Multidisciplinary teams for complex patients.
Tomek says that a look at the data revealed 85%-90% of the knee replacement candidates were obese or morbidly obese, and many of them had been diagnosed with associated co-morbidities like diabetes, precarious kidney function, or peripheral vascular disease.
"What we discovered was that one healthcare system that did well had a multidisciplinary team—not just orthopedists, but anesthesiologists and internists that triaged patients preoperatively to identify the ones they think would run into trouble," he says. These patients were then singled out for special scrutiny.
"It may turn out that someone would really be better off having surgery three months from now, once they get their blood sugars under control. And if so, you would cancel the surgery until that time,"Tomek says. "It was a valuable lesson that if you take the time at the front end, involving internists and affiliated medical staff to enter the discussion about whether the surgery is safe to do, it pays dividends."