Scholarlink

The convergence of an aging population, rising comorbidities, and escalating healthcare costs necessitates a transformative approach to perioperative care (U.S. Census Bureau. U.S. population grows at fastest pace in more than two decades. 2024 Dec 20 [cited 2025 Mar 01]. Available from: https://www.census.gov/library/stories/2024/12/population-estimates.html ; Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med 9(3):193–196, 2014. https://doi.org/10.1002/jhm.2145 ; Centers for Medicare & Medicaid Services. National health expenditure data: historical. 2024 [cited 2025 Mar 23]. Available from: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical ). This chapter underscores the pivotal role of Anesthesiologist Leadership in Perioperative Optimization, demonstrating how our expertise extends beyond the operating room to improve patient outcomes and drive system-wide improvements. Through Preoperative Assessment in dedicated clinics (Aronson S, Martin G, Gulur P, Lipkin ME, Lagoo-Deenadayalan SA, Mantyh CR, et al. Anesth Analg 130(4):808–810, 2020. https://doi.org/10.1213/ANE.0000000000004492 ), including robust Risk Stratification (Matthews L, Levett DZH, Grocott MPW. Anesthesiol Clin 40(1S):e1–e23, 2022. https://doi.org/10.1016/j.anclin.2022.03.001 ), physician anesthesiologists lead multidisciplinary teams to identify and mitigate patient-specific risk factors before surgery (Aronson S, Murray S, Martin G, Blitz J, Crittenden T, Lipkin ME, et al. Anesth Analg 130(4):811–819, 2020. https://doi.org/10.1213/ANE.0000000000004571 ). The chapter details how anesthesiologists spearhead initiatives such as preoperative anemia management (Guinn NR, Fuller M, Murray S, Aronson S, Duke Perioperative Enhancement Team (POET). Transfusion 62(3):569–578, 2022. https://doi.org/10.1111/trf.16847 ; Moores C, Fry A, Mak M, et al. Perioper Med 12(1):25, 2023. https://doi.org/10.1186/s13741-023-00324-1 ), glycemic control (Duggan EW, Carlson K, Umpierrez GE. Anesthesiology 126(3):547–560, 2017. https://doi.org/10.1097/ALN.0000000000001515 ), and prehabilitation (McIsaac DI, Kidd G, Gillis C, et al. BMJ 388:e081164, 2025. Published 2025 Jan 22. https://doi.org/10.1136/bmj-2024-081164 ; D’Amico F, Dormio S, Veronesi G, et al. Br J Anaesth 134(4):1018–1028, 2025. https://doi.org/10.1016/j.bja.2025.01.010 ; Carli F. Anesthesiology 133(3):645–652, 2020. https://doi.org/10.1097/ALN.0000000000003331 ; Molenaar CJL, Papen-Botterhuis NE, Herrle F, Slooter GD. Innov Surg Sci 4(4):132–138, 2019. https://doi.org/10.1515/iss-2019-0017 . PMID: 33977122; PMCID: PMC8059351)—increasingly recognized as critical components of surgical preparation. Furthermore, it explores the implementation and impact of Enhanced Recovery After Surgery (ERAS) protocols (Ljungqvist O, Scott M, Fearon KC. JAMA Surg 152(3):292–298, 2017. https://doi.org/10.1001/jamasurg.2016.4952 ), emphasizing the role of perioperative physicians in driving these evidence-based patient pathways. The economic benefits of this proactive approach are examined, demonstrating how anesthesiologist leadership in perioperative optimization and Quality Improvement (QI) initiatives leads to significant cost reduction (Healthcare) (Stokes SM, Scaife CL, Brooke BS, Glasgow RE, Mulvihill SJ, Finlayson SRG, Varghese TK. Ann Surg 275(2):e375–e381, 2022. https://doi.org/10.1097/SLA.0000000000004243 ; Goldfield N, Kelly WP, Patel K. Qual Manag Health Care 21(4):213–219, 2012. https://doi.org/10.1097/QMH.0b013e31826d1d3a ; Steinle T, Lees M. J Med Econ 14(1):65–74, 2011. https://doi.org/10.3111/13696998.2010.546465 ) through reduced complications, shorter lengths of stay, and fewer readmissions. Finally, the role of value-based care principles is presented (Porter ME. N Engl J Med 363(26):2477–2481, 2010. https://doi.org/10.1056/NEJMp1011024 ). By embracing a systems-based, patient-centered approach, anesthesiologists are positioned as key leaders in delivering high-quality, efficient, and cost-effective surgical care (Vetter TR, Goeddel LA, Boudreaux AM, Hunt TR, Jones KA, Pittet JF. Anesth Analg 118(5):1131–1136, 2014. https://doi.org/10.1213/ANE.0000000000000230 ).

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Preoperative Optimization and Risk Reduction: A Systems-Based Role for Anesthesiologists

  • 章节

  • 发表日期：

    2026年

查看全文
  • Stephen Rivoli,
  • Darryl Brown,
  • Janet Mutschler,
  • John Choi,
  • Alexandra Jankulov,
  • Rohini Loke

摘要

The convergence of an aging population, rising comorbidities, and escalating healthcare costs necessitates a transformative approach to perioperative care (U.S. Census Bureau. U.S. population grows at fastest pace in more than two decades. 2024 Dec 20 [cited 2025 Mar 01]. Available from: https://www.census.gov/library/stories/2024/12/population-estimates.html ; Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med 9(3):193–196, 2014. https://doi.org/10.1002/jhm.2145 ; Centers for Medicare & Medicaid Services. National health expenditure data: historical. 2024 [cited 2025 Mar 23]. Available from: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical ). This chapter underscores the pivotal role of Anesthesiologist Leadership in Perioperative Optimization, demonstrating how our expertise extends beyond the operating room to improve patient outcomes and drive system-wide improvements. Through Preoperative Assessment in dedicated clinics (Aronson S, Martin G, Gulur P, Lipkin ME, Lagoo-Deenadayalan SA, Mantyh CR, et al. Anesth Analg 130(4):808–810, 2020. https://doi.org/10.1213/ANE.0000000000004492 ), including robust Risk Stratification (Matthews L, Levett DZH, Grocott MPW. Anesthesiol Clin 40(1S):e1–e23, 2022. https://doi.org/10.1016/j.anclin.2022.03.001 ), physician anesthesiologists lead multidisciplinary teams to identify and mitigate patient-specific risk factors before surgery (Aronson S, Murray S, Martin G, Blitz J, Crittenden T, Lipkin ME, et al. Anesth Analg 130(4):811–819, 2020. https://doi.org/10.1213/ANE.0000000000004571 ). The chapter details how anesthesiologists spearhead initiatives such as preoperative anemia management (Guinn NR, Fuller M, Murray S, Aronson S, Duke Perioperative Enhancement Team (POET). Transfusion 62(3):569–578, 2022. https://doi.org/10.1111/trf.16847 ; Moores C, Fry A, Mak M, et al. Perioper Med 12(1):25, 2023. https://doi.org/10.1186/s13741-023-00324-1 ), glycemic control (Duggan EW, Carlson K, Umpierrez GE. Anesthesiology 126(3):547–560, 2017. https://doi.org/10.1097/ALN.0000000000001515 ), and prehabilitation (McIsaac DI, Kidd G, Gillis C, et al. BMJ 388:e081164, 2025. Published 2025 Jan 22. https://doi.org/10.1136/bmj-2024-081164 ; D’Amico F, Dormio S, Veronesi G, et al. Br J Anaesth 134(4):1018–1028, 2025. https://doi.org/10.1016/j.bja.2025.01.010 ; Carli F. Anesthesiology 133(3):645–652, 2020. https://doi.org/10.1097/ALN.0000000000003331 ; Molenaar CJL, Papen-Botterhuis NE, Herrle F, Slooter GD. Innov Surg Sci 4(4):132–138, 2019. https://doi.org/10.1515/iss-2019-0017 . PMID: 33977122; PMCID: PMC8059351)—increasingly recognized as critical components of surgical preparation. Furthermore, it explores the implementation and impact of Enhanced Recovery After Surgery (ERAS) protocols (Ljungqvist O, Scott M, Fearon KC. JAMA Surg 152(3):292–298, 2017. https://doi.org/10.1001/jamasurg.2016.4952 ), emphasizing the role of perioperative physicians in driving these evidence-based patient pathways. The economic benefits of this proactive approach are examined, demonstrating how anesthesiologist leadership in perioperative optimization and Quality Improvement (QI) initiatives leads to significant cost reduction (Healthcare) (Stokes SM, Scaife CL, Brooke BS, Glasgow RE, Mulvihill SJ, Finlayson SRG, Varghese TK. Ann Surg 275(2):e375–e381, 2022. https://doi.org/10.1097/SLA.0000000000004243 ; Goldfield N, Kelly WP, Patel K. Qual Manag Health Care 21(4):213–219, 2012. https://doi.org/10.1097/QMH.0b013e31826d1d3a ; Steinle T, Lees M. J Med Econ 14(1):65–74, 2011. https://doi.org/10.3111/13696998.2010.546465 ) through reduced complications, shorter lengths of stay, and fewer readmissions. Finally, the role of value-based care principles is presented (Porter ME. N Engl J Med 363(26):2477–2481, 2010. https://doi.org/10.1056/NEJMp1011024 ). By embracing a systems-based, patient-centered approach, anesthesiologists are positioned as key leaders in delivering high-quality, efficient, and cost-effective surgical care (Vetter TR, Goeddel LA, Boudreaux AM, Hunt TR, Jones KA, Pittet JF. Anesth Analg 118(5):1131–1136, 2014. https://doi.org/10.1213/ANE.0000000000000230 ).