Pre-surgical optimization for hip or knee replacement procedures

Brett Smith, M.D., M.S.
Hip & Knee Replacement Specialist
Andrews Institute for Orthopaedics & Sports Medicine
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 Q: Why is it so important for a patient to go through pre-surgical optimization prior to a hip or knee replacement?
Brett Smith, M.D., M.S.: Previously to this program, we would have the patient’s primary care physician clear them for surgery with a chest x-ray, EKG and some blood work and they would check a box saying they're safe to have the surgery. What we have developed at the Andrews Institute over the last two years or so is an optimization clinic that encompasses everything preoperatively to make sure that not only is the patient safe (for the procedure), but that they are optimized for surgery. We've had a few patients that we've canceled surgery because they weren't optimized, we had patients that we could optimize in the timeframe before surgery. It's been tremendous, and I think that really is what's driving our reduced complications is the pre-surgical optimization clinic.
 Q: Talk about some of the risk factors that may be addressed in pre-surgical optimization?
Brett Smith, M.D., M.S.: The risk factors are numerous. Obviously we check nutrition. The two biggest risk factors are the patient’s diabetes status and then obesity. We know that you know what the BMI over a certain number the complications go up. So we're working hard in advance having them reduce their BMI so they are safer after the surgery.
 Q: How does pre-surgical optimization impact a patient postoperatively?
Brett Smith, M.D., M.S.: I tell patients that 10 to 20 years ago, we told them the hospital stay is five days. Now we say the hospital stay is one day, maybe two – you're going home after surgery with outpatient therapy. This is all about moving and getting back to their life. That push has been well received by the patients and their families. They're not questioning why it's a one-day stay versus two and why ten years ago it was five days. They're excited to get back home. They're excited to get back out in the community to go to church on Sundays and to go to dinner on Friday with their family a week after surgery. So really it's been exciting, I mean, I think we're doing a pretty good job before, but we've gotten better because of it.


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