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Jules-Elysee KM, Sigmund AE, Tsai MH, Simmons JW. Expanding the perioperative lens: Does the end justify the means? J Clin Anesth 2024; 97:111522. [PMID: 38870702 DOI: 10.1016/j.jclinane.2024.111522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/26/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
In 1994, Fischer et al. established the preoperative clinic for the perioperative services at Stanford University Medical Center. By lowering the risk of cancellation and reducing morbidity and mortality against the push to move surgeries to an outpatient, basis, they demonstrated a return on investment. In the 2000s, Aronson et al. designed the prehabilitation clinics at Duke University with the notion that the preoperative process should not only ensure that patients were appropriately risk-stratified, but also clinically optimized before surgery. With a trend towards ambulatory procedures due to current reimbursement structures, hospital administrators should be searching for potential avenues to bolster sagging profits. In this narrative review, we argue that the perioperative services needs to extend beyond the hospital into the postoperative period.
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Affiliation(s)
- Kethy M Jules-Elysee
- Hospital for Special Surgery, Department of Anesthesiology, Critical Care, and Pain Management, New York, NY, USA.
| | - Alana E Sigmund
- Hospital for Special Surgery, Department of Internal Medicine, Division of Perioperative Medicine, New York, NY, USA.
| | - Mitchell H Tsai
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama Birmingham, Birmingham, AL, USA; Department of Anesthesiology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA; Department of Anesthesiology, University of Vermont, Larner College of Medicine, Burlington, VT, USA; Department of Orthopedics and Rehabilitation (by courtesy), Department of Surgery (by courtesy), Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | - Jeff W Simmons
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama Birmingham, Birmingham, AL, USA.
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Tran BW, Nelson M, Pal N. Association of preoperative anaesthesia consultation before elective noncardiac surgery with patient and health system outcomes. Comment on Br J Anaesth 2023; 131: 937-46. Br J Anaesth 2024; 132:433-434. [PMID: 38042724 DOI: 10.1016/j.bja.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/04/2023] Open
Affiliation(s)
- Bryant W Tran
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Mark Nelson
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
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Polidori MC, Sieber C. [Frailty: Prevention]. Dtsch Med Wochenschr 2024; 149:15-22. [PMID: 38158202 DOI: 10.1055/a-2033-4924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The Frailty syndrome is usually related to the aging process and chronological age, but it is not an inevitable consequence of it - at least until the final phase of life. Primary care interventions that promote physical activity and nutrition can prevent the progression from pre-frailty to frailty. This article presents the current state of knowledge on primary and secondary prevention of frailty.
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