The goal is to identify possible risk factors that increase the risk of complications postoperatively


Screening patients with hyperglycemia with HbA1C testing. An HbA1C> 6.7 is associated with an increased risk of wound complications. The exact HbA1C target (roughly <8) varies by surgeon and hospital, Not all patients will be able to achieve the target.


Consistently shown to increase the risk of postoperative complications acute kidney failure, CV complications, wound complications, and infection. A BMI >40 has been used in many studies as having an increased risk of complications, but this is a continuous variable without a clear cutoff. Weight loss of >5% may be needed to decrease the risk.

Cardiovascular disease

Preoperative cardiovascular disease and older age are major risk factors for postoperative cardiovascular events. Delayed elective surgery in patients whose dual antiplatelet therapy will be stopped within 30 days from bare-metal stent (BMS), and 12 months after drug-elution stent (DES), Clopidogrel management should be discussed with a cardiologist and restarted as soon as possible. Stopping 7 days preop can lower bleeding events and the need for transfusion without increasing perioperative cardiovascular events.

Blood transfusion

Perioperative blood transfusions are associated with higher rates of postoperative complications.

Renal disease

Patients on dialysis at the time of THR or TKR have a 10-20 times increased risk of complications. ESRD patients may have improved outcomes if they undergo an elective kidney transplant prior to arthroplasty and have to weigh the risk of transient septicemia from dialysis versus immunosuppression following the transplant.

Methicillin-Resistant Staphylococcus aureus

Screening for MRSA colonisation is often undertaken, and if required decolonisation with Mupirocin ointment or Chlorhexidine wipes. Some Hospitals implement a universal decolonisation protocol.

Tobacco abuse

Increased risk of postoperative complications and infection. Referral to a formal smoking cessation program, ideally 6 weeks of cessation, and some surgeons require nicotine testing pre-operatively.

Illicit drug use

History of substance abuse/misuse has a 5x increase in the risk of mortality. Increased risk of infectious and non-infectious complications as well. Higher risk of mortality, readmission, and reoperation in patients who failed a toxicology screen.

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