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

BACKGROUND: Routine blood tests following total shoulder arthroplasty (TSA) cost the British national health system over £65,000 in 2018 without definite evidence of their impact on patients' outcomes. This study aimed to ascertain whether routine laboratory tests are necessary after elective TSA. METHODS: A retrospective review of electronic records was completed for 274 patients that underwent TSA in the past six years. In total, 216 patients were eligible for analysis. The primary outcome was intervention rate for abnormal postoperative blood tests. Secondary outcomes were hospital length of stay (LOS), and readmissions at 30 and 90 days. RESULTS: In total, 193 patients underwent 216 TSAs; 72% were female, and the mean cohort age was 78 ± 7.2 years. Overall, 136 patients (63%) had an abnormal postoperative blood test, however; only 8 (3.7%) required intervention. The average postoperative drop in haemoglobin (Hb) was 19g/l. In four patients (1.8%) Hb levels dropped to < 80g/l; however, only two (0.9%) were symptomatic and received a red blood cell transfusion. Six patients (2.8%) developed acute kidney injury and did not require haemofiltration. The mean LOS was 3.2 ± 2.9 days. Five patients (2.3%) were readmitted within 30 days and six patients (2.8%) within 90 days. Univariate analysis only showed association between patients with abnormal creatinine and LOS (p < 0.05), and all of these patients had raised preoperative creatinine levels. CONCLUSIONS: Routine postoperative blood tests are not required as they did not change the clinical outcome in this cohort or the readmission rate, causing unnecessary costs. It is recommended to request postoperative blood tests for patients with raised preoperative creatinine levels.

The association between intraoperative correction of Dupuytren's disease and residual postoperative contracture.

The purpose of this study was to determine whether preoperative contracture and the amount of intraoperative correction can be used to predict the postoperative outcome of fasciectomy for Dupuytren's disease. A prospective study of 52 patients undergoing primary fasciectomy during an 18 month period was undertaken. The contracture of each joint was measured preoperatively, after fasciectomy during the operation and 6 months after surgery. Forty-two metacarpophalangeal (MCPJ) and 58 proximal interphalangeal (PIPJ) joints were treated surgically. Full intraoperative correction was achieved in 41 MCPJs. Thirty-seven had full correction at follow-up. Full intraoperative correction was obtained in 35 PIPJs and 13 had complete correction at follow-up. The extent of the preoperative deformity was a significant predictor of complete intraoperative correction. The extent of both preoperative deformity and intraoperative correction were significant predictors of loss of surgical correction after operation.

The association between referral source and stage of disease in patients with colorectal cancer.

OBJECTIVE: The colorectal fast track (FT) referral system was set up to ensure patients with suspected cases of colorectal cancer (CRC) received prompt access to specialized services. The aim of this study was to ascertain the association between referral source and the time it took to be seen by a colorectal surgeon to establish whether referral source had any association with the stage of disease at presentation in patients with CRC. METHOD: Consecutive patients with newly diagnosed CRC presenting between October 2002 and September 2004 were identified retrospectively. Mode of presentation, symptoms, treatment and histopathology data were analysed. RESULTS: Data for 193 patients were analysed. Ninety seven patients (50%) presented via the FT system, 43 (22.5%) from nonfast track outpatient sources (NFT) and 53 (27.5%) as emergencies. NFT patients took significantly longer to be seen by a colorectal specialist than FT patients (median 69 vs 31 days; P < 0.001) and to initiation of treatment (median 57.5 vs 42.5 days; P = 0.001). Overall 152 patients (79%) presented with symptoms that met the FT criteria. A significantly lower number of NFT (P = 0.001) and emergency patients (P < 0.001) presented with FT symptoms compared with patients referred through the FT system. There was no significant difference between referral groups in patients undergoing surgery with potentially curative intent or stage of disease. CONCLUSION: Nonfast track referral leads to a significant delay in being seen by a specialist and in initiation of treatment but no association with more advanced stage of disease or a reduction in potentially curative surgery was found.