The SwiftPath Program, LLC recently held its West Regional Annual Meeting: Launching the SwiftPath Triple Aim: A Bioskills Lab and RoundTable at the Woodmark Hotel in Kirkland, Wash.
The morning session included a cadaver-based bioskills training and live video interviews of faculty and panel members. The afternoon session featured a SwiftPath RoundTable Consensus Meeting focusing on preoperative nutrition and hydration prior to joint replacement surgery.
“Despite the significant body of evidence indicating that preoperative nutrition and hydration affect outcomes, many patients are not adequately counseled about nutrition and hydration before joint replacement surgery," said Dr. McAllister. “In fact, it has been stated that up to 50 percent of adult patients are actually malnourished when they are admitted to the hospital. This level of malnutrition contributes to wound complications, prolonged hospitalizations, readmissions, and other issues.” We also have become aware that preoperative fasting actually increases the metabolic stress, hyperglycemia and insulin resistance inherent in joint replacement surgery.
Dr. Tom Meade was asked to open the discussion on preoperative preparation and nutrition. He focused on over the counter nutraceuticals and provided an extensive review of relevant literature. He reviewed the role of nonprescription supplements including CoQ10, L-Carnitine, magnesium and a host of other supplements that can help prevent wound complications, lower cardiac risks and act as natural blood thinners.
During the RoundTable discussions, it was agreed that all patients can potentially benefit from preoperative nutritional therapy, especially in major orthopedic surgeries such as hip and knee replacement. The group agreed that prolonged preoperative fasting should be avoided, but that adequately educating patients on this and other nutritional matters is very difficult in the usual setting of orthopedic practices and hospital-based joint replacement.
There was consensus that joint replacement care demands better online, written, and JointCamp emphasis and counseling about the importance of nutrition and hydration prior to joint replacement surgery. Further, it was agreed that there should be postoperative audits and outcome metrics focusing on nutritional issues.
As Dr. Richard Roux pointed out, “This is where SwiftPath’s integrated approach to patient education can be of great value.” SwiftPath provides computer-based software for communication with patients. The cloud-based platform is fully integrated with multimedia patient education and has a tracking feature which allows providers to monitor their patients’ outcomes and obtain information on the impact of the program.
Dr. Meade summarized by pointing out healthy patients with no medical problems could do well with simple counseling, proper hydration, a healthy diet and some simple, over the counter supplements. However, Dr. Meade was quick to also point out that in this world of obese adults, toxic fish, nutritionally deficient food products, and fast food mania, many adults are already at risk. Dr. McAllister added, “Since the majority of patients undergoing elective joint replacement are elderly, the problems of malnutrition are especially relevant.”
According to Dr. Meade, “Essentially all joint replacement patients should be advised on a basic, inexpensive set of nutritional supplements.” He went on to advise that patients with chronic medical problems should have guidance on a more extensive set of “the Dynamic Dozen.”
For details on the list of recommendations developed during this meeting, visit www.swiftpath.com.