Paragon Press – July 2014

What You Can Do To Increase Your Chances of Successful Surgery

First, are you a good candidate?

You have an appointment with your surgeon and he tells you your problem requires surgery. You ask how soon it can be done, and he tells you he can’t do it, or even that he won’t do it. Nobody wants to be told they can’t have what they want, but surgeons realize with some patient choices, the chances of the surgery being successful are slim to none. A surgeon wants your surgery to be successful, just like you do, but did you know certain choices can make you a poor surgical candidate?

Two that are too risky

Statistics show that certain unhealthy behaviors make surgery less successful. Two behaviors which are frequently the cause of poor surgical outcomes are:

  • Smoking
  • Obesity

We would like to think we all heal the same, but studies show this is not the case. Factors such as age and preexisting health problems can be causes for failed surgeries, but they are beyond our control. There is a significant body of research that shows smoking and obesity can drastically decrease the chances of a successful surgical outcome and these are behaviors that a patient can change. Smokers and obese patients in England are being denied for in vitro fertilization, breast reconstruction, and new hip/knee surgery unless they slimmed down or stopped smoking.


A recent study found in the Journal of Bone and Joint Surgery (JBJS) compared the clinical outcomes of nonsmokers, current smokers, and former smokers following knee surgery. The researchers concluded smoking had a negative effect on surgery and heavy smokers showed even worse outcomes. Patients who stopped smoking at least one month prior to surgery had the same outcome as a patient who never smoked. According to the American Association of Orthopedic Surgeons (AAOS), smoking may be the single most important factor in postoperative complications. Smoking complications include:

  • Poor wound healing
  • Infection
  • Less satisfaction in the final outcome of surgery

Broken bones take longer to heal in smokers because of the harmful effects of nicotine on the production of bone-forming cells.

Cigarette smoking is recognized as one of the major causes of preventable disease. Many people are very aware of how smoking affects your lungs, but not many know that it has serious negative effects on bones, muscles, and joints, and that smoking often leads to poorer surgical outcomes, especially in orthopedics.


Two-thirds of the American population is considered overweight or obese. Study after study has shown the deleterious effects of obesity on a person’s health. Obesity is associated with over 60 medical conditions. Among the more studied are:

  • Cardiac fitness-Studies show the stress of surgery on the heart might increase the chances of a cardiac event or increase chance of death in an obese person.
  • Diabetes-In one study of diabetics, 28.3% developed post-operative complications after orthopedic surgery as a result of their diabetes.
  • High blood pressure-This can negatively affect cardiac function, as well as many other organs within the body.
  • Sleep apnea-According to Dr. William Mihalko of the Campbell Clinic at the University of Tennessee, obese patients with sleep apnea have higher complication rates after orthopedic procedures.

Obese patients tend to have poorer outcomes and the expense of treating them is much higher than that for non-obese patients. Complication rates for patients with a BMI over 40 (considered “morbidly obese” is 22%. Children are also included in all these warnings, since nearly one in three children is overweight or obese. Inactivity and obesity combined can take as many as 7 years off life expectancy.

This should open your eyes to what you can do for your health. If you struggle with your weight, it’s easier to take off the weight before arthritis occurs and makes it more difficult exercise. If you can quit smoking even just one month prior to surgery, you have increased chances of surgical success. Talk to your surgeon to make sure you are in the best position to have a successful surgery. Both of you want only the best!

The following articles were referenced for this newsletter: