Transforming Health: How HSS Lifestyle Medicine Prepares Chronic Disease Patients for Elective Orthopedic Surgery

Recent studies by researchers at the Hospital for Special Surgery (HSS) indicate that thorough lifestyle medicine interventions, which encompass nutrition and physical activity, prove to be significantly beneficial in enhancing patient health prior to elective orthopedic procedures.

The research, first published online on May 16 in the American Journal of Lifestyle Medicine, detailed preliminary outcomes for 54 patients who participated in the HSS Lifestyle Medicine Program from March 2022 through December 2023. Nearly 90% of these individuals presented with two or more lifestyle-associated chronic conditions. Almost all, 96%, successfully attained their health improvement objectives before elective orthopedic surgery.

Surgeons at HSS recognize patients with an increased risk for surgical complications and unfavorable outcomes due to lifestyle-related chronic diseases, such as obesity, type 2 diabetes, cardiovascular illness, metabolic disorders, and unhealthy lifestyle habits like smoking, and subsequently refer them to the program. These issues have been associated with extended hospital stays, a rise in complications, elevated early surgical revision rates, and increased readmission occurrences.

The HSS Lifestyle Medicine Program aids patients in either enhancing their health before a planned elective surgery or qualifying for a surgical procedure they could not previously undertake because of the severity of their chronic conditions. Patients collaborate with a multidisciplinary team to establish personal objectives aimed at alleviating pain, improving function, enhancing sleep, and elevating overall wellness.

Among the 54 patients, 41 had surgical dates already scheduled, with 93% achieving health improvements and undergoing surgery as planned. From the group of 13 patients referred to the program to enhance their health and later reassess eligibility for surgery based on improved health indicators, 85% were successful in moving forward with the surgery. In total, 91% of patients had surgery after joining the program.

“We were astonished at how swiftly patients could implement lifestyle alterations,” remarked HSS physiatrist Heidi Prather, DO, who is the founder and Medical Director of the HSS Lifestyle Medicine Program and a Diplomat of the American Board of Lifestyle Medicine. “Change is notoriously difficult, so the significant results our comprehensive program achieved is remarkable. We expect that reaching these individual health goals will contribute to better outcomes post-surgery.”

“We employ motivational interviewing techniques to comprehend patients’ unique health enhancement aspirations,” Dr. Prather explained. “The majority of patients exhibit a strong desire to make changes and choose to engage in the program once they realize that their pain and mobility issues stem from or are worsened by chronic diseases and lifestyle choices.”

The rigorous program emphasizes the “six pillars of lifestyle medicine,” which consist of following a whole-food, plant-focused dietary regimen; engaging in regular physical activity; ensuring adequate sleep; managing stress; fostering positive social relationships; and avoiding or limiting tobacco and alcohol use. It is primarily conducted online over a period of about three months.

Each participant receives a customized plan tailored to their personal ambitions. A dedicated scheduler assists in arranging appointments, while a care navigator aids them in communicating with team members of the program. The HSS interprofessional Lifestyle Medicine Team comprises a physiatrist and a nurse practitioner, both Diplomats of the American Board of Lifestyle Medicine, as well as an endocrinologist, dietitian, health coach, exercise physiologist, physical therapist, and advanced practice providers specializing in smoking cessation.

Nearly 90% of patients were diagnosed with two or more lifestyle-related chronic conditions; 79% suffered from inadequate sleep; and 57% reported no accumulated minutes of weekly physical activity. The majority of study participants were contending with obesity, holding an average body mass index (BMI) of 43.2 kg/m².

In total, 42 patients (72%) experienced weight reduction and lowered their BMIs, albeit marginally: The average weight lost was 11 pounds, and the mean BMI decline was 1.8 kg/m².

“While tackling obesity is crucial for many individuals, our program is not primarily a weight reduction initiative. There is no predefined weight-loss target to mitigate chronic disease risk,” stated Dr. Prather. “Instead, our focus is on diminishing systemic inflammation through the six pillars of lifestyle medicine. The change we strive for is paramount. Even a slight weight loss, such as five pounds, combined with better sleep, increased physical activity, and improved diabetes management, can enhance surgical outcomes.”

Participants in the study also reported enhancements in pain levels, physical and mental health, as well as reductions in anxiety and depression metrics.

“We are ongoingly gathering data to assess the program’s influence on patient health, reduction of surgical risks, functional improvement, patient satisfaction, and long-term outcomes related to adopting healthier lifestyle changes,” Dr. Prather mentioned. The team is also investigating novel ways to make lifestyle-focused strategies more engaging and accessible. For example, later this year, HSS program participants will have the opportunity to partake in live online cooking classes conducted by nutritional chef Caryn Dugan, a new consulting member of the HSS team and the founder of the Center for Plant-Based Living.