Managing risk factors to drive down hip and knee replacement 30-day readmissions
The pre-operative evaluation done with the patient’s primary care doctor is essential for identifying and treating any risk factors, Gardner says. With hip and knee replacements, there are well-known perimeters.
“For example, a BMI over 40 increases the risk of blood clots, wound complications, dislocations, and nerve injury,” he says. “In diabetics, a hemoglobin A1C that is above 8 significantly increases the potential risks and must be lowered before proceeding with surgery. In addition, if the absolute levels of protein in the body are not high enough, we would postpone surgery until the lab values are below the threshold for minimizing risk factors.”
Stephen Fealy, MD, leading orthopaedic surgeon at Hospital for Special Surgery in New York, says one of the best ways to manage and mitigate the risk of readmission after orthopaedic surgery is to ensure patients have access to and receive physical therapy as expeditiously as possible.
“When you’re dealing with musculoskeletal injuries and surgeries, the healing process can be complex, long-term, and often requires recurring specialized attention and practice, such as safe incremental exercise to help patients gain back and maintain their strength and range of motion,” he says. “The sooner this can start, the better off the patient will be in both the near- and long-term.”
Hallstrom notes the first, and best step, is optimizing patients prior to surgery. Things like weight loss, smoking cessation, and controlling diabetes before surgery are all ways to help avoid post-operative problems.
Keith Loria is an award-winning journalist who has been writing for major newspapers and magazines for close to 20 years.