Routine postoperative laboratory tests are not required in patients undergoing elective total shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Clinical Pathology
• Health Economics

Background:

• Routine blood tests post-total shoulder arthroplasty (TSA) incur significant costs for the National Health Service.
• Evidence supporting the clinical impact of these routine tests on patient outcomes is lacking.
• This study evaluated the necessity of routine laboratory testing following elective TSA.

Purpose of the Study:

• To determine if routine postoperative laboratory tests are necessary after total shoulder arthroplasty.
• To assess the impact of routine blood tests on patient intervention rates and clinical outcomes.
• To analyze the cost-effectiveness of current blood testing protocols in TSA patients.

Main Methods:

• Retrospective review of electronic health records for 216 patients undergoing TSA over six years.
• Primary outcome: intervention rate for abnormal postoperative blood tests.
• Secondary outcomes: length of stay (LOS), 30-day and 90-day readmission rates.

Main Results:

• 63% of patients had abnormal postoperative blood tests, but only 3.7% required intervention.
• Hemoglobin levels dropped an average of 19g/L; only 0.9% needed transfusion.
• Acute kidney injury occurred in 2.8% without requiring haemofiltration; abnormal creatinine was linked to LOS.

Conclusions:

• Routine postoperative blood tests following TSA are not clinically indicated and do not affect outcomes or readmission rates.
• Discontinuing routine tests can reduce healthcare costs without compromising patient care.
• Postoperative blood tests should be reserved for patients with pre-existing elevated creatinine levels.