Transforming Health: HSS Lifestyle Medicine Program Enhances Outcomes for Elective Orthopedic Surgery Patients with Chronic Conditions

HSS Lifestyle Medicine Program Enhances Health Prior to Elective Orthopedic Surgery for Patients with Chronic Illnesses

Recent findings from researchers at Hospital for Special Surgery (HSS) indicate that thorough lifestyle medicine strategies, encompassing nutrition and physical activity, are exceptionally effective 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 results for 54 individuals who participated in the HSS Lifestyle Medicine Program between March 2022 and December 2023. Nearly 90% of participants had two or more chronic ailments related to lifestyle. Almost all, 96%, successfully met their objectives for enhancing health before undergoing elective orthopedic surgery.

HSS orthopedic surgeons identify individuals at heightened risk for surgical complications and adverse outcomes due to lifestyle-related chronic conditions, such as obesity, type 2 diabetes, cardiovascular ailments, metabolic disorders, and unhealthy habits like smoking, and refer them to the program. These issues have been associated with prolonged hospital stays, increased complications, higher early revision rates, and escalated readmission rates.

The HSS Lifestyle Medicine Program assists patients in either enhancing their health prior to an upcoming elective operation or qualifying for surgery that they could not pursue earlier due to the severity of their chronic conditions. Participants collaborate with a multidisciplinary team to establish personal goals aimed at improving their pain, function, sleep, and overall health.

Among the 54 individuals, 41 had surgery dates already planned, and 93% enhanced their health and underwent surgery as scheduled. For the 13 patients who were referred to the program to attempt to better their health and then be reassessed for surgical qualification based on improved health metrics, 85% were cleared for surgery. Overall, 91% of patients proceeded with surgery following their enrollment in the program.

“We were astounded at how swiftly patients could implement lifestyle adjustments,” stated HSS physiatrist Heidi Prather, DO, creator and Medical Director of the HSS Lifestyle Medicine Program and a Diplomat of the American Board of Lifestyle Medicine. “Transformations can be quite challenging, thus the robust outcomes achieved by our intensive program are impressive. We expect that reaching these personal health targets will enhance post-surgical results.”

“We utilize motivational interviewing methods to comprehend the individual health enhancement aspirations of our patients,” Dr. Prather noted. “Most patients are profoundly driven to initiate changes and agree to join the program after realizing that their pain and functional mobility challenges are related to or exacerbated by chronic ailments and lifestyle selections.”

The rigorous program emphasizes the “six pillars of lifestyle medicine,” which encompass consuming a whole-food, plant-centric diet; engaging in regular physical activity; fostering healthy sleep habits; managing stress; prioritizing positive social interactions; and avoiding or minimizing tobacco and alcohol use. The program is primarily conducted online over approximately three months.

Every participant receives a tailored plan based on their unique objectives. A devoted scheduler aids in arranging appointments, and a care navigator assists in facilitating communication with the program team members. The HSS multidisciplinary Lifestyle Medicine Team consists of a physiatrist and nurse practitioner, both Diplomats of the American Board of Lifestyle Medicine, along with an endocrinologist, dietitian, health coach, exercise physiologist, physical therapist, and smoking cessation advanced practice providers.

Almost 90% of participants had two or more lifestyle-related chronic illnesses; a significant portion, 79%, reported poor sleep; and 57% indicated having no cumulative minutes of physical activity per week. The majority of study participants experienced obesity, with an average body mass index (BMI) of 43.2 kg/m2.

In total, 42 participants (72%) achieved weight loss and decreased their BMIs, albeit marginally: The mean weight loss recorded was 11 pounds, and the average reduction in BMI was 1.8 kg/m2.

“Addressing obesity is crucial for many participants, yet our program is not primarily focused on weight loss. There is no definitive weight-loss target for diminishing chronic disease risk,” explained Dr. Prather. “Instead, our emphasis lies on reducing systemic inflammation via the six pillars of lifestyle medicine. Change is our primary goal. Even a modest weight reduction, such as five pounds, combined with improved sleep, enhanced physical activity, and better diabetes regulation, can facilitate improved surgical outcomes.”

Study participants also reported enhancements in pain management, physical and mental health, as well as reductions in anxiety and depression levels.

“We are continually gathering data to assess the influence of the program on patient health, surgical risk minimization, patient satisfaction and functionality, as well as long-term outcomes relating to healthier lifestyle transformations,” Dr. Prather commented. The team is also investigating new methods to make lifestyle-oriented strategies more engaging and accessible. Later this year, for instance, HSS program participants will have the opportunity to engage in live online culinary sessions led by nutritional chef Caryn Dugan, a newconsulting associate of the HSS team and the initiator of the Center for Plant-Based Living.

About HSS

HSS stands as the premier academic medical center globally, concentrating on musculoskeletal wellness. At its heart is the Hospital for Special Surgery, recognized nationally as No. 1 in orthopedics (marking the 15th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2024-2025), and the top pediatric orthopedic facility in NY, NJ and CT according to the U.S. News & World Report “Best Children’s Hospitals” rankings (2023-2024). In a study of healthcare professionals across more than 20 nations by Newsweek, HSS has been placed as the world’s foremost institution in orthopedics for the fifth year in a row (2025). Established in 1863, the Hospital boasts the lowest readmission figures in the country for orthopedics, and maintains some of the lowest rates of infection and complications. HSS was the pioneer in New York State in receiving Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center for five consecutive iterations. An affiliate of Weill Cornell Medical College, HSS operates a primary campus in New York City alongside facilities in New Jersey, Connecticut, the Long Island and Westchester County areas of New York State, in addition to locations in Florida. Besides patient services, HSS is a leader in the realm of musculoskeletal health through research, innovation, and education. The HSS Research Institute encompasses 20 laboratories and 300 personnel dedicated to advancing musculoskeletal health by preventing degeneration, fostering tissue repair, and promoting tissue regeneration. Furthermore, over 200 HSS clinical researchers are engaged in enhancing patient outcomes by developing improved methods for the prevention, diagnosis, and treatment of orthopedic, rheumatic, and musculoskeletal conditions. The HSS Innovation Institute aims to actualize the potential of new pharmaceuticals, therapeutics, and devices. The HSS Education Institute serves as a reputable authority in furthering knowledge and research on musculoskeletal issues for physicians, nurses, allied health professionals, academic trainees, and patients in excess of 165 countries. The organization is collaborating with medical institutions and various entities to elevate the quality and efficacy of musculoskeletal care, striving to expand the accessibility of world-class HSS care both nationally and internationally. www.hss.edu.

Noelle Caccia / Rachael Rennich / Tracy Hickenbottom

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