Preoperative Evaluation for Patients with Chronic Conditions Undergoing TKA

Essential Preoperative Workup

The American College of Cardiology recommends obtaining a current ECG to compare with prior tracings and evaluate for new ischemic changes, tachycardia, or arrhythmias beyond the baseline RBBB, as well as signs of progression from isolated RBBB to more advanced conduction disease in patients with chronic RBBB undergoing TKA 1, 2
The American Diabetes Association suggests screening for cardiac autonomic neuropathy (CAN) in patients with diabetes, as this significantly impacts perioperative risk, by checking for symptoms such as permanent tachycardia, orthostatic hypotension, or severe hypoglycemia without warning symptoms, and measuring orthostatic vital signs and performing respiratory heart rate variability testing 1, 2, 4, 5
The American Heart Association recommends calculating the Lee (Revised Cardiac Risk Index) score to assess the risk of cardiac complications in patients undergoing non-cardiac surgery, and referring patients with a score ≥2 and poor functional capacity to cardiology for further evaluation 1, 2

The American Society of Anesthesiologists suggests that regional anesthesia (spinal/epidural) is preferred for TKA in diabetic patients, as it reduces sympathetic hyperactivity, may improve outcomes in patients with cardiac autonomic neuropathy, and allows for better postoperative pain control and early mobilization 1, 5, 7

The American College of Cardiology recommends assessing functional capacity by asking patients if they can climb two flights of stairs or walk four blocks without symptoms, to determine the need for further cardiac evaluation in patients with chronic RBBB undergoing TKA 1
The American Diabetes Association suggests verifying current glycemic control by checking HbA1c, creatinine, and urinalysis, and assessing for diabetic complications such as nephropathy, neuropathy, and retinopathy in patients with diabetes undergoing TKA 1, 2