Date of Award

January 2023

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Daniel H. Wiznia

Abstract

Introduction: Preoperative risk management has been introduced as an avenue to improve postoperative outcomes for patients considering total joint arthroplasty (TJA). However, preoperative risk management programs may be contributing to healthcare disparities by preventing certain patient populations from accessing TJA care.Methods: We performed a systematic literature review to better understand potential impacts of preoperative risk management programs on healthcare disparities related to postoperative outcomes following TJA. In addition, we performed an additional study to determine the use of preoperative cutoffs for hemoglobin A1c and body mass index (BMI) at the top orthopaedic institutions as well as the availability of resources for weight loss, smoking cessation, and dental care. Results: Our literature review found a total of 12 studies that described the implementation of comprehensive risk management programs. The majority of these programs utilized artificial cutoffs for hemoglobin A1c and BMI and did not perform stratified analyses to assess the impact of preoperative risk management programs on specific patient populations. We found similar trends in our complementary study as the majority of top orthopaedic institutions utilized cutoffs for hemoglobin A1c and BMI while providing limited resources for smoking cessation and dental care. Conclusions: Preoperative risk management programs have the potential to improve patient outcomes, however care must be taken to ensure that these programs are not further contributing to healthcare disparities in orthopaedics.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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