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Medical Optimization and Risk Mitigation for Readmission

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Outpatient Hip and Knee Replacement

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Abstract

Preoperative optimization is a crucial part of successful total joint arthroplasty (TJA). In the case of outpatient TJA, preoperative optimization improves outcomes and decreases rates of periprosthetic joint infection (PJI). An evidence-based review of the literature has highlighted the following modifiable risk factors as important variables for optimization in order to reduce rates of PJI: glycemic control, obesity, malnutrition, smoking, Vitamin D, preoperative Staphylococcus aureus screening, management of antirheumatic medications, and appropriate antibiotic prophylaxis. This chapter provides surgeons a practical approach to preoperatively optimize modifiable risk factors.

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References

  1. Krause A, Sayeed Z, El-Othmani M, Pallekonda V, Mihalko W, Saleh KJ. Outpatient Total knee arthroplasty: are we there yet? (part 1). Orthop Clin North Am. 2018;49(1):1–6.

    Article  PubMed  Google Scholar 

  2. Bert JM, Hooper J, Moen S. Outpatient Total joint arthroplasty. Curr Rev Musculoskelet Med. 2017;10(4):567–74.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lovett-Carter D, Sayeed Z, Abaab L, Pallekonda V, Mihalko W, Saleh KJ. Impact of outpatient Total joint replacement on postoperative outcomes. Orthop Clin North Am. 2018;49(1):35–44.

    Article  PubMed  Google Scholar 

  4. Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009;91(7):1621–9.

    Article  PubMed  Google Scholar 

  5. Stryker LS, Abdel MP, Morrey ME, Morrow MM, Kor DJ, Morrey BF. Elevated postoperative blood glucose and preoperative hemoglobin A1C are associated with increased wound complications following total joint arthroplasty. J Bone Joint Surg Am. 2013;95(9):808–14. S1–2

    Article  PubMed  Google Scholar 

  6. Iorio R, Williams KM, Marcantonio AJ, Specht LM, Tilzey JF, Healy WL. Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection. J Arthroplast. 2012;27(5):726–9 e1.

    Article  Google Scholar 

  7. Shohat N, Tarabichi M, Tischler EH, Jabbour S, Parvizi J. Serum Fructosamine: a simple and inexpensive test for assessing preoperative glycemic control. J Bone Joint Surg Am. 2017;99(22):1900–8.

    Article  PubMed  Google Scholar 

  8. Kheir MM, Tan TL, Kheir M, Maltenfort MG, Chen AF. Postoperative blood glucose levels predict infection after Total joint arthroplasty. J Bone Joint Surg Am. 2018;100(16):1423–31.

    Article  PubMed  Google Scholar 

  9. Gallagher JM, Erich RA, Gattermeyer R, Beam KK. Postoperative hyperglycemia can be safely and effectively controlled in both diabetic and nondiabetic patients with use of a subcutaneous insulin protocol. JB JS Open Access. 2017;2(1):e0008.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Workgroup of the American Association of H, Knee Surgeons Evidence Based C. Obesity and total joint arthroplasty: a literature based review. J Arthroplast. 2013;28(5):714–21.

    Article  Google Scholar 

  11. Mason JB, Callaghan JJ, Hozack WJ, Krebs V, Mont MA, Parvizi J. Obesity in total joint arthroplasty: an issue with gravity. J Arthroplast. 2014;29(10):1879.

    Article  Google Scholar 

  12. Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J. Longer operative time results in a higher rate of subsequent Periprosthetic joint infection in patients undergoing primary joint arthroplasty. J Arthroplast. 2019;34(5):947–53. https://doi.org/10.1016/j.arth.2019.01.027. Epub 2019 Jan 18

    Article  Google Scholar 

  13. Gage MJ, Schwarzkopf R, Abrouk M, Slover JD. Impact of metabolic syndrome on perioperative complication rates after total joint arthroplasty surgery. J Arthroplast. 2014;29(9):1842–5.

    Article  Google Scholar 

  14. Zmistowski B, Dizdarevic I, Jacovides CL, Radcliff KE, Mraovic B, Parvizi J. Patients with uncontrolled components of metabolic syndrome have increased risk of complications following total joint arthroplasty. J Arthroplast. 2013;28(6):904–7.

    Article  Google Scholar 

  15. Huang R, Greenky M, Kerr GJ, Austin MS, Parvizi J. The effect of malnutrition on patients undergoing elective joint arthroplasty. J Arthroplast. 2013;28(8 Suppl):21–4.

    Article  Google Scholar 

  16. Duchman KR, Gao Y, Pugely AJ, Martin CT, Noiseux NO, Callaghan JJ. The effect of smoking on short-term complications following Total hip and knee arthroplasty. J Bone Joint Surg Am. 2015;97(13):1049–58.

    Article  PubMed  Google Scholar 

  17. Teng S, Yi C, Krettek C, Jagodzinski M. Smoking and risk of prosthesis-related complications after total hip arthroplasty: a meta-analysis of cohort studies. PLoS One. 2015;10(4):e0125294.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lindstrom D, Sadr Azodi O, Wladis A, Tonnesen H, Linder S, Nasell H, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008;248(5):739–45.

    Article  PubMed  Google Scholar 

  19. Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011;31(1):48–54.

    Article  CAS  PubMed  Google Scholar 

  20. Hegde V, Dworsky EM, Stavrakis AI, Loftin AH, Zoller SD, Park HY, et al. Single-dose, preoperative vitamin-D supplementation decreases infection in a mouse model of periprosthetic joint infection. J Bone Joint Surg Am. 2017;99(20):1737–44.

    Article  PubMed  Google Scholar 

  21. Kim DH, Spencer M, Davidson SM, Li L, Shaw JD, Gulczynski D, et al. Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. J Bone Joint Surg Am. 2010;92(9):1820–6.

    Article  PubMed  Google Scholar 

  22. Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J. 2017;14(3):529–36.

    Article  PubMed  Google Scholar 

  23. Momohara S, Kawakami K, Iwamoto T, Yano K, Sakuma Y, Hiroshima R, et al. Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. Mod Rheumatol. 2011;21(5):469–75.

    Article  PubMed  Google Scholar 

  24. Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, et al. 2017 American College of Rheumatology/American Association of hip and Knee Surgeons Guideline for the perioperative Management of Antirheumatic Medication in patients with rheumatic diseases undergoing elective Total hip or Total knee arthroplasty. J Arthroplast. 2017;32(9):2628–38.

    Article  Google Scholar 

  25. Fernandez AH, Monge V, Garcinuno MA. Surgical antibiotic prophylaxis: effect in postoperative infections. Eur J Epidemiol. 2001;17(4):369–74.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hospital for Special Surgery, New York, NY, USA

    Vignesh K. Alamanda & Bryan D. Springer

  2. OrthoCarolina Hip and Knee Center, Charlotte, NC, USA

    Bryan D. Springer

Authors
  1. Vignesh K. Alamanda
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  2. Bryan D. Springer
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Corresponding author

Correspondence to Bryan D. Springer .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Indiana University School of Medicine, Indiana Joint Replacement Institute, Indianapolis, IN, USA

    R. Michael Meneghini

  2. Department of Orthopedic Surgery, Indiana University Health, Fishers, IN, USA

    Leonard T. Buller

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Alamanda, V.K., Springer, B.D. (2023). Medical Optimization and Risk Mitigation for Readmission. In: Meneghini, R.M., Buller, L.T. (eds) Outpatient Hip and Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-031-27037-6_2

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  • DOI: https://doi.org/10.1007/978-3-031-27037-6_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-27036-9

  • Online ISBN: 978-3-031-27037-6

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