The association of preoperative blood markers with postoperative readmissions following arthroplasty

Abstract

Aims While preoperative bloodwork is routinely ordered, its value in determining which patients are at risk of postoperative readmission following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is unclear. The objective of this study was to determine which routinely ordered preoperative blood markers have the strongest association with acute hospital readmission for patients undergoing elective TKA and THA. Methods Two population-based retrospective cohorts were assembled for all adult primary elective TKA (n = 137,969) and THA (n = 78,532) patients between 2011 to 2018 across 678 North American hospitals using the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) registry. Six routinely ordered preoperative blood markers - albumin, haematocrit, platelet count, white blood cell count (WBC), estimated glomerular filtration rate (eGFR), and sodium level - were queried. The association between preoperative blood marker values and all-cause readmission within 30 days of surgery was compared using univariable analysis and multivariable logistic regression adjusted for relevant patient and treatment factors. Results The mean TKA age was 66.6 years (SD 9.6) with 62% being females (n = 85,163/137,969), while in the THA cohort the mean age was 64.7 years (SD 11.4) with 54% being female (n = 42,637/78,532). In both cohorts, preoperative hypoalbuminemia (< 35 g/l) was associated with a 1.5- and 1.8-times increased odds of 30-day readmission following TKA and THA, respectively. In TKA patients, decreased eGFR demonstrated the strongest association with acute readmission with a standardized odds ratio of 0.75 per two standard deviations increase (p < 0.0001). Conclusion In this population level cohort analysis of arthroplasty patients, low albumin demonstrated the strongest association with acute readmission in comparison to five other commonly ordered preoperative blood markers. Identification and optimization of preoperative hypoalbuminemia could help healthcare providers recognize and address at-risk patients undergoing TKA and THA. This is the most comprehensive and rigorous examination of the association between preoperative blood markers and readmission for TKA and THA patients to date. Cite this article: Bone Jt Open 2021;2(6):388–396.

Abnormal preoperative platelet count may predict postoperative complications following shoulder arthroplasty

“… 31 In addition, the database is audited on a regular basis to ensure that patient data is accurate. 30 The NSQIP database has been utilized for many other clinical studies pertaining to general orthopedics, 4 , 15 as well as shoulder arthroplasty. 20 , 21 …”

Preoperative Malnutrition and Metabolic Markers May Predict Periprosthetic Fractures in Total Hip Arthroplasty

“…The National Surgical Quality Improvement Program (NSQIP) database was queried using Current Procedural Terminology code 27130 for all primary THA performed during the years 2007 to 2020. The NSQIP database is a commonly utilized resource in the field of orthopedics and has been employed many times in general orthopedics as well as in the hip arthroplasty literature [ [16] , [17] , [18] , [19] ]. The database contains well-organized patient information gathered from over 600 hospitals from across the United States.…”

“…Patients were determined to have no anemia (hematocrit >36% for women, >39% for men), mild anemia (hematocrit 33%-36% for women, 33%-39% for men) or moderate-to-severe anemia (hematocrit <33% for either women or men) based on serum hematocrit. The blood urea nitrogen (BUN)–to–creatinine (Cr) ratio was used as a marker for dehydration, with nondehydrated subjects defined as those with a BUN/Cr < 20, moderately dehydrated patients defined as those with a BUN/Cr of 20 to 25, and severely dehydrated subjects defined as those with a BUN/Cr > 25 [ 19 ]. Body mass index (BMI) was separated into kg/m 2 ranges (<18.5, 18.5-24.9, 25-29.9, 30-39.9, and >40).…”

“…Body mass index (BMI) was separated into kg/m 2 ranges (<18.5, 18.5-24.9, 25-29.9, 30-39.9, and >40). Albumin levels were utilized as a marker for malnutrition, with hypoalbuminemia defined as <3.5 g/dl [ 19 ].…”

Alkaline Phosphatase is an Independent Risk Factor for Periprosthetic Fractures in Total Joint Arthroplasty

“…10 The NSQIP database has been used for many other research studies relating to general orthopaedics, 11,12 including joint arthroplasty. 13,14 Current Procedural Terminology codes 27130 and 27447 were used to identify 664,599 patients who underwent TJA from 2005 to 2019. A total of 324,592 patients with available serum ALP levels were included and stratified to low (,44 IU/L), normal (44 to 147 IU/L), and high (.147 IU/L).…”