Abstract
BackgroundPerforming postoperative laboratory tests following joint arthroplasty is a regular practice. However, the role of routine postoperative laboratory tests in primary hip arthroplasty is currently in doubt. This study aimed to assess the role of routine postoperative laboratory tests for femoral neck fractures in elderly patients who underwent hip hemiarthroplasty and to evaluate the risk factors for postoperative laboratory testing abnormalities and related interventions.MethodsThis retrospective study reviewed 735 consecutive patients with femoral neck fractures (FNFs) who underwent hip hemiarthroplasty at a single tertiary academic organization. Patient characteristic features and laboratory testing values were recorded. Logistic regression models were calculated to identify risk factors.ResultsA total of 321 elderly patients (> 75 years of age) were ultimately enrolled for analysis. Abnormal postoperative laboratory tests were found in 265 patients (82.6%). Only a minority of the included patients (7.5%) needed medical intervention to treat postoperative laboratory testing abnormalities. Multivariate logistic regression analysis reported that a higher Charlson comorbidity index (CCI) (P = 0.03), abnormal preoperative haemoglobin level (P < 0.01), higher intraoperative blood loss (P < 0.01) and less frequent tranexamic acid use (P = 0.05) were risk factors for abnormal postoperative laboratory tests. Furthermore, a higher CCI has been identified as a risk factor for patients needing clinical interventions related to laboratory abnormalities.ConclusionsBecause 92.5% of laboratory tests did not influence postoperative management, the authors suggest that routine laboratory tests after hip hemiarthroplasty for FNFs are less instructive for the majority of elderly patients. Nevertheless, for patients with identified risk factors, postoperative laboratory tests are still required to identify the abnormalities that need to be managed.
Highlights
Performing postoperative laboratory tests following joint arthroplasty is a regular practice
Previous studies provided evidence that the application of routine postoperative laboratory tests was not required in patients with joint arthroplasty unless patients were at risk for laboratory testing abnormalities [7,8,9]
A total of 265 patients who had either an abnormal complete blood count or an abnormal comprehensive metabolic panel were included in the abnormal postoperative laboratory test group, and the remaining patients who had normal postoperative laboratory tests were included in another group
Summary
Performing postoperative laboratory tests following joint arthroplasty is a regular practice. The role of routine postoperative laboratory tests in primary hip arthroplasty is currently in doubt. This study aimed to assess the role of routine postoperative laboratory tests for femoral neck fractures in elderly patients who underwent hip hemiarthroplasty and to evaluate the risk factors for postoperative laboratory testing abnormalities and related interventions. Hip hemiarthroplasty is considered one of the most effective orthopaedic surgeries to aim for pain relief and early mobilization in patients with displaced femoral neck fractures [6]. Surgeons are accustomed to performing postoperative laboratory tests routinely after joint replacement without evidence as to whether they are necessary. Little is known about whether routine laboratory tests following hip hemiarthroplasty contribute to actionable information in elderly patients with displaced femoral neck fractures
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