How to Optimize Rheumatoid Patients for Podiatric Surgery

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Hi, I'm Dr. Nicole DeLauro. I am currently in private practice in both New York and New Jersey.
 
Q: What are the most important considerations in optimizing rheumatoid patients?
 
It's really important to understand that these patients are immunocompromised. You have to consider both pre-op, peri-op and post-operative details. You know, the overall health of the patient. Are they obese? Are they a smoker? Do they have other comorbidities? Are they followed routinely by a rheumatologist? Do they actively take their medications? You know, what's the routine? Will the medications need to be held prior to the surgery? And what are the patient's goals for surgery?
 
Okay, those are just things for pre-op considerations. Perioperatively, did they need medication replacement or adjustment? Is anesthesia aware of the patient's needs so that they receive proper care? How is the bone density? Is that gonna change how your fixation is going to be planned? So what kind of adjustments may I have to make intraoperatively?
 
And then post-op, does the patient have familial support? You don't know what their home environment is. You know, what's gonna be their recovery? Do they have a flight of stairs that they're going to have to go up? What's gonna be their weight-bearing status? So, you know, will they need crutches, wheelchair, walker? Can they physically do that? Those are all things to think of to optimize the patient for surgery.
 
Q: What red flags should podiatric surgeons be aware of?
 
I think the biggest thing is for patients to be on board with their treatment plan. If someone's not well-managed or they're kind of aloof about the severity of the disease process, if they have other comorbidities that are not controlled, such as diabetes, you know, they may not be your best candidate for surgery and you may want to avoid doing surgery on those patients and going with conservative care.
 
Are they willing to do the complete workup? This takes a lot of interdisciplinary medicine to optimize these patients and they have to be willing to be on board with that. If they're not, that could be a potential red flag.
 
And lastly, do they have a support system? If they're lacking a support system, it may be a red flag and you may not want to proceed with surgery.
 
Q: What are the most important points of your session?
 
The biggest take-home point is that you have to evaluate the patient as a whole.

It's not just a foot issue. It's not just a bunion or some surgical correction that you're going to make. These are patients that need to be worked up medically prior.

They're going to have to be monitored perioperatively and you're going to have to watch them postoperatively. And all of these things need to be planned prior to and you have to work with the other medical specialists to achieve this goal.