Utility of postoperative hemoglobin testing following total shoulder arthroplasty.
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2021-01
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Abstract
Background
Identifying areas of excess cost for shoulder arthroplasty patients can play a role in effective health care spending. The purpose of this study was to assess the utility of postoperative complete blood count (CBC) testing after total shoulder arthroplasty (TSA) and identify which patients benefit from routine CBC testing.Methods
We performed a retrospective review of a cohort of patients who underwent primary TSA from January 2018 through January 2019. All patients in this cohort received tranexamic acid. Patient demographic characteristics and patient-specific risk factors such as American Society of Anesthesiologists score, Elixhauser index, body mass index, smoking status, and coagulopathy history were obtained. Perioperative values including length of surgery, preoperative and postoperative hemoglobin (Hgb) levels, and need for transfusion were also obtained.Results
This study included 387 TSA patients in the final analysis. Comparison between the cohort requiring transfusion and the cohort undergoing no intervention revealed no statistically significant differences in age, sex, body mass index, American Society of Anesthesiologists score, or Elixhauser index. The group receiving transfusions was found to have significantly lower levels of preoperative Hgb (11.3 g/dL) and postoperative Hgb (8.1 g/dL) (P < .0001). Additionally, the percentages of patients with abnormal preoperative Hgb levels (<12 g/dL) (72.3%) and postoperative day 1 Hgb levels < 9 g/dL (81.8%) were significantly higher in the group receiving transfusions (P < .0001). A multivariate regression model identified an abnormal preoperative Hgb level (<12 g/dL), with an odds ratio of 3.8 (95% confidence interval, 1.5-6.2; P < .001), and postoperative day 1 Hgb level < 9 g/dL, with an odds ratio of 3.3 (95% confidence interval, 0.4-6.1; P < .03), as significant predictors of the risk of transfusion with a sensitivity of 64% and specificity of 96.2% with an area under the curve of 0.87.Conclusion
Routine CBC testing may not be necessary for patients who receive tranexamic acid and have preoperative Hgb levels > 12 mg/dL and first postoperative Hgb levels > 9 mg/dL. This translates to potential health care cost savings and improves current evidence-based perioperative management in shoulder arthroplasty.Type
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Belay, Elshaday S, Etienne Flamant, Barrie Sugarman, Daniel E Goltz, Christopher S Klifto and Oke Anakwenze (2021). Utility of postoperative hemoglobin testing following total shoulder arthroplasty. JSES international, 5(1). pp. 149–153. 10.1016/j.jseint.2020.07.020 Retrieved from https://hdl.handle.net/10161/22481.
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Christopher Scott Klifto
Christopher S. Klifto grew up outside Philadelphia. He graduated from Carnegie Mellon University where he received a degree in Chemical and Biomechanical Engineering. He received his medical degree from Rutgers-Robert Wood Johnson Medical School, and completed his Orthopaedic residency and Hand and Upper Extremity fellowship at NYU- Hospital for Joint Diseases.
Dr. Klifto is an orthopaedic surgeon specializing in upper extremity. He treats orthopaedic conditions for the shoulder and elbow including arthritis, rotator cuff injuries, labral tears, frozen shoulder, sports injuries, fractures, tendon injuries, cubital tunnel syndrome. He treats patients both conservatively and surgically; meeting with each patient, hearing their goals and determining the best plan of care together. He specializes in shoulder surgeries such as reverse total shoulder arthroplasty, anatomic shoulder arthroplasty and shoulder hemiarthroplasty. He also performs rotator cuff repair, shoulder labral reconstruction, and shoulder arthroscopy. He treats upper extremity fractures including shoulder and clavicle, humeral shaft, and elbow injuries. He chose orthopaedics from having injuries himself over the years, so he understands what patients are going through when they see him and treat them with as much compassion and respect as possible. "I am very involved in Research, with a particular focus in the shoulder. The research here at Duke is second to none; the best minds are here in one area, all collaborating and trying to figure out how to get better. The most gratifying part of my job is to see patients get back to the level of activity where they would like to be.”
He is a Clinical Associate Professor at Duke University. He has published articles in nationally recognized publications on many conditions of the upper extremity and continues to actively conduct clinical research and contribute to national textbooks.
Dr. Klifto serves as the division lead of shoulder and elbow surgery at the Durham VA in addition to his clinical practice at Duke Orthopaedics/North Carolina Orthopaedic Clinic.
Dr. Klifto lives in Durham with his wife Meredith, an Ophthalmologist. He has three wonderful daughters (Madeline, Anna, and Grace) and a labradoodle named Goose that are the joys of his life. He enjoys golf, fishing, skiing, tennis, kite boarding and professional and collegiate sports.
Oke Adrian Anakwenze
Complex shoulder and elbow surgeon, researcher and innovator.
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