How to Reduce Surgical Risks and Complications in Cardiac and Musculoskeletal Care: Modifiable Lifestyle Factors


The Silver Tsunami Facing the U.S. Healthcare System

Within the next 10 years, older adults are projected to outnumber children under the age of 18 for the first time in U.S. history, further stressing an already taxed healthcare ecosystem. Nearly 20 percent of all adults have two or more chronic conditions – that proportion reaches 52% among those 65 and up. Almost 15 million Americans have surgery each year. This aging, growing, population has a substantial burden of disease and shows just how important it is to consider modifiable risk factors, like smoking status and body mass index (BMI), as critical components in building a healthier, more resilient healthcare landscape.  

High BMI and Current Smoking Status are Associated with Surgical Complications

A high BMI is not merely a number on a scale; it can significantly impact surgical outcomes – leading to poor wound and bone healing, increased infection rates, implant failure, and reduced quality of life for the patient. Moreover, high BMI is often associated with comorbid conditions such as diabetes, coronary artery disease (CAD), deep vein thrombosis (DVT), pulmonary embolism (PE), malignancy, obstructive sleep apnea, and asthma, all of which can make certain surgeries riskier for certain patients.  

Similar negative outcomes are associated with smoking status; previous or current smokers face a 50% increased risk of post-operative complications, heavy smokers at a staggering 120% risk. The good news is that quitting smoking weeks or even months before surgery can substantially reduce these risks, particularly for those who stop smoking one year or more before their procedure.

Patients Can Improve Risks of Surgical Complications through Lifestyle Modifications Before Surgery

If quitting smoking or losing weight were easy, everyone would do it. Studies show that 1 in 10 adults quit smoking each year and several attempts are needed. Half of all Americans report “trying to lose weight”, but the year-over-year obesity continues to climb nationwide. Medical interventions, particularly at the point of surgery, represent a real opportunity to bring about measurable, sustained lifestyle modifications regarding smoking and body weight.  

The TurningPoint Surgical Quality & Safety program exists to ensure that patients are getting the right care in the right setting at the right time. Behind that north star are medical policies and CarePaths created by our clinical leadership team hand-in-hand with the payer and provider community. When building these CarePaths with our clients, we often suggest including BMI and Smoking criteria for the best possible outcomes. These policies are reviewed and updated – at times quarterly – always with the safety of the patient in mind.

Medical Policies that Examine BMI and Smoking Status Can Create Positive Lifestyle Changes in Some Patients

In a state-specific review in the Southern U.S., TurningPoint examined prior-year care redirections for smoking and BMI. What we found was significant - nearly 43% of patients with BMI and/or smoking risk factors leading up to surgery either quit smoking temporarily, permanently, or lost a significant amount of weight, then underwent a surgical procedure as the best possible candidate. Our data suggest that the pre-surgical period is an excellent intervention point to achieve the best possible outcomes in elective Cardiac and MSK surgeries, and the data proves that out.

It's not just about policy implementation; it's about changing lives. When someone quits smoking for one year, their risk of coronary heart disease drops by 50%. One example - a smoker who sought a cervical spinal fusion was advised to quit smoking before surgery and did. That patient underwent a safe, successful procedure, then a year later, needed an additional spinal fusion. Pre-surgical data showed a sustained commitment to a smoke-free life over that year. Weight loss is no different - we’ve seen patients lose 50, 60, even 70 pounds leading up to surgery – significant behavioral changes that set the patient up for success and a fulfilling life post-surgery.  

A Collaborative Approach to Complex Condition Management

Patients expect the best from their surgeons. The best training, focus, attention to detail. Surgeons should expect their patients to be at their best as well – the healthiest and most prepared they can be for a successful procedure. Addressing modifiable risk factors such as smoking and BMI is a fundamental step in ensuring that patients are in the best possible condition before undergoing surgery. Just as surgeons dedicate their expertise and precision to every procedure, patients can contribute by making the necessary lifestyle changes to improve their health and reduce potential risks.  

To learn more about how TurningPoint can improve healthcare outcomes and reduce costs, download our case study


About TurningPoint Healthcare Solutions

TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people across numerous clinical specialties nationwide and currently manages more than $4 billion in healthcare costs annually.  TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. To stay up-to-date with TurningPoint, follow us on LinkedIn.

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