ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY

Ali Assaf; Shady Hermena; Eleni Hadjikyriacou; Oliver Donaldson

doi:10.1302/1358-992X.2021.2.089

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ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY

The British Orthopaedic Research Society (BORS) Annual Meeting 2020, held online, 7–8 September 2020.

Ali Assaf
Shady Hermena
Eleni Hadjikyriacou
Oliver Donaldson

ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY

Assaf A, Hermena S, Hadjikyriacou E, Donaldson O. ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY. Orthop Procs. 2021;103-B(SUPP_2):89-89. doi:10.1302/1358-992X.2021.2.089

Assaf, Ali, et al. “ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY.” Orthopaedic Proceedings, vol. 103-B, no. SUPP_2, 2021, pp. 89-89., https://doi.org/10.1302/1358-992X.2021.2.089

Assaf, A., Hermena, S., Hadjikyriacou, E., & Donaldson, O. (2021). ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY. Orthopaedic Proceedings, 103-B(SUPP_2), 89-89. https://doi.org/10.1302/1358-992X.2021.2.089

Assaf, A., Hermena, S., Hadjikyriacou, E. and Donaldson, O. (2021) “ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY.” Orthopaedic Proceedings, 103-B(SUPP_2), pp. 89-89. Available at: https://doi.org/10.1302/1358-992X.2021.2.089

Assaf, Ali, Shady Hermena, Eleni Hadjikyriacou, and Oliver Donaldson. “ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY.” Orthopaedic Proceedings 103-B, no. SUPP_2 (2021): 89-89. https://doi.org/10.1302/1358-992X.2021.2.089

Assaf A, Hermena S, Hadjikyriacou E, Donaldson O. ROUTINE POSTOPERATIVE LABORATORY TESTS ARE NOT REQUIRED IN PATIENTS UNDERGOING ELECTIVE TOTAL SHOULDER ARTHROPLASTY. Orthop Procs. 2021 Mar 1;103-B(SUPP_2):89-89. https://doi.org/10.1302/1358-992X.2021.2.089

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Abstract

Objectives

Routine blood test following total shoulder arthroplasty (TSA) cost the NHS more than £72000 in 2018 without definite evidence of their impact on patients’ management or outcomes. This study aimed to ascertain if routine laboratory tests are a necessity post TSA or can be implemented on a per-patient

Methods

A retrospective review of the electronic records completed for 251 patients underwent TSA over 6 years. 193 patients were eligible for analysis. Primary outcomes were interventions to the abnormal postoperative blood tests. Secondary outcomes were the length of stay (LOS), and readmission within 30 days and 90 days.

Results

193 patients underwent 216 TSAs; 72 % were females and 18% males. The mean age was 78 ± 7.2 years. Completed procedures included 134 reverse, 64 anatomical and 18 revision TSAs. 136 patients (63%) had an abnormal postoperative blood test, however, only 8 (3.7%) required intervention. The average postoperative haemoglobin (Hb) drop was 19 g/L with 94 patients (43.5%) having Hb <109g/L. 4 patients (1.8%) dropped Hb < 80g/L; only 2 patients (0.9%) were symptomatic and received RBC transfusion . 6 patients (2.8%) developed acute kidney injury and treated by IV fluids. The mean LOS was 3.2 ± 2.9 days .5 patients (2.3%) were readmitted within 30 days and 6 patients (2.8%) within 90 days. Univariate analysis showed association only between abnormal Creatinine and LOS (p<0.05) and of these patients, all had abnormal preoperative Creatinine baseline. No statistical correlation detected between age (p=0.287), postoperative Hb (p=0.230) and LOS nor readmission at 30 or 90 days.

Conclusions

Routine postoperative blood tests are not required as they have not shown to produce a meaningful clinical impact in this cohort of patients nor on the re-admission rate, causing unnecessary costs. We recommend assessing each patient and request for investigations in a coherent and justified manner.

Declaration of Interest

(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.