Publication in Perioperative Medicine

Introduction

Perioperative medicine encompasses the interdisciplinary, collaborative, patient-centered, and integrated medical care of patients from initial consideration for surgery with a shared decision-making process through their entire postoperative course and postdischarge recovery.

The practice of perioperative medicine identifies patients at increased risk for significant morbidity and mortality and proactively optimizes their care rather than simply rescuing them from complications. Providers with expertise in anesthesiology, surgery, and internal medicine have complementary expertise and thus ideally work together in delivering perioperative care.

Although the various elements of perioperative care have historically been the topics of hypothesis-based research, perioperative medicine as a specialized area of investigation is relatively new. A well-accepted definition of perioperative medicine research does not exist. Few current journals consistently have content or a section devoted to this specialty. As previously noted, perioperative medicine is very broadly defined. Therefore research and publications in this field preferably include an interdisciplinary approach and patient-centered focus.

Perioperative Population Health Management: A Current Overarching Theme and Important Driver

Medical research typically focuses on a particular intervention in a very specific group of patients, looking at outcomes that may or may not be relevant from a larger perspective. For example, studying the effects of different anesthetic agents in geriatric surgery patients on a primary outcome occurring before hospital discharge, without considering overall geriatric vulnerability screening and delirium prevention, can lessen translational impact.

Unlike most medical research, perioperative medicine research is often translated to a population health management level. Therefore perioperative medicine research generally considers the impact of the intervention studied on a population level, with the goal being to improve value not only for an individual patient but also for a population, resulting in an overall improvement in population health management. Such research is thus expected to provide evidence that an intervention can be readily translated to improve perioperative care with appropriate implementation in the targeted population.

The perioperative medicine and management literature has generally focused on the value of the care provided, initially defined as the ratio of quality (or outcomes) to the cost of achieving the desired outcomes. The numerator of this value ratio has subsequently been expanded: Value = (Safe + Effective + Efficiency + Patient-Centeredness + Timely + Equitable) ÷ Cost.

The cost of an intervention is important in perioperative research findings, unlike other medical research that can examine technologies that would be prohibitively expensive on a population level. Nevertheless, direct and indirect perioperative costs remain underreported in the literature.