British Journal of Anaesthesia Page 1 of 2doi:10.1093/bja/aeu265

EDITORIAL

Anaesthesiology and perioperative medicine aroundthe world: different names, same goalsM. Cannesson1*, F. Ani1, M. M. Mythen2 and Z. Kain2

1 Department of Anesthesiology and Perioperative Care, University of California Irvine, 101 S City Drive, Irvine, CA 92868, USA2 Department of Anaesthesiology and Critical Care, University College of London, London, UK

*Corresponding author: E-mail: mcanness@uci.edu

As mosthealthcare systems around the globe have been forcedto find innovative ways to improve patients’ outcome and sat-isfaction while reducing their cost,1 many countries, includingthe USA, UK, France, the rest of Europe, and Australia, havedeveloped strategies to increase the role of anaesthesiologistsin perioperative medicine. These countries have responded todiminishing fiscal resources in their healthcare system with in-novative models such as enhanced recovery after surgery(ERAS)2 and perioperative surgical home (PSH).3 4 Regardlessof what these clinical delivery models are called, they are allfocusing on delivering care with better clinical outcome, betterservice,andmore efficiency. This is achievedbyreducedvariabil-ity, standardized protocols, and improved coordinated care byleveraging information technology and evidence-based medi-cine.2 5 6 Interestingly, all of these systems are slowly butsurely proving to be viable and sustainable solutions.7–9

Regardless of the different names, these new delivery caremodels are called in various countries, one of the things theyall have in common is that anaesthetists are often leadingthem. Why is this the trend? Not to say that other specialistsare not capable of providing care for surgical patients, butthe nature of our training and of our practice makes usnatural candidates to become the leaders of the perioperativeenvironment. During the past decade, we have demonstratedour ability to improve patients’ safety10 and to act as systemexperts. We have developed unique and extensive trainingsin preoperative evaluation, intraoperative management, post-operative and critical care, and also in pain management of thesurgical patient. We are system thinkers and are already trans-versally involved almost everywhere in the hospital (e.g. ob-stetrical wards, intensive care units, operating theatres,interventional radiology suites, inpatient wards, gastrointes-tinal procedural areas). We are already in the unique positionof managing complex operating and procedural schedulesfor various hospitals’ operating theatres and many of us haveled perioperative care committees even long before the riseof the ERAS or PSH concepts and our value has long been recog-nized by hospital administrators.

As perioperative specialists, we have already developed aninstinctive heightened awareness and expertise in early recog-nition of the physiological signs of deterioration in patientsmuch before adverse events occur. We have developed theskills, knowledge, and expertise necessary to medically opti-mize patients for surgery and to ensure the best outcome, es-pecially for those with significant comorbidities and chronicdisease, which we see on the rise as life-expectancy increasesin western nations.

Our anaesthesia community is starting to embrace thismovement towards becoming perioperative physicians as anexpansion of the speciality or broadening of the scope of prac-tice vs the traditional intraoperative role. We submit that thisapproach will more likely bring several benefits to our profes-sion. Indeed, the economic impact of PSH or ERAS programmesmay strengthen our position in today’s world of limited fiscalresources and intense competition from other healthcareextenders. With the changing payment paradigm in the USAto a value-based economy (value based purchasing, bundledpayments, and even accountable care arrangements), ourexpanded role can further help secure our position as leadersin the hospital. Also, these new clinical practice models mayattract future generations of some of the best and brightestphysicians in training to the field, which could eventuallyfurther transform our speciality. This expanded role of our spe-ciality may reduce the notion that the field is one ‘that lackscontinuity of care’ or is one in which patient interaction islimited.

Regardless of what the model is called around the globe, wehave to embrace our expanded role as perioperative physiciansas our main value proposition. This will add value in today’srapidly changing healthcare and it will also allow us to differen-tiate ourselves from others and secure our position. Just as an-aesthesia has constantlyevolved from the days of using nitrousoxide to ether, from just handling simple cases to expanding toeven subspecialities within the field, anaesthetists have to seethis change as another evolution of the field; and it is no secretthat evolution is key to survival.

& The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.For Permissions, please email: journals.permissions@oup.com

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Declaration of interestM.C. is a consultant for Covidien, Edwards Lifesciences, MasimoCorp., is the founder of Sironis, and received research fundingfrom Edwards Lifesciences and Masimo Corp. Z.K. is a Directorof the Academic Component for the board of Directors of theAmerican Society of Anesthesiologists. M.M.M. is National Clin-ical Advisor to the UK Department of Health Enhanced Recov-ery Partnership, Council Member Royal College of Anaesthetistslead for Perioperative Medicine Task and Finish Group, and Edi-torial Board Member of the British Journal of Anaesthesia.

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3 Kain ZN, Vakharia S, Garson L, et al. The perioperative surgical homeas a future perioperative practice model. Anesth Analg 2014; 118:1126–30

4 Vetter TR, Boudreaux AM, Jones KA, Hunter JM, Pittet JF. The peri-operative surgical home: how anesthesiology can achieve andleverage the triple aim in healthcare. Anesth Analg 2014; 118:1131–6

5 American Society of Anesthesiologists. The Perioperative SurgicalHome. Washington, DC: American Society of Anesthesiologists,2011

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7 Scott NB, McDonald D, Campbell J, et al. The use of enhanced recov-eryafter surgery (ERAS) principles in Scottishorthopaedic units—animplementation and follow-up at 1 year, 2010–2011: a report fromthe Musculoskeletal Audit, Scotland. Arch Orthop Trauma Surg 2013;133: 117–24

8 Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN.The enhanced recovery after surgery (ERAS) pathway for patientsundergoing major elective open colorectal surgery: a meta-analysisof randomized controlled trials. Clin Nutr 2010; 29: 434–40

9 Garson L, Schwartzkopf R, Vakharia S, et al. Implementation of atotal joint replacement-focused perioperative surgical home: amanagement case report. Anesth Analg 2014; 118: 1081–9

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