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Team Approach: Perioperative Optimization for Total Joint Arthroplasty

Feng, James E., MD1; Novikov, David, BS1; Anoushiravani, Afshin A., MD1; Wasterlain, Amy S., MD1; Lofton, Holly F., MD2; Oswald, William, DPT3; Nazemzadeh, Milad, MD4; Weiser, Sherri, PhD1; Berger, Jeffery S., MD, MS2; Iorio, Richard, MD5,a

doi: 10.2106/JBJS.RVW.17.00147
Team Approach Review Articles
Disclosures

  • * With the shift toward value-based patient care, greater emphasis has been placed on improving patient outcomes, reducing complications, and minimizing hospital costs. Optimal care therefore requires a multidisciplinary approach for perioperative patient optimization and episode management.
  • * Here we review the case of a 48-year-old woman with symptomatic osteoarthritis of the left hip and multiple medical comorbidities. We present appropriate optimization guidelines from a panel of multidisciplinary experts in their respective specialties.
  • * Continued clinical research is critical with regard to perioperative optimization and disease episode management as part of population health initiatives and will enable us to better identify at-risk patients early in the process. This will promote the development of improved evidence-based screening criteria and guidelines allowing for the optimization of patient outcomes, safety, and satisfaction following total joint arthroplasty.
  • * Historically, surgical risk stratification methods have emphasized the appraisal of non-modifiable risk factors. Consequently, this has incentivized surgeons to operate on healthy, low comorbidity burden patients, while avoiding surgical intervention on unhealthy, high-comorbidity patients. Only recently has the medical optimization of high-risk candidates undergoing total joint arthroplasty demonstrated improved outcomes by reducing hospital readmissions when patients undergo total joint arthroplasty after optimization.

1Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, NY

2Division of Cardiology (J.S.B.), Department of Medicine (H.F.L.), and Division of Vascular Surgery, Department of Surgery (J.S.B.), NYU Langone Health, New York, NY

3Department of Physical Therapy, Center for Musculoskeletal Care, NYU Langone Health, New York, NY

4Department of Anesthesiology, Johns Hopkins Medicine, Sibley Memorial Hospital, Washington, D.C.

5Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

aE-mail address for R. Iorio: riorio@bwh.harvard.edu

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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