Optimizing preoperative nutrition using enhanced recovery from surgery (ERAS) guidelines to improve clinical outcomes for patients undergoing total joint replacement

Abstract

Surgical site infection (SSI) following total joint arthroplasty (TJA) is one of the most frequently encountered hospital-acquired conditions. Consequently, as the largest population of people in the United States known as the 'baby boomers' continue to age, the need for TJA to treat arthritis is projected to grow exponentially as is the incidence of SSI. Evidence-based enhanced recovery after surgery (ERAS) guidelines have been shown to decrease the prevalence of postoperative complications, hospital length of stay, improve the patient's return to normal function, and quality of life. ERAS guidelines recommend screening for risk of malnutrition with referral to a registered dietician and consumption of a preoperative oral carbohydrate (POC) the night before and the day of surgery. Current research does not directly link the use of POC to decreased occurrence of SSI. It is hypothesized that implementing nutritional screening and POC will be associated with a decreased occurrence of postoperative SSI. The primary goal of this project is to build a consistent preoperative nutritional optimization program utilizing ERAS guidelines in the pre-anesthesia clinic (PAC) for patients aged 50-70 and scheduled for elective TJA.