Optimizing For Surgery

Medical Comorbidity Management

Systematic management of medical comorbidities significantly impacts outcomes. Evidence-based optimization protocols should be implemented preoperatively.

Diabetes Management

HbA1c <7% associated with improved healing rates. Consider delaying surgery if HbA1c >8%. Continuous glucose monitoring may benefit perioperative management.

Smoking Cessation

Minimum 4-week cessation recommended. Nicotine replacement therapy acceptable. Studies show 3x higher healing rates with cessation >4 weeks preoperatively.

BMI Optimization

BMI >35 associated with increased complications. Consider structured weight loss programs preoperatively. Even 10% weight loss improves outcomes significantly.

Sleep Apnea Screening

CPAP compliance improves tissue oxygenation and healing. Screen with STOP-BANG questionnaire.

Nutritional Optimization for Healing

Emerging evidence demonstrates that nutritional status significantly impacts healing after surgery. Targeted nutritional interventions can optimize the biological environment for tissue repair and reduce complications.

Vitamin D

Bone metabolism, muscle function

2000-4000 IU daily

Vitamin C

Collagen synthesis cofactor

1000-2000mg daily

Protein

Amino acids for tissue repair

1.2-1.6 g/kg body weight

Magnesium

Helps with Vitamin C and D absorption and helps with tendon healing

up to 300mg daily

Omega-3 Fatty Acids

Anti-inflammatory effects

2-3g EPA/DHA daily

Zinc

Metalloproteinase function

15-20mg daily

Arginine

Nitric oxide synthesis, wound healing

10-15g daily

Optimization Timeline

• Begin nutritional supplementation 4-6 weeks preoperatively
• Achieve glycemic control (HbA1c <7%) before surgery
• Smoking cessation minimum 4 weeks prior
• Continue optimization protocols 12 weeks postoperatively
• Consider delayed surgery for suboptimal patients when possible

Inflammation and Pain Management

A balanced approach to inflammation management is crucial for optimal healing. While some inflammatory response is necessary for healing, excessive inflammation can impair tissue repair and lead to poor outcomes.  We generally use NSAIDs for the first 5-14 days after surgery to minimize initial inflammation and to modulate pain and then can consider low dosages afterwards on a case-by-case basis.

Anti-inflammatory Strategy

Systematic reviews suggests selective COX-2 inhibitors may be preferable to traditional NSAIDs in the early healing phase (0-6 weeks). Corticosteroid injections should be avoided within 3 months of surgery due to deleterious effects on tendon healing.