A 75-year-old man, with severe osteoarthritis of the hip and American Society of Anesthesiologists Physical Status Classification score of 3, is evaluated for surgery in the orthopedic clinic. A health-screening… Click to show full abstract
A 75-year-old man, with severe osteoarthritis of the hip and American Society of Anesthesiologists Physical Status Classification score of 3, is evaluated for surgery in the orthopedic clinic. A health-screening questionnaire is provided to the patient during the appointment that addresses multifactorial prehabilitation, and he screens positive for poor nutritional status and inadequate knowledge about his planned surgery. The surgery clinic ensures the patient is scheduled for a joint replacement education class and refers the patient to the Preoperative Assessment, Consultation, and Treatment (PACT) clinic before his definitive surgery date is scheduled. The PACT clinic assesses the patient and determines that no further cardiopulmonary workup is necessary before surgery. Nutritional support will require 2 weeks, based on his degree of malnutrition, as defined in the Prehabilitation Perioperative Risk Optimization and Management Planning Tool (PROMPT). This is conveyed to the surgery clinic for scheduling purposes. The patient is prescribed 2 weeks of protein-rich oral supplementation, followed by 2 days of carbohydrate-rich supplementation
               
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