Raja Muhammad Mussab
Introduction
Routine day-one postoperative blood tests are commonly performed following elective total hip replacement (THR) & total knee replacement (TKR) to detect complications like anaemia, electrolyte imbalance & acute kidney injury. However, the clinical value of routine testing for all patients remains uncertain. This study aimed to evaluate whether postoperative blood tests influence management & to identify patient factors needing clinically actionable results.
Methods
A retrospective observational study was conducted of 770 consecutive patients undergoing THR or TKR at a single centre. Data collected included ASA grade, body mass index (BMI), comorbidity burden, preoperative anticoagulant use, postoperative length of stay. The primary outcome was whether postoperative blood results led to a clinical intervention, including blood transfusion, intravenous fluids, or electrolyte correction. Logistic regression analysis was used to identify independent predictors of actionable results, & receiver operating characteristic (ROC) curve analysis assessed predictive performance.
Results
All patients received routine postoperative day-one blood tests. Only 60 patients (7.8%) had results that led to clinical intervention, while 710 patients (92.2%) had no actionable abnormalities. Clinically relevant results were significantly more common in patients with ASA grade 3–4, higher BMI, multiple comorbidities, & preoperative anticoagulant use. Logistic regression identified ASA grade as the strongest independent predictor of actionable results. ROC analysis demonstrated an area under the curve of 0.76, indicating fair discriminative ability.
Conclusion
Routine postoperative blood testing following elective arthroplasty rarely alters management. A targeted, risk-stratified approach may safely reduce unnecessary investigations, improve staff efficiency, & reduce healthcare costs. Prospective validation of a clinical risk score is recommended.
Authors
Raja Mussab
Hywel Dda Health Board, Carmarthen, United Kingdom & Epsom and St Helier Hospital, London, United Kingdom
Hamid Daud, Fouzia Khan, Htett Latt, Dean Kamiyab, Jehan Zaib
Hywel Dda Health Board, Carmarthen, United Kingdom.