Utilization of a Lifestyle Medicine Program for Presurgical Health Optimization: Impact on Early Postoperative Outcomes of Hip and Knee Arthroplasty.

Background

Chronic systemic inflammation is associated with osteoarthritis and chronic diseases that increase surgical risk before total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study compares early postoperative outcomes between patients who did and did not complete an intensive lifestyle medicine (LSM) program to reduce chronic systemic inflammation.

Methods

Anthropometric variables, lifestyle measures, patient-reported outcome measures, and postoperative 90-day outcomes (ie, length of stay, infection, persistent pain, opioids) were obtained from an LSM repository. Comparisons were made between patients who completed the intensive LSM track (multiple visits, interprofessional providers) and those who declined behavior change preoperatively (selective track: single provider visit). A subanalysis evaluated glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1RA) medication users.

Results

Among 292 patients (72% women; 62 ± 9 years; 76% White), 154 completed the intensive track and 138 participated in the selective track. Most (91%) had ≥2 chronic diseases. Baseline characteristics were similar between tracks, except for higher anxiety/depression scores in the intensive track (3.3 ± 3.0 vs 1.8 ± 2.4[ < .001]). Postoperatively, the selective track reported significantly higher persistent pain rates (26% vs 10%[ < .001]) than the intensive track. GLP-1RA users were more likely to refill outpatient opioids than nonusers (57% vs 36%[ = .001]), with no differences in other outcomes.

Conclusions

Postoperative persistent pain rates were significantly lower in patients who completed an intensive LSM program before THA or TKA, compared to patients who did not engage in health improvement. GLP-1RA users showed no health benefits and required more opioid refills.

Keywords

Arthroplasty, Hip, Knee, Lifestyle medicine, Postoperative outcomes