The majority of orthopedic surgeries are considered “elective” because they are not being performed for life-threatening or limb-threatening problems. They are pre-planned and done on a non-emergent basis. These surgeries might be considered simple or low risk (like a knee arthroscopy or carpal tunnel surgery), or more major and higher risk (like joint replacement or spinal fusion). In general, you need to meet some health parameters in order to be considered a good candidate for elective surgery, especially if it is a major surgery. If you don’t meet those parameters, your surgeon might require you to postpone your surgery until you are “healthy enough” to proceed with surgery. This is not a punishment, but rather it is out of concern for you as a patient, as your surgeon wants you to have the best possible outcome from your procedure, with the lowest possible risk of complication. It is important to understand that there is no such thing as a “risk-free” surgery, no matter how minor the procedure is.
Some of the more common parameters considered when determining if a patient is healthy enough for a major surgery include, but are not limited to: blood pressure, lab values, body mass index, blood sugar/HgA1c, heart health, and lung function/smoking. If any of these parameters don’t meet criteria, surgery might need to be postponed until the problem is addressed. If the problem can’t be improved, then surgery might not be an option. Here is a list of some of the health problems, and a few of their respective associated risks, that need to be corrected before undergoing elective orthopedic surgery:
- Blood pressure greater than 180/110 mmHg (120/80 is normal): higher risk of heart attack or stroke during or soon after surgery.
- White blood cell count greater than 11,000/microliter (4,500-11,000 is normal): could indicate an infection somewhere, increasing risk for surgical infection.
- Hemoglobin less than 10 g/dL (normal for men is 13.2-16.6 and for women is 11.5-15): increased risk of needing blood transfusions, wound healing problems, and increased risk of death post operatively.
- Electrolytes such as potassium or sodium too high or too low (normal for potassium is 3.6-5.2 mmol/L and normal for sodium is 135-145 mEq/L): abnormal heart rhythms, muscle cramps, fatigue, or confusion.
- Albumin level less than 3.4 g/dL (3.4-5.4 is normal): significant risk for wound healing problems, prolonged hospitalization, and even death.
- Body Mass Index greater than 40 (18.5-24.9 is normal): significant increased risk of blood clots, infection, blood loss, and anesthetic complications, as well as increased risk of in-hospital death.
- Blood sugar greater than 200 mg/dL (90-110 is normal) or HgA1c greater than 8.0% (normal is below 5.7): significant increased risk for infection and wound healing problems.
- Heart disease: increased risk for stroke, heart attack, and death during or after surgery.
- Lung disease and/or being a smoker: risk for anesthesia complications, cardiovascular events (stroke, heart attack, etc.), delayed wound healing, wound infections, pneumonia, delayed bone healing, and death.
Your individual surgeon will have their own parameters that might slightly differ from those listed. This list is not complete, but reflects some of the more common health issues that need to be optimized prior to having elective orthopedic surgery. Anesthesiologists also have their own parameters that have to be met, though they are similar to those listed here. You don’t have to be perfectly healthy to have orthopedic surgery, but you do need to be “healthy enough.” Remember that your surgeon has your best interests at heart, and wants you to have a complication-free surgery and a full recovery. While they can’t eliminate all risks related to surgery, optimizing your health goes a long way to lowering your risk of complications.