Preoperative medical optimization of patients is an approach orthopedic surgeons can use to reduce postoperative complications and improve the overall safety of procedures they perform.

If we asked an individual to run a marathon tomorrow, without any preparation, we would almost certainly be disappointed by the result as their bodies would not be able to handle such significant stress. Similarly, if we do not prepare our patients’ bodies to be ready for surgery, it likely will not go as well,” George F. “Rick” Hatch III, MD, associate professor of clinical orthopedic surgery at Keck School of Medicine of USC, said.

Classically, we consider substance use (e.g., cigarette smoking), diabetes control, mental health disorders, and obesity, among others, as modifiable factors that increase the risk of complications in orthopedic surgery,” Hatch said.

When health care professionals do not attempt to improve the modifiable medical risk factors, patients may experience complications. James J. Purtill, MD, said these might include wound healing problems, cardiovascular difficulties, infection, increased readmission rates, long-term medical problems and worsening of existing medical conditions. Pre-admission testing done well before surgery is scheduled can indicate which patients need to be optimized to mitigate intraoperative or postoperative issues possibly.

“We should do the best we can to help patients optimize their condition when going through elective surgical procedures. While it may take some extra time and effort, that time and effort are well-invested concerning the patient’s overall well-being,” Purtill, vice chairman of the department of orthopedic surgery at Thomas Jefferson University and Rothman Orthopaedic Institute, told Orthopedics Today.

Weight and Nutrition Management

Maintaining a healthy weight and eating well are ways patients can be optimized for elective orthopedic surgery. The American Academy of Orthopaedic Surgeons recommends patients with symptomatic hip and knee osteoarthritis and a BMI higher than or equal to 25 kg/m2 lose weight.

“In patients who are morbidly obese, they should be encouraged to lose weight and [be] given all the resources that they may need to lose weight to the extent that they can, and to lose weight safely,” Purtill said. “Nutritionists and weight loss programs are beneficial along those lines