Has Postop Lab Work Run Amok?

A study 319 total knee arthroplasties (TKAs) has found that postoperative lab work has run amok.

A retrospective review of cases performed at a single institution over a two-year period says “yes.”

The study, “Re-evaluating the utility of routine postoperative laboratory tests after primary total knee arthroplasty,” appears in January 18, 2019 edition of The Journal of Clinical Orthopaedics and Trauma.

Mohamad Halawi, M.D. an orthopedic surgeon at the University of Connecticut Health Center in Farmington and co-author explained his rationale for the study to OTW, “The practice of ordering laboratory tests on a routine basis is a lingering habit from the days when hip replacement was a lengthy operation, was often performed under general anesthesia, and not infrequently resulted in a number of hemodynamic derangements, particularly acute kidney injury and symptomatic anemia.”

“Today, we perform the same operation safer and more efficiently, taking advantage of a number of refinements in surgical and anesthetic techniques, blood-conservation strategies, opioid-sparing analgesia, and preoperative planning to optimize patients and minimize potential complications.”

According to the study authors, “Laboratory results did not change the course of care in 305 of 319 patients. There was no increased risk for 90-days ED visits or readmissions with abnormal laboratory values.”

Dr. Halawi told OTW, “The rates of acute kidney injury and blood transfusion in modern day total hip arthroplasty are extremely low. Derangement in electrolytes balance was the most common finding in abnormal laboratory results, although this imbalance was mild in most cases and did not require treatment.”

“In a value-conscious healthcare system, the practice of ordering routine postoperative laboratory tests after primary, elective, unilateral total hip arthroplasty is not justified.”

“These tests should be guided by patient characteristics as well as intraoperative factors. Several studies have been published to help identify patients at risk for experiencing certain complication that can be identified through laboratory tests.”

“It should not go without saying that a strategy aimed at understanding/optimizing the whole patient, utilizing evidence-based medicine, and obtaining a good clinical exam are of paramount importance and often replace the need for unnecessary tests.”