Routine Postoperative Complete Blood Counts Are Not Necessary After Most Primary Total Hip and Knee Arthroplasties. 2021

Alex K Gilde, and Katheryne L Downes, and Sherri Leverett, and Michael A Miranda
Orthopaedic Associates of Michigan, Grand Rapids, MI.

Routine postoperative complete blood count tests are commonplace after total joint arthroplasty. The goal of this study was to identify if these result in any clinically meaningful action and if it would be safe to forego this testing in a population without known risk factors for transfusion. A retrospective review of 1060 patients undergoing a total knee or total hip arthroplasty at a single institution was performed. Data points including patient demographics, preoperative and postoperative laboratory results, tranexamic acid use, preoperative and postoperative medication for venous thromboembolism prophylaxis and anticoagulation, as well as 90-day readmission related to anemia were collected. The transfusion rate for all patients was 0.66% (7/1060) and there was only one transfusion for a patient with a preoperative hemoglobin (Hb) greater than 12 g/dL (1/976; 0.1%). There was no difference in the change from preoperative to postoperative day 1 Hb levels in patients treated with aspirin compared with those on direct oral anticoagulation (P = .73). There were no 90-day readmissions related to acute blood loss anemia. This study demonstrates that routine postoperative complete blood count testing is not absolutely necessary and does not provide additional value in the vast majority of patients with preoperative Hb levels equal to or greater than 12 g/dL when tranexamic acid is administered. This could avoid unnecessary testing in patients and increased savings to the health care system. Level 3, retrospective cohort.

UI MeSH Term Description Entries
D001772 Blood Cell Count The number of LEUKOCYTES and ERYTHROCYTES per unit volume in a sample of venous BLOOD. A complete blood count (CBC) also includes measurement of the HEMOGLOBIN; HEMATOCRIT; and ERYTHROCYTE INDICES. Blood Cell Number,Blood Count, Complete,Blood Cell Counts,Blood Cell Numbers,Blood Counts, Complete,Complete Blood Count,Complete Blood Counts,Count, Blood Cell,Count, Complete Blood,Counts, Blood Cell,Counts, Complete Blood,Number, Blood Cell,Numbers, Blood Cell
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000933 Antifibrinolytic Agents Agents that prevent fibrinolysis or lysis of a blood clot or thrombus. Several endogenous antiplasmins are known. The drugs are used to control massive hemorrhage and in other coagulation disorders. Antifibrinolysin,Antifibrinolysins,Antifibrinolytic,Antifibrinolytic Agent,Antiplasmin,Antiplasmins,Antifibrinolytics,Plasmin Inhibitor,Plasmin Inhibitors,Agent, Antifibrinolytic,Agents, Antifibrinolytic,Inhibitor, Plasmin,Inhibitors, Plasmin
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D014148 Tranexamic Acid Antifibrinolytic hemostatic used in severe hemorrhage. AMCHA,AMCA,Amchafibrin,Anvitoff,Cyklokapron,Exacyl,KABI 2161,Spotof,Transamin,Ugurol,t-AMCHA,trans-4-(Aminomethyl)cyclohexanecarboxylic Acid
D016063 Blood Loss, Surgical Loss of blood during a surgical procedure. Hemorrhage, Surgical,Surgical Blood Loss,Surgical Hemorrhage,Surgical Blood Losses,Surgical Hemorrhages
D019644 Arthroplasty, Replacement, Hip Replacement of the hip joint. Hip Prosthesis Implantation,Hip Replacement, Total,Total Hip Arthroplasty,Arthroplasties, Hip Replacement,Arthroplasties, Replacement, Hip,Arthroplasty, Hip Replacement,Hip Replacement Arthroplasties,Hip Replacement Arthroplasty,Replacement Arthroplasties, Hip,Replacement Arthroplasty, Hip,Replacement, Total Hip,Total Hip Replacement,Arthroplasty, Total Hip,Hip Arthroplasty, Total,Hip Prosthesis Implantations,Implantation, Hip Prosthesis,Prosthesis Implantation, Hip,Total Hip Arthroplasties,Total Hip Replacements
D019645 Arthroplasty, Replacement, Knee Replacement of the knee joint. Knee Replacement, Total,Arthroplasties, Knee Replacement,Arthroplasties, Replacement, Knee,Arthroplasty, Knee Replacement,Arthroplasty, Replacement, Partial Knee,Knee Arthroplasty,Knee Arthroplasty, Total,Knee Replacement Arthroplasties,Knee Replacement Arthroplasty,Partial Knee Arthroplasty,Partial Knee Replacement,Replacement Arthroplasties, Knee,Replacement Arthroplasty, Knee,Replacement, Total Knee,Total Knee Replacement,Unicompartmental Knee Arthroplasty,Unicompartmental Knee Replacement,Unicondylar Knee Arthroplasty,Unicondylar Knee Replacement,Arthroplasty, Knee,Arthroplasty, Partial Knee,Arthroplasty, Total Knee,Arthroplasty, Unicompartmental Knee,Arthroplasty, Unicondylar Knee,Knee Arthroplasty, Partial,Knee Arthroplasty, Unicompartmental,Knee Arthroplasty, Unicondylar,Knee Replacement, Partial,Knee Replacement, Unicompartmental,Knee Replacement, Unicondylar,Total Knee Arthroplasty

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