

Marc R Angerame; David C Holst; Alexandria Phocas; Michael A Williams; Douglas A Dennis; Jason M Jennings

doi:10.1016/j.artd.2020.12.001

Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients?

Arthroplast Today. 2021 Jan 30:7:136-142. doi: 10.1016/j.artd.2020.12.001. eCollection 2021 Feb.

Authors

Marc R Angerame¹, David C Holst², Alexandria Phocas³, Michael A Williams⁴, Douglas A Dennis^{3

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7}, Jason M Jennings^{3

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Affiliations

¹ Illinois Bone and Joint Institute, Barrington, IL, USA.
² Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
³ Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA.
⁴ Porter Adventist Hospital, Denver, CO, USA.
⁵ Department of Mechanical and Materials Engineering, Denver University, Denver, CO, USA.
⁶ Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA.
⁷ Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA.

Abstract

Background: 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.

Methods: 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.

Results: 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 (P = .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.

Conclusion: 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.

Keywords: Basic metabolic panel; Complete metabolic panel; PT/INR; Postoperative labs; Preoperative labs; Total joint replacement.