Patient Preoperative Optimization: How to Do It and How to Be Paid for the Work

Area of Science:

• Orthopaedic Surgery
• Patient Optimization
• Health Services Research

Background:

• Preoperative optimization is vital for orthopaedic surgeons, especially with rising outpatient total joint arthroplasty (TJA).
• Identifying and managing modifiable patient risk factors is essential for surgical success.
• Navigating reimbursement for preoperative services presents a challenge.

Purpose of the Study:

• To review key aspects of preoperative optimization for TJA.
• To explore strategies for managing patient comorbidities and risk factors.
• To discuss reimbursement pathways for preoperative care.

Main Methods:

• Review of medical evaluations for anemia, glycemic control, and smoking cessation.
• Assessment of comorbidity management (e.g., rheumatoid arthritis, OSA, PVD).
• Exploration of nutritional support, obesity management, and perioperative medication use.

Main Results:

• Optimizing risk factors like glycemic control and smoking cessation reduces complications (e.g., infection, poor wound healing).
• Nutritional interventions and patient-centered obesity management improve outcomes.
• Outpatient TJA is safe and feasible with proper patient selection and preparedness.
• Principal Care Management codes offer reimbursement for complex preoperative planning.

Conclusions:

• Preoperative optimization is critical for reducing TJA risks and enhancing outcomes, especially in outpatient settings.
• Surgeons are central to managing patient factors and implementing standardized protocols.
• Principal Care Management codes recognize and compensate for extensive preoperative planning, ensuring high standards of care.