Preoperative Risk Factor Screening Protocols in Total Joint Arthroplasty: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Arthroplasty
• Evidence-Based Medicine

Background:

• Complications in lower extremity total joint arthroplasty (LE-TJA) can be reduced by optimizing modifiable risk factors preoperatively.
• Evidence on preoperative screening protocols for modifiable risk factors and their impact on LE-TJA outcomes is summarized.

Purpose of the Study:

• To assess the effect of preoperative screening protocols targeting modifiable risk factors on postoperative outcomes in primary LE-TJA.

Main Methods:

• A systematic literature search was conducted across major databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) in August 2019.
• Included studies reported outcomes such as surgical site infection (SSI), hospital length of stay (LOS), and readmissions following preoperative optimization protocols.
• Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Main Results:

• Eight retrospective cohort studies involving 9915 patients were reviewed.
• Preoperative optimization protocols were associated with significant reductions in SSI (0.56% vs. 2.60%), hospital LOS, mean cost of care, and hospital readmission rates.
• The mean MINORS score for comparative studies was 16.285.

Conclusions:

• Implementing evidence-based preoperative protocols for modifiable risk factors improves outcomes in LE-TJA.
• Favorable outcomes include reduced SSI, hospital LOS, cost of care, and readmission rates.
• Further prospective studies are needed to refine protocols and referral algorithms.