NEW YORK--(BUSINESS WIRE)--New research by investigators at Hospital for Special Surgery (HSS) shows that comprehensive lifestyle medicine interventions, including nutrition and exercise, are highly effective in improving patient health before elective orthopedic surgeries.
The study, published first online May 16 in the American Journal of Lifestyle Medicine, reported early outcomes for 54 patients who enrolled in the HSS Lifestyle Medicine Program between March 2022 and December 2023. Almost 90% of patients had two or more lifestyle-related chronic diseases. Nearly all, 96%, successfully achieved their goals for improving health prior to elective orthopedic surgery.
HSS orthopedic surgeons identify patients with an elevated risk for surgical complications and poor outcomes based on lifestyle-related chronic diseases, including obesity, type 2 diabetes, cardiovascular disease, metabolic disease and poor lifestyle behaviors such as smoking, and refer them to the program. These conditions have been linked to longer hospital stays, increased complications, higher early surgical revision rates, and increased readmissions.
The HSS Lifestyle Medicine Program helps patients either improve their health before a scheduled elective surgery or qualify for a surgery they previously could not schedule due to the severity of their chronic diseases. Patients work with an interprofessional team to set personal goals to improve their pain, function, sleep and overall health.
Of the 54 patients, 41 had surgical dates already set, and 93% improved their health and had surgery on time. For the group of 13 patients referred to the program to try to improve their health and then be reassessed to see if they could qualify for surgery based on improved health measures, 85% were able to proceed with surgery. Collectively, 91% of patients underwent surgery following enrollment in the program.
“We were surprised at how quickly patients could make lifestyle changes,” said HSS physiatrist Heidi Prather, DO, founder and Medical Director of the HSS Lifestyle Medicine Program and a Diplomat of the American Board of Lifestyle Medicine. “Change is really hard, so the fact that our intensive program achieved such strong results is amazing. We anticipate that attaining these personal health goals will lead to improved post-surgical outcomes.”
“We use motivational interview techniques to understand patients’ individual health improvement goals,” said Dr. Prather. “Most patients are highly motivated to make changes and opt in to the program after learning that their pain and functional mobility issues are related to or exacerbated by chronic diseases and lifestyle choices.”
The intensive program focuses on the “six pillars of lifestyle medicine,” which include eating a whole-food, plant-predominant diet; maintaining physical activity; practicing healthy sleep; managing stress; making time for positive social connections; and avoiding or limiting tobacco and alcohol. It is delivered primarily online over about three months.
Each patient receives an individualized plan based on their personal goals. A dedicated scheduler facilitates booking appointments and a care navigator helps them communicate with program team members. The HSS interprofessional Lifestyle Medicine Team includes a physiatrist and nurse practitioner, both Diplomats of the American Board of Lifestyle Medicine, as well as an endocrinologist, dietitian, health coach, exercise physiologist, physical therapist, and smoking cessation advanced practice providers.
Almost 90% of patients had two or more lifestyle-related chronic diseases; a majority, 79%, had poor sleep; and 57% had zero cumulative minutes of weekly physical activity. Most study participants were living with obesity, with an average body mass index (BMI) of 43.2 kg/m2.
Overall, 42 patients (72%) lost weight and reduced their BMIs, albeit modestly: The average weight loss was 11 pounds, and the average BMI reduction was 1.8 kg/m2.
“While addressing obesity is important to many patients, our program is not a weight loss program. There is no magic weight-loss goal for reducing chronic disease risk,” said Dr. Prather. “Instead, we focus on lowering systemic inflammation through the six pillars of lifestyle medicine. Change is what we’re looking for. Even a modest weight reduction, such as five pounds, along with improved sleep, physical activity and diabetes control, can help improve surgical outcomes.”
Study participants also reported improvements in pain, physical and mental health, and anxiety and depression scores.
“We continue to collect data to evaluate the impact of the program on patient health, surgical risk reduction, functional and patient satisfaction, and longer-term outcomes related to adopting healthier lifestyle changes,” Dr. Prather said. The team is also exploring new ways to make lifestyle-based approaches more appealing and accessible. For example, later this year, HSS program participants will be able to take part in live online cooking sessions offered by nutritional chef Caryn Dugan, a new consulting member of the HSS team and the founder of the Center for Plant-Based Living.
About HSS
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 15th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2024-2025), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fifth consecutive year (2025). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field of musculoskeletal health in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
