The incidence and risk factors for abnormal postoperative blood tests following primary total joint replacement.

Aims: We aim to evaluate the usefulness of postoperative blood tests by investigating the incidence of abnormal results following total joint replacement (TJR), as well as identifying preoperative risk factors for abnormal blood test results postoperatively, especially pertaining to anaemia and acute kidney injury (AKI). Methods: This is a retrospective cohort study of patients who had elective TJR between January and December 2019 at a tertiary centre. Data gathered included age at time of surgery, sex, BMI, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative laboratory test results, haemoglobin (Hgb), white blood count (WBC), haematocrit (Hct), platelets (Plts), sodium (Na+), potassium (K+), creatinine (Cr), estimated glomerular filtration rate (eGFR), and Ferritin (ug/l). Abnormal blood tests, AKI, electrolyte imbalance, anaemia, transfusion, reoperation, and readmission within one year were reported. Results: The study included 2,721 patients with a mean age of 69 years, of whom 1,266 (46.6%) were male. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥ 65 years), female sex, and ASA grade ≥ III as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dl) and packed cell volume (≤ 0.395 l/l) were noted to be significant risk factors for postoperative anaemia, and potassium (≤ 3.7 mmol/l) was noted to be a significant risk factor for AKI. Conclusion: The costs outweigh the benefits of ordering routine postoperative blood tests in TJR patients. Clinicians should risk-stratify their patients and have a lower threshold for ordering blood tests in patients with abnormal preoperative haemoglobin (≤ 127 g/l), blood loss > 300 ml, chronic kidney disease, ASA grade ≥ III, and clinical concern.

Venous thromboembolism incidence in upper limb orthopedic surgery: do these procedures increase venous thromboembolism risk?

BACKGROUND: In 2005, the House of Commons (HoC) Health Committee stated deaths attributed to preventable, hospital-acquired venous thromboembolism (VTE) numbered upwards of 25,000 per annum. Nationwide prevention of VTE became the topic of a major health campaign. The HoC Health Committee stated there was an unstratified VTE risk of between 45% and 51% associated with orthopedic surgery. VTE research in orthopedic surgery has been concentrated on lower limb procedures. Experience suggests that this kind of relation does not hold true for upper limb orthopedic procedures. This project aimed to estimate the incidence of postoperative VTE in upper limb orthopedic surgery. METHODS: The incidence of postoperative VTE was assessed in 3357 consecutive upper limb orthopedic operations performed by 4 surgeons in Lancashire Teaching Hospitals National Health Service (NHS) Trust (LTHTR) between July 1, 2009, and July 31, 2012. RESULTS: Four pulmonary embolisms and 2 deep vein thromboses occurred. Incidence of postoperative VTE was 0.0018%, significantly lower than rates reported in the literature. Five of 6 patients who developed a VTE reported a personal or family history of VTE. Three patients would not have been identified as at risk under the current VTE screening guidelines. Three of these patients received appropriate anticoagulation according to present guidelines, yet VTE events still occurred. CONCLUSION: These results indicate VTE risk in orthopedic upper limb surgery is much lower than reported in the literature. The necessity for screening for VTE in upper limb surgery is contested. The efficacy of VTE screening and current VTE prophylaxis is discussed, and an alternative and much simplified method of screening is suggested.

Skin Prepping for Upper Limb Procedures: Should I Keep my Eyes Closed Doc?

Antiseptics containing alcohol are commonly used due to their effective antiseptic properties. However, they may cause eye irritation if splashed into the eyes in awake patients receiving regional anaesthesia. We present a simple technique to avoid such cases.

These Wire Cutters are Broken.

K-wire cutters have a fixed range of cutting capabilities. Wire cutters are most efficiently applied perpendicular to the K-wire as oblique application increases the effective diameter of the K-wire, which may cause the wire cutters to break.

Paper and dynamic hip screw surgery--a cheap and effective aid for hip fracture reduction.

The reduction of hip fractures prior to using dynamic hip screw devices can be challenging. The use of folded paper recreates an optimal angle of 135 degrees to assess adequacy of hip fracture reduction and to alert the surgeon as to the precise entry point of the guidewire in the lateral cortex of the femur.