Is the natural course of perioperative laboratory testing effective in identifying wound-related complications following primary total hip arthroplasty?

Introduction: Previous study did not clarify the correlation between the natural course of perioperative blood tests and occurrence of wound-related complications, including SSI, PJI, and delayed wound healing. This study aimed to investigate whether perioperative laboratory test is effective in identifying wound-related complications after THA.

Materials And Methods: This retrospective, single-institutional study enrolled 1072 patients who underwent primary THAs. We identified all cases of perioperative wound-related complications, including surgical site infection (SSI), periprosthetic joint infection (PJI), and delayed wound healing. First, we investigated which factors influenced perioperative wound complications using multivariate analysis. Second, we did 2:1 case-control study between no complications and complication group by matching on age, BMI, diagnosis, ASA class, Charlson comorbidity index. The results of perioperative laboratory tests were compared between two groups. Third, we investigated whether there was an effective threshold for perioperative wound complications on serum CRP and D-dimer.

Results: Twenty-six cases of THA, comprising SSI in 9 hips (0.8%), PJI in 10 hips (0.9%), and 7 hips with wound delay healing (0.7%), demonstrated perioperative wound-related complications. Multivariate analysis showed that ASA class, Charlson comorbidity index, and serum CRP values in 1 week postoperatively influenced perioperative wound complications, meanwhile serum D-dimer did not show the statistical difference. After case-control matching on patient factors, the result of any blood samples did not show statistical difference in complication group. Also, no significant threshold for detecting wound-related complications was found in serum CRP and D-dimer.

Conclusion: The main role of perioperative blood tests is to recognize preoperative patient factors in order to early detect of perioperative wound complications. Serum CRP values in 1 week postoperatively may play a supplemental role in taking care of perioperative wound complication.