Table 3.

Summary of Guidelines Supporting the Reviewed Components.^a

Component “Bin”	Procedure	Society	Yearb	Recommendation/Statement
Preoperative management
Risk factor assessment
Anemia	Not available
Diabetes	TKA	AAOS	2015	Patients with diabetes mellitus are at increased risk of complications (moderate evidence)
Smoking	THA	AAOS	2017	Tobacco users are at increased risk of complications (limited evidence)
	Surgery	ACS SSI	2016	Cessation 4-6 weeks before surgery reduces risk of SSI and is recommended for all current smokers
Obesity	THA	AAOS	2017	Obese patients may achieve lower clinical scores but a similar level of patient satisfaction and relative improvement in pain and function after surgery (moderate evidence)
	THA	AAOS	2017	Obese patients are at increased risk of dislocation, superficial wound infection, and blood loss (limited evidence)
	TKA	AAOS	2015	Obese patients have less improvement in outcomes (strong evidence)
Malnutrition	Not available
Opiates/drug abuse	TKA	AAOS	2015	Patients with select chronic pain conditions (eg, low-back pain) have less improvement in patient-reported outcomes (moderate evidence)
Immune modulators	TKA/THA	ACR/AAHKS	2017	For patients with rheumatoid arthritis, continue conventional agents (eg, methotrexate) and hold biologic agents (eg, TNF-α inhibitors)
Preoperative education	Not available
Preoperative bathing/  decolonization	Ortho	WHO	2016	Nasal carriers of Staphylococcus aureus should receive intranasal mupirocin +/− chlorhexidine body wash (strong recommendation)
	Surgery	WHO	2016	Patients should bathe prior to surgery with plain or antimicrobial soap; inadequate evidence to assess chlorhexidine (conditional recommendation)
	Surgery	CDC SSI	2017	Patients should bathe prior to surgery with plain or antimicrobial soap at least the night before the operation (strong recommendation); optimal timing/number of applications/use of chlorhexidine unclear
	Ortho	ACS SSI	2017	Nasal carriers of Staphylococcus aureus should receive intranasal mupirocin +/− chlorhexidine body wash
Preoperative VTE prophylaxis	Ortho	CHEST	2012	No preference preoperative versus postoperative initiation; however, if using LMWH, therapy should be initiated >12 hours before or after surgery compared to <4 hours before or after surgery
Intraoperative management
Drains	TKA	AAOS	2015	There is no benefit to the use of drains with respect to complications or patient outcomes (strong evidence)
Postoperative management
Early mobilization	THA	AAOS	2017	Postoperative physical therapy can improve early function (moderate evidence)
	TKA	AAOS	2015	Rehabilitation started on the day of TKA reduces length of stay (strong evidence) and improves pain and function (moderate evidence)
Continuous passive motion	TKA	AAOS	2015	Continuous passive motion after TKA does not improve outcomes (strong evidence)
Extended duration VTE  prophylaxis	TKA/THA	AAOS	2011	Recommend use of pharmacologic agents and/or mechanical compressive devices for VTE prophylaxis, but they make no recommendation regarding which strategy or the duration of therapy
	TKA/THA	CHEST	2012	Recommend therapy over no therapy; dual (pharmacologic and mechanical) over single; LMWH over fondaparinux, DOAC (apixaban, dabigatran, and rivaroxaban), UFH, VKA, or ASA; and therapy should be continued for up to 35 days
	THA	NICE	2016	Combined mechanical and pharmacologic prophylaxis; any of the following are acceptable with start times in parenthesis: dabigatran (1-4 hours), fondaparinux (6 hours), LMWH (6-12 hours), rivaroxaban (6-10 hours), UFH if renal impairment (6-12 hours) and continue for 28-35 days; timing based on manufacturer recommendations
	TKA	NICE	2016	Same as above but continue for 10-14 days
Early oral alimentation and  enhanced nutrition	Not available
Discharge planning/discharge  criteria	Not available

Abbreviations: AAHKS, Association of Hip and Knee Surgeons; AAOS, American Academy of Orthopedic Surgeons; ACR, American College of Rheumatology; ASA, aspirin; CDC, Centers for Disease Control; CHEST, The American College of Chest Physicians; DOAC, direct oral anticoagulant (eg, apixaban, dabigatran, and rivaroxaban); LMWH, low-molecular-weight heparin (eg, enoxaparin); NICE, National Institute for Health and Care Excellence; Ortho, orthopedic operations; SSI, surgical site infection; THA, total hip arthroplasty; TKA, total knee arthroplasty; TNF, tumor necrosis factor; UFH, unfractionated heparin; VKA, vitamin K antagonist (eg, warfarin); WHO, World Health Organization; VTE, venous thromboembolism.

^aAdapted from American Academy of Orthopedic Surgeons,⁹ American College of Rheumatology/American Association of Hip and Knee Surgeons,¹⁰ American College of Surgeons and Surgical Infection Society,⁸ Centers for Disease Control and Prevention surgical site infection,¹¹ CHEST,¹² and National Institute for Health and Care Excellence.¹³

^bYear includes published date or date guidelines were last updated, whichever is later.