Urinalysis in asymptomatic patients before joint replacement is a waste

POEMs Research Summaries

Clinical Question

Should asymptomatic patients have a routine urinalysis before undergoing total joint replacement surgery?

Bottom Line

Asymptomatic patients undergoing total joint replacement have a low rate (5%) of symptomatic urinary tract infections (UTIs) during the 3 months following surgery. This low rate supports discontinuing routine preoperative urinalyses in asymptomatic patients. (LOE = 1b)

Reference

Bouvet C, Lübbeke A, Bandi C, et al. Is there any benefit in pre-operative urinary analysis before elective total joint replacement? Bone Joint J 2014;96-B(3):390-394.
Study Design: Cohort (prospective)
Funding: Self-funded or unfunded
Setting: Inpatient (any location) with outpatient follow-up
Allocation: Unknown

Synopsis

These authors evaluated patients undergoing elective total joint replacement (knees or hips) at a single Swiss university. The authors report that their practice is to perform a urinalysis before surgery, but they questioned whether this practice should continue. After excluding patients with symptoms of UTIs or chronic indwelling catheters, they identified 504 patients undergoing 510 surgeries. All patients received a single parenteral dose of cefuroxime or vancomycin perioperatively. The researchers evaluated the patients on day 3 and month 3 after surgery. Most of the patients (61%) were women; the mean age was 69 years (range = 16 to 97 years). Approximately 33% of the patients had a positive urine culture before surgery and 41% had a positive urine culture on the third day after surgery. However, only 5% of patients (n = 25) developed a symptomatic UTI after surgery or during the 3 months after. Additionally, most UTIs were secondary to pathogens unrelated to the initial cultures. This study, like many others, questions a routine preoperative test. The low rate of symptomatic UTIs and the lack of correlation with any surgical infectious complications in this study reinforces this literature base. One caveat: This is not a randomized trial, so we can’t really say that patients are truly better off with or without routine testing. The authors had hoped to do a randomized trial, but estimated it would take bazillions of patients to pull it off!

Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI

 

 

 

 

 

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