Table 1.

Evidence-based recommendations and practices at our institution for detection and optimization of preoperative risk factors prior to total joint arthroplasty.

Risk factor	Recommendations
Obesity	• Identify and optimize concomitant comorbidities, eg, malnutrition, diabetes, hypertension • Delay surgery for BMI ≥40 kg/m2 until BMI is reduced below this threshold
Malnutrition and hypoalbuminemia	• Perform thorough clinical assessment of nutritional status • Obtain preoperative serum albumin, transferrin, and TLC in patients with particular comorbidities a • For albumin <3.5 g/dL, transferrin <200 mg/dL, or TLC <1500 cells/mm3, delay surgery and refer for nutritional counseling
Diabetes	• Screen patients preoperatively for diabetes according to guidelines from the American Diabetes Association [4] • Delay surgery until HbA1c <7.5%
Anemia	• Obtain hemoglobin level 4 weeks preoperatively • Work-up and treat newly diagnosed or chronic anemia • Delay surgery until Hgb levels >12.0 g/dL in women and >13.0 g/dL in men
Smoking	• Ensure smoking cessation by 4 weeks preoperatively with negative cotinine test
Opioid use	• Use multimodal pain management to minimize opioid prescribing, eg, with NSAIDs and acetaminophen • Wean off opioids by at least 50% 4 weeks prior to surgery

BMI body mass index, TLC total lymphocyte count, Hgb hemoglobin, NSAIDs nonsteroidal anti-inflammatory drugs.

^aSee text for listing of specific comorbidities.