Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization: Substance Use.
Martha Kebeh, Chloe C Dlott, Donna Kurek and 2 others
PMID 37989152WHAT IT FOUND
Nurse navigators often screen joint replacement patients for smoking, alcohol, and opioids, but practices vary.
Smoking cessation support can help patients quit before surgery and may reduce wound complications.
Key findings
01Most nurse navigators reported that smoking was assessed during the first patient encounter, but only 28% said patients were uniformly required to avoid nicotine products for up to 6 weeks before surgery.
02In a cited smoking cessation study, patients received weekly nurse meetings, free nicotine replacement products, and counseling; 64% of intervention patients stopped smoking during the study period, while 7.7% of patients not participating stopped smoking, and the intervention group had lower overall and wound-related complication rates. The study cannot separate the contribution of each component.
03Preoperative opioid use was linked to persistent opioid use after surgery and lower postoperative functional scores.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The navigator sample was described as modest, with no number given, and the conversations were semi-structured, so the reported practices varied. The article is a review and set of recommendations, not a trial of navigator-led optimization. The smoking cessation study cited was not a study of the nurse navigator role alone; it included weekly meetings, free nicotine replacement, and counseling. For alcohol, the literature review focused on alcohol use disorder, while the navigator discussions covered alcohol use that did not meet that diagnosis. One alcohol intervention trial was ongoing and unpublished, so its results were not available.
The easy way to misread this
Do not read the smoking cessation study as proof that nurse navigator counseling alone improves surgical outcomes. It was a cited intervention that included weekly nurse meetings, free nicotine replacement, and counseling, and the navigator survey described practices rather than testing them.