From the Guidelines
Prior to orthopedic surgery, the typical labs to order include a complete blood count (CBC), comprehensive metabolic panel (CMP), coagulation studies (PT/INR, PTT), urinalysis, and type and screen or crossmatch if blood transfusion might be needed, as these tests help identify conditions that could increase surgical risks and guide anesthesia decisions 1. When evaluating the need for preoperative testing, it's essential to consider the patient's history, physical examination findings, perioperative risk assessment, and clinical judgment 1.
- The decision to perform preoperative testing should be based on the history and physical examination findings, perioperative risk assessment, and clinical judgment 1.
- Patients with signs and symptoms of cardiovascular disease should undergo preoperative electrocardiography 1.
- Preoperative urinalysis is indicated for patients undergoing urologic procedures or implantation of foreign material, which may include some orthopedic surgeries 1.
- Preoperative electrolyte and creatinine testing should be reserved for patients at risk of electrolyte abnormalities or renal impairment 1.
- A preoperative complete blood count is indicated for patients at risk of anemia based on their history and physical examination findings, and those in whom significant perioperative blood loss is anticipated 1.
- Preoperative coagulation testing should be reserved for patients who are taking anticoagulants, who have a history of bleeding, or who have medical conditions that predispose them to coagulopathy (e.g., liver disease) 1. Additionally, guidelines from the Network for Advancement of Transfusion Alternatives (NATA) recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible, and that the patient’s target Hb before elective surgery be within the normal range, according to the World Health Organization criteria 1.
- We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C) 1.
- We suggest that the patient’s target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C) 1. The most critical aspect of preoperative testing is to identify conditions that could increase surgical risks and guide anesthesia decisions, and the specific tests ordered may vary based on the patient's age, medical history, medications, and the type of orthopedic procedure planned 1.
From the Research
Preoperative Laboratory Tests
The following laboratory tests are typically ordered prior to orthopedic surgery:
- Complete Blood Count (CBC) 2
- Complete Metabolic Panel (CMP) 2
- Prothrombin Time (PT) and International Normalized Ratio (INR) 2
- Blood typing and cross-matching (if blood transfusion is anticipated)
- Electrolyte panel
- Renal function tests (e.g., creatinine, urea)
- Liver function tests (e.g., ALT, AST)
Special Considerations
- Patients with a history of anemia or those at risk of anemia may require additional tests, such as iron studies and erythropoietin levels 3, 4
- Patients on anticoagulant therapy may require coagulation studies, such as PT/INR, to assess their risk of bleeding 5
- Patients with underlying medical conditions, such as diabetes or renal disease, may require additional tests to assess their risk of complications 2