These authors point out that correctable risk factors can be identified before elective surgery.
Nutritional risk factors include total lymphocyte count, serum albumin <3.4 g/dL, prealbumin <3.5 g/dL, serum zinc <95 micrograms/dL, and vitamin D <20 ng/mL.
They state that when the Rainey-MacDonald Nutritional Index, or the total of 1.2 X serum albumin + .013 X serum transferrin - 6.43 is 0 or less, there is likely to be nutritional depletion. Alternatively when the total of 1.489 X albumin (g/dL) + 41.7 X body weight/ideal body weight is less than 92, there is a risk of nutritional deficiency.
Smoking has been documented to increase the risk of bone and soft tissue healing problems, cardiopulmonary complications, surgical complications, deep venous thrombosis, infection, and dissatisfaction with the results of surgery.
Pulmonary disease, including pulmonary hypertension and obstructive sleep apnea are also associated with increased surgical risk.
They point out that these risk factors are modifiable and attention should be directed at them before elective surgery.
We suggest that other factors that could be added to this list include depression, chronic opioid use, and obesity.
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