Instructional course lectures
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Because orthopaedic surgeons focus on identifying serious potential complications, such as heart attack, stroke, and deep vein thrombosis, during the preoperative assessment, correctable factors, such as smoking, may be overlooked. Chronic exposure to nicotine has been correlated with perioperative complications that lead to worse outcomes, including decreased patient satisfaction, longer hospitalization periods, and an increased rate of hospital readmission. ⋯ Physician-led preoperative smoking cessation programs that include, but are not limited to, pharmacotherapy plans have been shown to improve primary surgical outcomes and smoking cessation rates. Smoking has detrimental effects on specialty-specific physiology; however, there are many effective options for intervention that can improve primary outcomes.
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Although the Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January 2013, it may be years before the data can determine if the BPCI Initiative enhances value without decreasing quality. Private insurers have implemented other bundled payment arrangements for the delivery of total joint arthroplasty in a variety of practice settings. It is important for surgeons to review the early results of the BPCI Initiative and other bundled payment arrangements to understand the challenges and benefits of healthcare delivery systems with respect to total joint arthroplasty. In addition, surgeons should understand methods of cost control and quality improvement to determine the effect of the BPCI Initiative on the value-quality equation with respect to total joint arthroplasty.
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To minimize perioperative complications after elective orthopaedic procedures, patients may undergo preoperative medical optimization, which includes an assessment of their renal function and gastrointestinal system. The gastrointestinal and renal systems are complex, and their proper optimization in the preoperative period can influence the success of any procedure. Several factors, including a thorough evaluation and screening, with particular emphasis on anemia and its renal and gastrointestinal causes; the management of medications that are metabolized by the liver and excreted by the kidneys; and careful attention to the patient's nutritional status, can prevent complications and reduce morbidity, mortality, and the cost of care after elective orthopaedic procedures.
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Vitamin D is a steroid hormone that affects not only bone metabolism and strength but also a variety of musculoskeletal health and surgical outcomes that are relevant to orthopaedic medicine. Risk factors for vitamin D deficiency include sex, age, skin pigmentation, obesity, and preexisting conditions such as nephritic syndrome and malabsorption syndrome. Furthermore, vitamin D deficiency is associated with the development of postoperative complications, such as an increased risk of infection, morbidity, and mortality. The standardization of vitamin D terminology as well as a thorough understanding of the medical considerations associated with vitamin D deficiency can improve preoperative planning and clearance, and, ultimately, patient outcomes and satisfaction.
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Heart disease is the leading cause of death in the United States. Cardiovascular complications are associated with higher morbidity and mortality rates for patients who undergo orthopaedic surgery. Therefore, the clinical importance of a comprehensive preoperative evaluation and medical clearance is crucial and may substantially improve postoperative outcomes. A thorough knowledge of cardiovascular perioperative planning and management can enable healthcare professionals to identify patients who are potentially at risk for cardiovascular complications, and eventually improve both short- and long-term patient outcomes and satisfaction.