Clinical evaluation and cost effectiveness of preoperative laboratory assessment on patients undergoing total hip arthroplasty.

By examining the records of 101 admissions (86 patients) undergoing total hip replacement for osteoarthritis, we studied the impact of 24 preoperative laboratory assessments on the postoperative course. Four patients had their procedures postponed or canceled because of laboratory abnormalities; three of these patients had abnormal urinalyses and one had abnormal liver function tests. No other patients had alterations in their perioperative course as a result of the tests. No subsequent postoperative complications were attributable to either an abnormal or deficient preoperative assessment. Two patients with postoperative hepatitis had normal preoperative liver function studies. One patient had a postoperative bleeding episode but had had normal preoperative PT and PTT values. The economic implications are discussed in a cost-effectiveness model. On the basis of these results, we recommend that only a minimal set of preoperative laboratory tests be added to the detailed medical history and physical examination in otherwise healthy patients about to undergo total hip replacement surgery.