What are the post-operative blood test results on day one after orthopedic (ortho) joint surgery?

From the Guidelines

On day one after orthopedic joint surgery, it is crucial to prioritize post-operative blood tests that assess for potential complications, with a focus on complete blood count (CBC) to evaluate anemia, as supported by the NATA guidelines 1. When considering the necessary blood tests for day one post-operative care, the following should be included:

• Complete blood count (CBC) to assess for anemia from surgical blood loss, with particular attention to hemoglobin and hematocrit levels, as anaemia is a serious and treatable medical condition that can impact patient outcomes 1.
• Basic metabolic panel (BMP) to evaluate kidney function and electrolyte balance, which may be affected by perioperative fluid management.
• C-reactive protein (CRP) as a baseline inflammatory marker to monitor for potential infection. Additional tests to consider include:
• Coagulation studies (PT/INR, PTT) if the patient is on anticoagulation therapy.
• Type and screen if significant blood loss occurred or is anticipated. These tests should be ordered in the morning to establish baseline values and allow for timely intervention if abnormalities are detected, with the goal of improving patient outcomes by managing anaemia and other potential complications 1. Results should be interpreted in the context of the patient's preoperative values, as some changes (like decreased hemoglobin or elevated CRP) are expected after surgery, and significant deviations from expected post-operative values may indicate complications requiring prompt intervention.

From the Research

Day One Ortho Joint Post Op Bloods

• The necessity of routine postoperative blood tests for patients undergoing total hip arthroplasty (THA) has been questioned in a study published in 2021 2.
• The study found that young and healthier patients (ASA grade 1 and 2 with age ≤70 years) seldom have significant abnormalities on routine post-operative blood analyses that require clinical intervention.
• However, the study also noted that 6.4% of patients with an ASA of 1-2 had postoperative blood results requiring intervention, and 17.8% of patients with ASA 3-4 required intervention.
• Another study published in 2020 discussed the utility of routine coagulation panels in the emergency department setting 3.
• The study found that coagulation panels have limited utility in medical decision-making for certain conditions, such as chest pain evaluation, routine perioperative assessment, and screening for admitted patients.
• The study recommended that coagulation testing should be considered in systemically ill patients, those with a prior history of bleeding or family history of bleeding, patients on anticoagulation, or patients with active hemorrhage and signs of bleeding.
• A study published in 1997 discussed the complete blood count (CBC) and its components, including red blood cell count, hemoglobin, hematocrit, and white blood cell count 4.
• The study noted that the CBC is one of the most frequently ordered laboratory tests in medicine and can be helpful in difficult diagnoses and in monitoring treatments for hematologic disorders and other medical problems.
• Another study published in 2007 discussed the use of heparin in preparing samples for blood-gas analysis 5.
• The study noted that heparin is the only anticoagulant used to prepare samples for blood-gas analysis and that the correct volume of blood must be sampled to achieve a correct heparin concentration.
• A study published in 2019 discussed updated guidelines for outpatient management of anticoagulation therapy 6.
• The study recommended that direct oral anticoagulants are first-line agents for eligible patients for treating venous thromboembolism and preventing stroke in those with nonvalvular atrial fibrillation.