Routine Laboratory Tests are not Necessary After Primary Total Joint Arthroplasty: A Prospective Study Utilizing a...

Standard practice in orthopedic surgery includes routine postoperative laboratory tests following total joint arthroplasty. However, no strong evidence supports this approach. Prior research has shown that many of these tests do not influence clinical decisions. That uncertainty drove this study to examine if selective testing could replace routine testing. No prior work had resolved whether eliminating these tests would affect complication rates. This gap motivated the development of an algorithmic approach. The study aimed to assess safety and effectiveness of this change. The focus was on primary unilateral TJA patients. The goal was to determine if selective testing could reduce unnecessary procedures.

The study aimed to evaluate whether discontinuing routine postoperative laboratory tests after primary unilateral TJA is safe and effective. Researchers sought to determine if this change impacts 90-day complication rates. The protocol change was tested at a high-volume surgical center. The control group received standard testing, while the protocol group used a selective algorithm. The study focused on patients without preexisting conditions that might require frequent monitoring. The primary outcome was 90-day complication rates. The goal was to ensure patient safety while reducing unnecessary interventions. The findings could inform future clinical guidelines.

The study was a prospective protocol change at a high-volume TJA center. Patients were divided into control and protocol groups. The control group received standard postoperative laboratory tests. The protocol group used a selective algorithm based on preoperative risk factors. Exclusions included patients with bleeding disorders, COPD, arrhythmia, heart disease, heart failure, chronic renal failure, dementia, or abnormal preoperative labs. Data collection included in-hospital and 90-day outcomes. Statistical methods included t-tests for continuous variables and chi-squared tests for categorical variables. A pre-hoc power analysis determined a sample size of 607 per group.

The protocol group included 937 patients and the control group included 891 patients. The protocol group had fewer females and fewer total hip arthroplasties. No differences were found in age, BMI, or estimated blood loss. Transfusion rates were similar between groups. Electrolyte corrections and unplanned consults were also unchanged. The protocol group had more fluid boluses and home discharges. Length of stay and transfers did not differ. 90-day complication rates were identical between groups.

The study found no difference in 90-day complications between the protocol and control groups. The authors propose that discontinuing routine postoperative laboratory tests is safe and effective. The selective algorithm reduced unnecessary testing without increasing risk. The findings suggest this approach could be applied to most primary unilateral TJA patients. The researchers suggest this protocol may improve resource use in orthopedic surgery. The results support a shift from routine to selective testing. The study does not claim this applies to all TJA patients. The authors recommend further validation in other settings.