Patients often think that surgical outcomes come down to choosing the best surgeon.
I disagree.
Now – more than ever – patients need to be personally responsible for their own recovery.
When you commit to replacing a joint, you generally have six weeks before your surgery to prepare your body. The following 12 weeks are focused on getting your life back to normal. Those 18 weeks total 3,024 hours.
The surgery itself only takes one to two hours. The time spent under the knife certainly matters, but how about the other 3,022 hours?
This is where you must own the process.
Medicare and commercial insurance have imposed severe pay cuts that force surgeons to focus almost exclusively on their time in the operating room. The cuts result in less hours spent on pre-operative education and optimization, as well as zero pay for post-operative recovery and counseling.
You and your surgeon want the best outcome for you despite the cost-cutting. Your surgeon needs you to focus on the other 3,022 hours.
Start by bringing this list to your regular doctor or look up the numbers yourself on your MyChart account.
1. Correct low albumin. Albu-what??? Albumin is a protein produced by the liver. It reflects your nutritional status. Low albumin is associated with the highest risk of complications. You ideally want to get your albumin to 4.0 or higher. Postpone your elective surgery if your level is less than 3.5. Work with your doctor to correct this deficiency before scheduling.
2. Correct anemia (low blood count). Many people have a low blood count without symptoms. For males, hemoglobin of less than 13 mg/dl increases risk. For females, it’s less than 12. Postpone your surgery until a diagnosis and treatment plan fixes the issue.
3. Get diabetes under control. Shoot for a hemoglobin A1c of less than 7.5. Your risk of infection increases every time your blood sugar spikes over 180.
4. Get your Body Mass Index (BMI) to between 20 and 25. Risk increases with a BMI greater than 30 or less than 18. Risk of complications with a BMI greater than 40 increases exponentially. Many insurance companies will cancel your surgery if your BMI is greater than 40. Even if you squeak under the wire with a BMI of 39.9, you should still try to lose 10 to 12 pounds during the six weeks before surgery since it will lower your risk.
Make the following lifestyle interventions six weeks before your surgery.
5. Stop smoking six weeks before through six weeks after surgery. Smoking impairs oxygenation and increases infection risk by two to three times. It also may lead to poor implant fixation that requires a second surgery to correct it.
6. Optimize the health of your leg by treating swelling before and after surgery. No farmer plants new seeds in a flooded field. Don’t get a new implant in a “flooded leg.” Get treatment for pre-op leg swelling from a certified lymphedema therapist and strongly consider a post-op protocol that lowers the swelling curve faster than old-school protocols.
7. Get your sleep apnea and high blood pressure corrected before surgery.
8. Try to perform 20 to 30 minutes of exercise daily as pain allows. This primes your lymphatic system and can help reduce post-op swelling.
9. Identify a friend or family member to act as your coach through the process. They should be involved from when you commit to surgery through several weeks post-op. Two sets of eyes are better than one.
10. An anti-inflammatory diet (think Mediterranean diet) that is low in salt (<1500mg/day) may significantly reduce risk and speed recovery. Consider essential amino acid supplementation, as it helps improve healing. Work with your doctor, a nutritionist or a medical health company to do this.
Make a plan for post-op recovery.
11. Ensure your post-op safety by preparing your home. Install grab bars and handrails where needed. Remove throw rugs and other trip hazards. Make a plan for rambunctious pets.
12. Find a therapy team that focuses on swelling reduction and range of motion recovery rather than excessive strengthening for the first five to six weeks. This may make rehabilitation less painful.
Yes, some of the specifics are intimidating, but you need to own your recovery. Don’t depend upon our broken health care system to do it for you.
Prime your body before surgery.
It’s within your power to facilitate the best outcome. Follow these 12 steps to prepare yourself for the most successful experience possible.
Dr. Andrew Wickline
Dr. Andrew Wickline, Fellow of the American Academy of Orthopaedic Surgeons, has performed more than 20,000 surgeries over the past 20 years in Utica, NY and around the world.
