The necessity of routine postoperative laboratory tests after total hip arthroplasty for hip fracture in a semi-urgent clinical setting

Abstract

Background Recent studies suggest that routine postoperative laboratory tests are not necessary after primary elective total hip arthroplasty (THA). This study aims to evaluate the utility of routine postoperative laboratory tests in patients undergoing THA for hip fracture in a semi-urgent clinical setting. Materials and methods This retrospective study included 213 consecutive patients who underwent primary unilateral THA for hip fractures. Patient demographics, clinical information, and laboratory tests were obtained from the electronic medical record system. Multivariate logistic regression analysis was performed to identify risk factors associated with abnormal laboratory test-related interventions. Results A total of 207 patients (97.18%) had abnormal postoperative laboratory results, which were mainly due to anemia (190/213, 89.20%) and hypoalbuminemia (154/213, 72.30%). Overall, 54 patients (25.35%) underwent a clinical intervention, 18 patients received blood transfusion, and 42 patients received albumin supplementation. Factors associated with blood transfusion were long operative time and low preoperative hemoglobin levels. Factors associated with albumin supplementation were long operative time and low preoperative albumin levels. Of the 33 patients with abnormal postoperative creatinine levels, 7 patients underwent a clinical intervention. For electrolyte abnormalities, sodium supplementation was not given for hyponatremia, three patients received potassium supplementation, and one patient received calcium supplementation. Conclusions This study demonstrated a high incidence of abnormal postoperative laboratory tests and a significant clinical intervention rate in patients who underwent THA for hip fracture in a semi-urgent clinical setting, which indicates that routine laboratory tests after THA for hip fracture are still necessary for patients with certain risk factors. Level of Evidence Level III. Trial registration Clinical trial registry number ChiCTR1900020690.

The role of routine postoperative laboratory tests following hip hemiarthroplasty for an elderly femoral neck fracture

“…Their results indicated that the utility of routine postoperative laboratory tests following THA is necessary for patients with long operative times and preoperative abnormalities. Compared to Wu et al [ 27 ], the results of the present study indicated that a higher Charlson comorbidity index was a significant risk factor for predicting clinical intervention for postoperative abnormalities. Our findings were partially consistent with Halawi et al [ 9 ], who reported that abnormal preoperative laboratory electrolyte levels and anaemia were indicators of abnormal postoperative laboratory results in total knee arthroplasty.…”

“…Kildow et al [ 24 ] demonstrated that there was no evidence that actionable information could be obtained from patients without severe comorbidities based on a routine postoperative basic metabolic panel unless patients were diagnosed with diabetes, chronic kidney disease, or preoperative laboratory abnormalities. Wu et al [ 27 ] conducted a study of THA for treating patients with hip fracture and reported a high occurrence of abnormal postoperative laboratory tests and a significant clinical intervention rate. Their results indicated that the utility of routine postoperative laboratory tests following THA is necessary for patients with long operative times and preoperative abnormalities.…”

Incidence and Risk Factors Associated with Human Albumin Administration Following Total Joint Arthroplasty.

“…In the current study, we found that preoperative anemia was an independent modi able risk factor for HA administration after THA, regardless of pre-ALB < 35 g/L or not, which has been con rmed before that anemia was associated with hypoalbuminemia [19]. In addition, we found that the incidence of anemia in patients undergoing THA was higher than those undergoing TKA, this may be related to that patients with hip fractures were included in the current study, because these patients were found to be with higher incidences of preoperative anemia, postoperative hypoalbuminemia, and HA administration [20].…”

Incidence and risk factors associated with human albumin administration following total joint arthroplasty: a multicenter retrospective study

“…In the current study, we found that preoperative anemia was an independent modifiable risk factor for HA administration after THA, regardless of pre-ALB < 35 g/L or not, which has been confirmed before that anemia was associated with hypoalbuminemia [ 27 ]. In addition, we found that the incidence of anemia in patients undergoing THA was higher than those undergoing TKA, this may be related to that patients with hip fractures were included in the current study, because these patients were found to be with higher incidences of preoperative anemia, postoperative hypoalbuminemia, and HA administration [ 28 ]. Therefore, for patients undergoing THA with preoperative anemia, especially those with hip fractures, more attention should be paid to correct their anemia and nutritional status.…”