Improving Total Joint Outcomes: A Survey of Surgeon Implementation of Perioperative Optimization Protocols

Perioperative nutritional, functional status, and bone health optimization has been supported in the literature before arthroplasty procedures; however, surgeon's perception and implementation of such efforts have yet to be investigated. This study aims to identify the current perception and implementation efforts of arthroplasty surgeons in the nation regarding nutritional, functional status, and bone health optimization.

A 28-question survey was anonymously distributed to orthopaedic arthroplasty surgeons through the American Association of Hip and Knee Surgeon contact database. Survey responses were compiled and analyzed with chi square.

Sixty-four total arthroplasty surgeons completed the questionnaire with the following geographic distribution: 33% Midwest, 27% Northeast, 23% Southeast, and 16% West. Forty-six percentage of survey participants reported a formal departmental nutrition optimization protocol despite 14% of surgeons doubting the benefits of nutritional optimization. The perceived goals of nutrition intervention were predominantly decreasing complications rates and weight loss. Seventy-five percentage of surveyed respondents report an absence of functional status optimization protocol in place with 38% of surgeons' initial functional assessment begins with patient ambulation dependency. In addition, 13% of surgeon routinely assess bone health with a dual energy x-ray absorptiometry scan for suspicion of osteoporosis, and 87% of surgeons would not delay surgery for bone health optimization.

Despite data suggesting the benefits of perioperative nutritional, functional status, and bone health optimization, many barriers to implementation exist. Predominant barriers include compliance rate and logistical challenges of implementation. Comprehension of current perceptions and common practice can provide information to direct future optimization protocol development.