Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization

Abstract

Substance use is one of the most common risk factors contributing to complications following total joint arthroplasty. Preoperative optimization programs can help patients modify or stop substance use. The purpose of this study was to provide recommendations and resources that will help nurse navigators standardize and improve preoperative optimization protocols regarding substance use. In a semistructured format, we asked nurse navigators how smoking, alcohol use, and opioid use were addressed. We conducted a literature review and combined findings with nurse navigator reports to create practice recommendations. We recommend consistently referring patients who smoke to smoking cessation programs; using validated screening tools to evaluate alcohol use and involving internists in caring for patients at risk for withdrawal; and involving pain specialists and local resources to assist patients who use opioids. There is a breadth of resources for managing substance use that nurse navigators can utilize to support stronger and more consistent preoperative optimization protocols.

Nutritional Considerations in Hip and Knee Arthroplasty

“…Perioperative protocols, pathways, and nurse navigators TJA patients allowed for improved standardization of evidence-based approaches that could lead to improved outcomes 6,7 . The process of developing such protocols relies on identification of modifiable risk factors in the preoperative period and implementing subsequent interventions to mitigate complications.…”