Is there Variation in Utilization of Preoperative Tests Among Patients Undergoing Total Hip and Knee Replacement in the US, and Does It Affect Outcomes? A Population-based Analysis

Abstract

Study Objective:To describe recent practice patterns of preoperative tests and to examine their association with 90-day all-cause readmissions and length of stay.Design: Retrospective cohort study using the New York Statewide Planning and Research Cooperative System (SPARCS).Setting: SPARCS from March 1, 2016, to July 1, 2017.Participants: Adults undergoing Total Hip Replacement (THR) or Total Knee Replacement (TKR) had a preoperative screening outpatient visit within two months before their surgery.Interventions: Electrocardiogram (EKG), chest X-ray, and seven preoperative laboratory tests (RBCs antibody screen, Prothrombin time (PT) and Thromboplastin time, Metabolic Panel, Complete Blood Count (CBC), Methicillin Resistance Staphylococcus Aureus (MRSA) Nasal DNA probe, Urine analysis, Urine culture) were identified. Primary and Secondary Outcome Measures: Regression analyses were utilized to determine the association between each preoperative test and two postoperative outcomes (90-day all-cause readmission and length of stay). Regression models adjusted for hospital-level random effects, patient demographics, insurance, hospital TKR, THR surgical volume, and comorbidities. Sensitivity analysis was conducted using the subset of patients with no comorbidities.Results:55,099 patients (60% Female, mean age 66.1+/-9.8 SD) were included. The most common tests were metabolic panel (74.5%), CBC (66.8%), and RBCs antibody screen (58.8%). The least common tests were MRSA Nasal DNA probe (13.0%), EKG (11.7%), urine culture (10.7%), and chest X-ray (7.9%). MRSA testing, urine culture, and EKG were associated with a lower likelihood of 90-day all-cause readmissions. No tests were associated with the length of hospital stay. Results were similar in the subset with no comorbidities.Conclusions:Wide variation exists in preoperative tests before THR and TKR. We identified three preoperative tests that may play a role in reducing readmissions. Further investigation is needed to evaluate these findings using more granular clinical data.