Was ist ein Muss in der präoperativen Diagnostik vor elektiver Endoprothetik?

Zusammenfassung

Hintergrund Im Vorfeld einer elektiven Endoprothesenimplantation sind diagnostische Maßnahmen erforderlich. Diese haben das Ziel, die patientenbezogene und eingriffsbezogene Risikokonstellation zu erfassen und durch die Einleitung geeigneter prä- und perioperativer Maßnahmen mögliche Komplikationen zu vermeiden bzw. deren Auftretenswahrscheinlichkeit zu reduzieren. Daneben dient die klinische und bildgebende Untersuchung des Patienten der Indikationsstellung zum Eingriff, die jedoch nicht Thema des vorliegenden Beitrags ist.

Ziel der Arbeit Die aktuelle Literatur zur präoperativen Diagnostik vor elektiven endoprothetischen Eingriffen wurde analysiert.

Methode Eine selektive Literaturrecherche wurde durchgeführt.

Ergebnisse Wir identifizierten studienbasierte Empfehlungen hinsichtlich (1) präoperativer Anämie, (2) Optimierung der Stoffwechsellage, (3) Gewichtskontrolle, (4) Schlafapnoesyndrom, (5) MRSA-Problematik und Hautdekontamination, (6) Harnwegsinfektion, (7) dentales Screening, (8) kardiologischer Diagnostik, (9) technisch-planerischen Vorbereitungen, insbesondere der Revisionsendoprothetik.

Schlussfolgerung Auch wenn nicht zu allen präoperativen diagnostischen Maßnahmen belastbare evidenzbasierte Empfehlungen vorliegen, bestehen bereits klare Anforderungen an die präoperative Diagnostik elektiver Patienten vor endoprothetischen Eingriffen. Die zunehmende Fokussierung auf erweiterte Maßnahmen im Rahmen des perioperativen Managements wird den Umfang notwendiger Untersuchungen im Vorfeld dieser Operationen erhöhen.

Abstract

Background A thorough pre-operative evaluation is required prior to total joint arthroplasty (TJA). The objective of screening is to identify patient- and procedure-related risk constellations. Pre-operative diagnostic measures are vital in order to anticipate, reduce or even eliminate threats to patient safety. Furthermore, the clinical and radiographical workup may confirm the indication and type of surgical procedure, but this is not the subject of this article.

Objective An overview of the current literature on pre-operative diagnostic principles is presented.

Methods A selective literature analysis was performed.

Results We identified recommendations related to the following: (1) preoperative anaemia, (2) metabolic optimisation, (3) weight control, (4) obstructive sleep apnoea, (5) MRSA and skin decontamination, (6) urinary tract infections (UTI), (7) dental screening (8) cardiological workup, (9) technical considerations on primary and revision arthroplasty.

Conclusion While clear evidence-based recommendations for every item are not yet available, a critical pre-operative evaluation including history taking, physical exam, laboratory tests and imaging studies remains essential. The ongoing evolution of improved perioperative care and implications for patient safety will further increase the scope of necessary preoperative diagnostic measures.

Schlüsselwörter

präoperative Diagnostik - Hüftgelenksendoprothetik - Kniegelenksendoprothetik - perioperatives Management - Patientensicherheit - Outcome

Key words

preoperative diagnostic evaluation - total hip arthroplasty - total knee arthroplasty - perioperative management - patient safety - outcome

• Literatur

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