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November 2016

The Perioperative Surgical Home: Cui Bono?

Author Affiliations
  • 1Department of Surgery, Pennsylvania State University College of Medicine, Hershey
  • 2Department of Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania
JAMA Surg. 2016;151(11):1003-1004. doi:10.1001/jamasurg.2016.2056

In recent years, attention has been directed to the concept of the Perioperative Surgical Home (PSH). The origin of this concept can be attributed to the introduction of ambulatory surgery and the rise of preadmission testing centers, which led to improvements in the preoperative recognition and management of risk factors and a reduction in the use of preoperative screening services and tests that provided no clear benefits.1 Beginning in the 1990s, a number of institutions began to formally address the problem of a perioperative system of anesthetic management for nonurgent procedures, viewing it through the Donabedian lens of quality2 that focuses attention on structure, process, and measurement of outcomes. Most recently, it has been recognized that outcomes of major elective operations can improve with the proactive, goal-directed, preoperative preparation of the patient coupled with early planning for discharge and postprocedure rehabilitation.3,4 The PSH is a vehicle for integrating preoperative, intraoperative, and postoperative phases of care on the theory that the highest value will be achieved for the patient and the payer. But it seems fair to ask, who actually will benefit?

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