What is Musculoskeletal (MSK) Surgery Optimization?
We've said it once, and we'll say it again: musculoskeletal health conditions account for 10% of all healthcare spending in the US. We repeat, 10% of all healthcare spending, and as much as 16% of total healthcare costs for employers. This costs for treating MSK conditions (like chronic osteoarthritis, shoulder replacements, meniscectomies, etc.) exceed the annual costs of treating every type of cancer...combined. In other words, controlling musculoskeletal costs offers a massive healthcare opportunity for providers, payers, and employers.
This is where the idea of 'surgery optimization' enters into the picture. Surgery optimization, also known as "PreHab" is quickly gaining traction as an offering to injured workers, employees, and patients around the world. Surgery optimization is a proven way to lower episode of care costs, improve surgery outcomes, and ultimately, get patients/claimants back to work and their normal routines, faster.
So, What Exactly is Surgery Optimization and "PreHab"?
To put it simply, surgery optimization is the process of preparing a patient for surgery as much possible to positively influence the outcome. We're all familiar with the idea of "rehab" which refers to actively participating in one's recovery from an injury or procedure.
Prehab exploits the under-utilized time period before a scheduled surgery to set an employee up for success and fast-track recovery.
Patients who actively and wholly prepare for surgery in the weeks leading up to their procedure have better outcomes. These better outcomes trickle down into savings for healthcare providers, insurers, third-party administrators and employers.
For instance, a recent study, "The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty", found that patients in the knee replacement control group who "PreHabbed" had benefits in hospital length of stay and discharge disposition. "In the prehabilitation patients, 77.2% went home without assistance, compared to 42.8% in the control group. Also, significantly fewer patients in the prehabilitation group were discharged to a SNF when compared to the control group (1.8% vs. 21.8%). As such, surgery optimization before major elective surgery influences outcomes and helps to control costs.
"Surgery optimization" is everything that a patient or claimant does in the time leading up to surgery to improve the outcome and reduce risk and cost.
Traditionally, when it comes to musculoskeletal health conditions treatment often looks like this: go to see a primary care physician, have injection therapy, physical therapy, and finally surgery. When dealing with a shoulder, back, joint, or other MSK issue and surgery is recommended, pre-op preparation tends to be limited and focused around just physical therapy.
Dr. Rupali Soeters, Physical Therapist, said when it comes to MSK issues and those preparing for surgery, "I often hear people say, 'I am going to physical therapy', and they think they're going to be fixed. However, coming to physical therapy alone isn't going to fix it. The idea that physical therapy can play the sole role is a perception created by society."
A complete surgery optimization (PreHab) program before any MSK surgery should be multi-disciplinary and focus on the whole patient, and the whole patient journey. This means education, lessons, and tasks that zero-in on physical, mental and environmental preparation.
Here's what musculoskeletal surgery optimization should have going for it:
Surgery Optimization Should:
Be multidisciplinary in nature. Surgery prep isn't just about getting your body physically prepared with a physical therapist. All aspects of health and surgery preparation should be actively worked at bt the patient or injured worker.
Meet the patient/ claimant at their level of understanding. As a rule of thumb, patient education materials should not exceed a sixth-grade reading level. A lot of surgery pamphlets are overwhelming, dense, and not written accessibly.
Be Empowering. Thick pamphlets on the procedure and recovery are difficult to consume. When surgery prep is broken down into daily bite-sized, digestible tasks and progress is tracked, patients are engaged and committed to the process.
Track Progress. Patients and care teams can track pre-op preparation, measure risk-level, predict return-to-work times, etc. Real benchmark metrics from others who've had the same surgery help injured workers' understand where they stand and keeps their eye on the prize.
Cover Before and After Surgery. Although surgery optimization focuses on mobilizing patients and workers in the pivotal window before surgery, a complete program guides them past the finish line. Optimizing for surgery means optimizing for recovery, which means guiding workers back to work (and beyond).
5 Pillars of Health in Surgery Optimization
"PeerWell looks at the patient as a whole: their diet, level of function, mental health, social support, environmental conditions etc., and really takes all of the aspects of the human being into consideration---not just the body part."- Dr. Soeters.
A well-rounded, complete surgery optimization (PreHab and ReHab) program incorporates everything that's proven to get a claimant the most prepared for surgery. Personalized, complete surgery prep means a less stressful and faster return-to-work and normal activity. Here are the five pillars musculoskeletal surgery optimization should be centred around: Physical Therapy, Nutrition, Pain & Anxiety, Health Literacy, and Environmental Preparation.
1. Physical Therapy- Physically prepping the body as a whole and also targeting the area of the musculoskeletal surgery (knee, shoulder, back, etc.) is pivotal. Strengthening, improving flexibility and endurance, and learning proper posture and movement is necessary for getting a headstart on recovery. Physical therapy can be learned with professional physical therapists through in-class sessions and executed at-home, or done via approved mobile at-home programs.
2. Nutrition- Not only is excess weight reduction important for lowering surgery-day risk, certain foods, vitamins, and minerals are proven to assist with healing. Foods have a lot of healing properties, reduce inflammation (which is at the heart of many MSK issues), and even boost mood. Better eating means better health and recovery.
3. Pain & Anxiety- Surgery is serious business and is something that happens when an employee or patient isn't feeling like themselves. Guidance, support, and exercises proven to reduce anxiety, depression, and increase mindfulness is key. The way pain is interpreted is linked to mental and emotional health. Offering emotional support does wonders for pain and pre (and post) surgery jitters.
4. Health Literacy- Knowledge is power and a surprising amount of patients don't fully understand their musculoskeletal condition, let alone the surgery or the recovery ahead. By breaking down the MSK condition's education into light, consumable daily lessons, a claimant is armed with the information to impact their recovery. In order to optimize for surgery, one must know what they're working with.
5. Environment- Recovery is even more stressful when an employee isn't prepared. Little things add up are aid in a safe, smoother recovery. For instance, tips for meal preparation, learning how to do the stairs after a knee replacement, or get in and out of the car after a back surgery, knowing what trip and fall hazards they could fall victim to (literally) is an important (and often forgotten) part of PreHab.