The American Academy of Orthopedic Surgeons had their annual meeting in New Orleans, Louisiana March 11th through the 16th. On March 15th, the hip society had their annual open meeting and there were several papers focused on preventing readmission to the hospital after joint replacement. There is emerging information particularly when looking at Medicare claims data, which allows the analysis of tens of thousands of patients. The focus of these papers was how to prevent readmission following surgery. Readmission often involves several causes. The most common being some type of cardiac event related to either coronary artery disease or irregular heart rates. Another source of readmission is infection as well as blood clots in the lower extremities. Several authors noted that there are many modifiable risk factors that if addressed prior to a surgery can avoid complications and readmission to the hospital. Looking at the most common risk factors associated with patients undergoing joint replacement they are in order or prevalence: Hypertension, elevated cholesterol, diabetes, depression, morbid obesity, and heart disease. Having appropriate preoperative evaluation by a patient’s internist or a hospital associated internal medicine group can help identify and hopefully treat many of these modifiable risk factors. High blood pressure can be controlled with medication as can elevated cholesterol. Diabetes can be appropriately managed so that the patient metabolically is as stable as possible prior to surgery. Obesity has gotten quite a bit of exposure over the last year to add the importance of losing weight to decrease the risk of infection and other complications after hip replacement. Most large volume centers are starting or have clinics in place to help patients with modifiable risk factors prior to surgery. Patients should look into these prior to considering joint replacement surgery.
