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

Xiangdong Wu1,2, Jiacheng Liu2, Yujian Li2, Jiawei Wang2, Guixing Qiu1, Wei Huang2
1Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
2Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

Tóm tắt

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.

Từ khóa


Tài liệu tham khảo

Johansen A, Golding D, Brent L, Close J, Gjertsen J-E, Holt G, Hommel A, Pedersen AB, Röck ND, Thorngren K-G (2017) Using national hip fracture registries and audit databases to develop an international perspective. Injury 48(10):2174–2179

Cooper C, Campion G, Lr M (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289

Johansen A, Parker M (2006) Hip fracture. BMJ 333:27–30

Varady NH, Ameen BT, Chen AF (2020) Is delayed time to surgery associated with increased short-term complications in patients with pathologic hip fractures? Clin Orthop Relat Res 478(3):607–615

Klestil T, Röder C, Stotter C, Winkler B, Nehrer S, Lutz M, Klerings I, Wagner G, Gartlehner G, Nussbaumer-Streit B (2018) Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 8(1):1–15

Pincus D, Ravi B, Wasserstein D, Huang A, Paterson JM, Nathens AB, Kreder HJ, Jenkinson RJ, Wodchis WP (2017) Association between wait time and 30–day mortality in adults undergoing hip fracture surgery. JAMA 318(20):1994–2003

AAOS American Academy of Orthopaedic Surgeons. Management of Hip Fractures in The Elderly: Timing of Surgical Intervention. https://aaos.org/globalassets/quality-and-practice-resources/hip-fractures-in-the-elderly/hip-fx-timing-measure-technical-report.pdf.

National Clinical Guideline Centre, (2011) [The Management of Hip Fracture in Adults]. London: National Clinical Guideline Centre. https://www.nice.org.uk/guidance/cg124.

TQIP A. Best practices in the management of orthopaedic trauma. ACS TQIP Best Practices in Management of Orthopaedic Trauma. 2015; https://www.facs.org/quality-programs/trauma/tqp/center-programs/tqip/best-practice.

Canadian Institute for Health Information. Wait Times for Priority Procedures in Canada, 2018: Technical Notes. Ottawa, ON: CIHI; 2018. https://secure.cihi.ca/free_products/wt2018-tech-notes-2018-en-web.pdf.

Ju DG, Rajaee SS, Mirocha J, Lin CA, Moon CN (2017) Nationwide analysis of femoral neck fractures in elderly patients: a receding tide. J Bone Joint Surg Am 99(22):1932–1940

Müller F, Galler M, Zellner M, Bäuml C, Grechenig S, Kottmann T, Füchtmeier B (2019) Total hip arthroplasty for hip fractures: time to surgery with respect to surgical revision, failure, and mortality. Geriatr Orthop Surg Rehabil 10:2151459318818162

Schroer WC, Diesfeld PJ, LeMarr AR, Morton DJ, Reedy ME (2018) Hip fracture does not belong in the elective arthroplasty bundle: presentation, outcomes, and service utilization differ in fracture arthroplasty care. J Arthroplasty 33(7):S56–S60

Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW (2013) 90-day mortality after 409 096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. The Lancet 382(9898):1097–1104

White S, Moppett I, Griffiths R (2014) Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. Anaesthesia 69(3):224–230

Halawi MJ, Plourde J, Cote MP (2019a) Response to letter to the editor on “Routine postoperative laboratory tests are not necessary after primary total hip arthroplasty.” J Arthroplasty 34(5):1045

Wu X-D, Jiang F, Xiang B-Y, Huang W (2019) Letter to the editor on “Routine postoperative laboratory tests are not necessary after primary total hip arthroplasty.” J Arthroplasty 34(5):1043–1045

Le Manach Y, Collins G, Bhandari M, Bessissow A, Boddaert J, Khiami F, Chaudhry H, De Beer J, Riou B, Landais P (2015) Outcomes after hip fracture surgery compared with elective total hip replacement. JAMA 314(11):1159–1166

Cook A, Cook S, Smith I (2014) Weinrauch P (2014) Hip resurfacing arthroplasty and perioperative blood testing. Adv Orthop 2014:109378

Jagow DM, Yacoubian SV, Yacoubian SV (2015) Complete blood count before and after total hip or knee arthroplasty. J Orthop Surg (Hong Kong) 23(2):209–212

Shaner JL, Karim AR, Casper DS, Ball CJ, Padegimas EM, Lonner JH (2016) Routine postoperative laboratory tests are unnecessary after partial knee arthroplasty. J Arthroplasty 31(12):2764–2767

Kildow BJ, Karas V, Howell E, Green CL, Baumgartner WT, Penrose CT, Bolognesi MP, Seyler TM (2018) The utility of basic metabolic panel tests after total joint arthroplasty. J Arthroplasty 33(9):2752–2758

Halawi MJ, Lyall V, Cote MP (2020) Re-evaluating the utility of routine postoperative laboratory tests after primary total knee arthroplasty. J Clin Orthop Trauma 11:S219–S222

Halawi MJ, Plourde JM, Cote MP (2019b) Routine postoperative laboratory tests are not necessary after primary total hip arthroplasty. J Arthroplasty 34(3):538–541

Howell EP, Kildow BJ, Karas V, Green CL, Cunningham DJ, Ryan SP, Bolognesi MP, Seyler TM (2019) Clinical impact of routine complete blood counts following total knee arthroplasty. J Arthroplasty 34(7):S168–S172

Greco N, Manocchio A, Lombardi A, Gao S, Adams J, Berend K (2019) Should postoperative haemoglobin and potassium levels be checked routinely following blood-conserving primary total joint arthroplasty? Bone Joint J 101(1_Supple_A):25–31

Wu XD, Zhu ZL, Xiao PC, Liu JC, Wang JW, Huang W (2020) Are routine postoperative laboratory tests necessary after primary total hip arthroplasty? J Arthroplasty. 35:2892–2898

Wu X-D, Xiao P-C, Zhu Z-L, Liu J-C, Li Y-J, Huang W (2019) The necessity of routine postoperative laboratory tests in enhanced recovery after surgery for primary hip and knee arthroplasty: a retrospective cohort study protocol. Medicine 98:18

World Health Organization (2011). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization https://apps.who.int/iris/handle/10665/85839.

Gatta A, Verardo A, Bolognesi M (2012) Hypoalbuminemia. Intern Emerg Med 7(Suppl 3):S193–S199

Zhang J, Zhang R, Wang Y, Li H, Han Q, Wu Y, Wang T, Liu F (2019) The level of serum albumin is associated with renal prognosis in patients with diabetic nephropathy. J Diabetes Res 2019:7825804

Metcalfe D, Perry DC, Costa ML (2016) Hip fracture surgery vs elective total hip replacement. JAMA 315(9):941–942

Grace TR, Patterson JT, Tangtiphaiboontana J, Krogue JD, Vail TP, Ward DT (2018) Hip fractures and the bundle: a cost analysis of patients undergoing hip arthroplasty for femoral neck fracture vs degenerative joint disease. J Arthroplasty 33(6):1681–1685

Wu VJ, Ross B, Sanchez FL, Billings CR, Sherman WF (2020) Complications following total hip arthroplasty: a nationwide database comparing elective vs. Hip Fracture Cases. J Arthroplasty. 35(8):2144–2148

Van Citters AD, Fahlman C, Goldmann DA, Lieberman JR, Koenig KM, DiGioia AM, O’Donnell B, Martin J, Federico FA, Bankowitz RA (2014) Developing a pathway for high-value, patient-centered total joint arthroplasty. Clin Orthop Relat Res 472(5):1619–1635

Desborough J (2000) The stress response to trauma and surgery. Br J Anaesth 85(1):109–117

Simunovic N, Devereaux P, Sprague S, Guyatt GH, Schemitsch E, DeBeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182(15):1609–1616

Bohl DD, Ondeck NT, Darrith B, Hannon CP, Fillingham YA, Della Valle CJ (2018) Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty 33(7):2256–2262

Wu X-D, Hu K-J, Tian M, Huang W (2018) Letter to the editor on “impact of operative time on adverse events following primary total joint arthroplasty.” J Arthroplasty 33(8):2701–2702

Anis HK, Sodhi N, Klika AK, Mont MA, Barsoum WK, Higuera CA, Molloy RM (2019) Is operative time a predictor for post-operative infection in primary total knee arthroplasty? J Arthroplasty 34(7):S331–S336

Willis-Owen C, Konyves A, Martin D (2010) Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 92(8):1128–1133

Helm A, Karski M, Parsons S, Sampath J, Bale R (2003) A strategy for reducing blood-transfusion requirements in elective orthopaedic surgery: audit of an algorithm for arthroplasty of the lower limb. J Bone Joint Surg Br 85(4):484–489

Ralley FE, Berta D, Binns V, Howard J, Naudie DD (2010) One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res 468(7):1905–1911

Friedman R, Homering M, Holberg G, Berkowitz SD (2014) Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Joint Surg Am 96(4):272–278

Bedard NA, Pugely AJ, Lux NR, Liu SS, Gao Y, Callaghan JJ (2017) Recent trends in blood utilization after primary hip and knee arthroplasty. J Arthroplasty 32(3):724–727

Lindman IS, Carlsson LV (2018) Extremely low transfusion rates: contemporary primary total hip and knee arthroplasties. J Arthroplasty 33(1):51–54

Wu X-D, Tian M, He Y, Chen Y, Tao Y-Z, Shao L, Luo C, Xiao P-C, Zhu Z-L, Liu J-C (2020) Efficacy of a three-day prolonged-course of multiple-dose versus a single-dose of tranexamic acid in total hip and knee arthroplasty. Ann Transl Med 8:6

Bistrian BR, Blackburn GL, Hallowell E, Heddle R (1974) Protein status of general surgical patients. JAMA 230(6):858–860

Huang R, Greenky M, Kerr GJ, Austin MS, Parvizi J (2013) The effect of malnutrition on patients undergoing elective joint arthroplasty. J Arthroplasty 28(8):21–24

Walls JD, Abraham D, Nelson CL, Kamath AF, Elkassabany NM, Liu J (2015) Hypoalbuminemia more than morbid obesity is an independent predictor of complications after total hip arthroplasty. J Arthroplasty 30(12):2290–2295

Paul HY, Frank RM, Vann E, Sonn KA, Moric M, Della Valle CJ (2015) Is potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty? Clin Orthop Relat Res 473(1):175–182

Sloan M, Sheth NP, Nelson CL (2020) Obesity and hypoalbuminaemia are independent risk factors for readmission and reoperation following primary total knee arthroplasty. Bone Joint J 102-B(6_Supple_A):31–35

Cao G, Huang Q, Xu B, Huang Z, Xie J, Pei F (2017) Multimodal nutritional management in primary total knee arthroplasty: a randomized controlled trial. J Arthroplasty 32(11):3390–3395

Liu M, Yang J, Yu X, Huang X, Vaidya S, Huang F, Xiang Z (2015) The role of perioperative oral nutritional supplementation in elderly patients after hip surgery. Clin Interv Aging 10:849

Nowicka A, Selvaraj T (2016) Incidence of acute kidney injury after elective lower limb arthroplasty. J Clin Anesth 34:520–523

Perregaard H, Damholt MB, Solgaard S, Petersen MB (2016) Renal function after elective total hip replacement: Incidence of acute kidney injury and prevalence of chronic kidney disease. Acta Orthop 87(3):235–238

Gai P, Sun H, Sui L, Wang G (2016) Hypocalcaemia after total knee arthroplasty and its clinical significance. Anticancer Res 36(3):1309–1311

Anastasio AT, Farley KX, Boden SD, Bradbury TL, Premkumar A, Gottschalk MB (2020) Modifiable, Postoperative Risk Factors for Delayed Discharge Following Total Knee Arthroplasty: The Influence of Hypotension and Opioid Use. J Arthroplasty 35(1):82–88