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.

867 A Novel Use for Silicone Expanders: Reducing Pelvic Dead Space and Preventing Bowel Herniation When Managing Radical Exenterative Surgery Complications

Aim

To date, there is no clear consensus regarding the best way to obliterate the pelvic dead space, as seen in patients treated for recurrent perineal herniation and entero-cutaneous fistuli following total pelvic exenteration (TPE) for locally advanced rectal cancer. We present a novel technique using saline-filled breast expander to fill the dead space and create an artificial pelvic floor using the implant capsule, thus preventing intestinal herniation and fistuli formation in the multi-operated and irradiated pelvis scenario.

Method

We present 2 patients who initially had TPE, IGAP flap perineal reconstruction and neoadjuvant chemoradiotherapy. Patient 1 had 2 laparotomies for persistent enteroperineal fistulae in the 2-year postoperative period. Patient 2 had persistent wound discharge 2 years post TPE and underwent an enterocutaneous fistula repair and wound debridement. Both cases were complicated by perineal herniation and re-presented with persistent fistulation. A Becker 25 breast expander was placed into the pelvis and inflated with 150 ml of saline, to help contain the small bowel in the abdomen and reduce the risk of perineal re-herniation and fistulae.

Results

The silicone device was removed at 7-12 months, preserving its capsule, by the time the wound had healed. The wounds remained healed at post-operative follow up without any further perineal wound complications, herniation or fistuli

Conclusions

Addressing the dead pelvic space by using a breast expander may treat this particular TPE complication. The capsule created following placement of breast implant, facilitates artificial pelvic floor.