Surgical Risk Abatement (SRA)
A structured preoperative process for identifying modifiable risk factors before total joint arthroplasty, reducing preventable complications, and preparing patients for safer surgery.
Reducing Modifiable Risk Before Surgery
We have made every effort to make total joint arthroplasty as safe as possible. The goal of risk abatement is to reduce the chance of perioperative complications by identifying and treating modifiable risk factors before surgery.
Any patient undergoing total joint arthroplasty has an approximately 2% chance of experiencing a perioperative complication, with infection, deep venous thrombosis, blood clot, and wound-healing problems among the most common concerns. Reaction to anesthetic is also possible, though rare.
Surgical Risk Assessment Forms
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Information That Helps Assess Risk
For any patient considering total joint arthroplasty, the surgical risk assessment form helps evaluate whether modifiable risk factors can be addressed before surgery. The form captures patient identifiers, surgery type, hospital, risk-factor checks, provider follow-up needs, and patient acknowledgement.
Smoking and Tobacco
Smoking is an independent risk factor that makes patients more likely to have a perioperative complication. Patients are expected to quit smoking at least 4 weeks before surgery to the reduce risk.
Diabetes Control
Patients with diabetes need to work closely with their endocrinologist or medical doctor to control blood sugars. A fasting blood glucose level greater than 180 on the morning of surgery will prevent surgery from proceeding as planned.
Dental Health
Patients will need to be up to date on dental work and cleanings before total joint replacement to reduce the chance of oral infection affecting a new joint.
Infection Prevention
The assessment also checks for recent antibiotic use, MRSA or staphylococcus aureus colonization, anticoagulant medications, and other factors that may influence timing or preparation.
Risk Factors Reviewed Before Surgery
The attached surgical risk assessment form organizes risk review into practical clinical categories. Each item helps the team identify whether additional optimization, testing, or referral may be needed before surgery.
Morbid obesity and BMI
The SRA form records BMI, height, weight, and goal weight. The form notes that BMI greater than 40 is associated with higher postoperative joint infection risk, and BMI greater than 50 carries substantially higher infection risk.
Poorly controlled diabetes
The assessment captures whether the patient checks sugars, insulin use, Hgb A1C, fasting blood glucose, treating provider, and whether referral is needed. The form highlights increased postoperative joint infection risk for diabetic patients compared with non-diabetic patients.
Tobacco use in all forms
The form screens for cigarettes, chew, patch, gum, and vaping. It notes that smokers have increased deep joint infection risk compared with non-smokers or former smokers, and that wound-healing capacity improves after smoking cessation.
Infection and colonization risks
- Hepatitis C infection
- Staphylococcus aureus colonization and MRSA
- Recent infections requiring antibiotic use
- Dental work status and pending dental needs
Substance use and chronic narcotic use
The assessment asks about drug or alcohol dependence, chronic narcotic use, and alcohol intake. It notes that reducing alcohol consumption before surgery can reduce postoperative morbidity in alcohol abusers.
Fall risk, deconditioning, and cardiovascular history
The form reviews high fall risk, physical deconditioning, and cardiovascular disease history including coronary artery disease, stroke, peripheral vascular disease, heart failure, and atrial fibrillation.
DVT, pulmonary embolism, and anticoagulants
The SRA checks for DVT and pulmonary embolism risk factors, including personal or family history of DVT, COPD, BMI greater than 30, CAD, stroke, PVD, Factor V Leiden, Protein C and S deficiency, CVA, and tobacco use. It also asks whether the patient takes anticoagulant medication.
Procedure-specific screening
- Men only: urinary difficulty and waking frequently at night to urinate
- Total and uni knee replacements: metal allergy history and desire for metal allergy testing
- Anesthesia: adverse feelings about spinal anesthetic and history of lumbar spinal fusion
Dr. Stewart's Postoperative Complication Data
The SRA form includes complication-rate data compiled from nearly 600 total hip arthroplasties performed by Dr. Stewart over a five-year period.
Additional Coverage for Higher-Risk Patients
The SRA form notes that patients with selected conditions may be placed on Duricef 500 mg twice daily for five days to help prevent wound complications.
Diabetes Mellitus
Patients with diabetes may receive added antibiotic coverage based on risk review.
Smoking History
History of smoking within the past six months is listed as a coverage consideration.
BMI Greater Than 40
Elevated BMI is included in the SRA antibiotic coverage criteria.
Renal Disease
Renal disease is included as a condition that may require additional coverage planning.
Learn About Dr. Stewart's Surgical Specialties
As industry leaders, Dr. Stewart and his team help patients return to active lives through advanced orthopedic procedures and focused recovery planning.
Hip Arthroscopy
Hip arthroscopy and appropriate hip replacement planning are presented together so patients can understand hip-preservation and hip-replacement options in one place.
Learn MoreTotal Hip Arthroplasty
Total hip arthroplasty replaces the damaged hip joint to reduce pain, improve mobility, and help patients return to daily activities with a focused recovery plan.
Learn MoreMako Robotic Total Knee Replacement
Robotic-assisted total knee replacement helps Dr. Stewart plan and position implants with precision for patients with advanced knee arthritis.
Learn MoreKnee Arthroscopy
A minimally invasive knee procedure used to evaluate and treat select meniscus, cartilage, and joint problems through small incisions.
Learn MoreQuestions About Surgical Risk?
Dr. Stewart and his team can review modifiable risk factors, optimization goals, and next steps before total joint arthroplasty.
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