Quo Vadis Anesthesiologist? The Value Proposition of Future Anesthesiologists Lies in Preserving or Restoring Presurgical Health after Surgical Insult

Abstract

Anesthesiology is an indispensable and ubiquitous field of modern healthcare. Advancements in delivering anesthesia result in a very low rate of anesthesia-related mortality, improved morbidity, and increased patient satisfaction. However, peri-surgical stress may trigger profound and lasting effects on the patient’s physiology, resulting in the emergence of a new allostatic balance. Such a balance may have variable effects on the patient’s recovery. However, in some individuals, the emergence of the new allostatic balance is delayed for years yet ultimately results in a less favorable outcome due to an increased risk of comorbidities. These changes are secondary to a single critical care grade insult such as significant tissue destruction, blood loss, alteration in microbiota with the possible leak of the inflammatory pathogen-associated molecular pattern (PAMP), and the induction of catabolism. Preparing patients for such stress is a novel requirement for anesthesiologists to expand their scope of practice in healthcare delivery by eliminating pre-existing stressors (smoking, obesity, substance abuse) and preconditioning patients to stress using pharmacological and nanotechnology means. Perioperative care should employ a human brain interface for more efficient care delivery and an early warning for excessive damage. Postsurgical care can involve the modification of the immune and metabolic system response. Selected techniques should include utilizing genome expression manipulation, multi-omics analysis, and predictive algorithms. Integration of these techniques into a per-operative recovery data-driven delivery system with the targeted goal of recovering presurgical homeostasis instead of allostatic recovery may represent a perfect nexus for future anesthesiologists.

Value-based preoperative assessment in a large academic hospital

“…This challenge is compounded by financial constraints and rising healthcare costs, which constrain the range of available healthcare options [ 3 ]. As a result, even if an effective preoperative assessment is necessary to reduce preventable outcomes during surgical procedures, several concerns are frequently raised about its efficiency, including (i) the overlap and redundancy between surgical staging visits and preoperative assessment visits, (ii) waste and inefficiencies for patients and providers (i.e., multiple hospital accesses for different visits and tests, repeated testing over time) [ 4 ], and (iii) the increased workload for healthcare professionals due to inefficient processes [ 5 ].…”

Value-based pre-operative assessment in a large academic hospital

“…2 In recent years, we have seen an increase in the demands and expectations placed on healthcare systems, as an increasing proportion of frail and elderly patients need higher levels of perioperative care, while nancial constraints and rising costs limit healthcare options. 3 As a result, even if an effective preoperative assessment is necessary to reduce preventable outcomes during surgical procedures, several concerns are frequently raised about its e ciency, including i) the overlap and redundancy between surgical staging visits and pre-operative assessment visits ii) waste and ine ciencies for patients and providers (i.e., multiple access, multiple testing over time) 4 iii) the increased workload for healthcare professionals due to ine cient processes 5 .…”