Enhanced Recovery and Prehabilitation in the Perioperative Setting

Perioperative care has seen remarkable advancements since the introduction of anesthesia in 1846, with anesthesia-related mortality rates now comparable to commercial aviation safety. However, significant challenges remain, particularly for high-risk patients undergoing major surgeries. This chapter explores critical opportunities to improve perioperative health outcomes by focusing on modifiable risk factors and adopting a more holistic approach to patient care. Key areas addressed include the importance of preoperative risk assessment and optimization, with particular emphasis on addressing modifiable factors such as anemia, malnutrition, opioid use, mood disorders, and frailty. The concept of prehabilitation is introduced as a means to enhance patients’ functional capacity before surgery, potentially reducing postoperative complications and improving outcomes. The chapter also discusses institutional approaches to perioperative care, highlighting the need for patient segmentation based on complexity and risk, and the implementation of standardized protocols for low-risk procedures while maintaining flexibility for complex cases. The role of technology in perioperative care is examined, including the use of electronic medical records, clinical decision support systems, and machine learning algorithms to predict and prevent adverse events. Enhanced Recovery Protocols (ERPs) are presented as an innovative approach to improving intraoperative and postoperative care across multiple surgical specialties. The chapter further explores the evolution of preoperative clinics and the development of comprehensive perioperative care centers, which aim to provide personalized risk assessment, optimization, and patient education. Finally, the chapter discusses the importance of digital health solutions and patient engagement platforms in improving protocol adherence and outcomes. By adopting these multifaceted approaches to perioperative care, healthcare providers can potentially reduce complications, improve patient outcomes, and decrease overall healthcare costs, ultimately transitioning from reactive to preventative medicine.