"Perioperative medicine is a multidisciplinary subspeciality composed of practitioners who can effectively identify and meet the complex medical needs of patients at particular risk from the adverse effects of surgical treatment.
This may require intervention before, during, or after surgery and may extend beyond the index admission for surgery. Doctors from many specialities are starting to identify themselves as ‘perioperative physicians’, but it is anaesthetists who are best placed to lead in this field, with an ideal combination of training, skills, and experience.
As surgeons increasingly focus on new and more specialized technical procedures, other specialists are taking more responsibility for the wider care of a patient population with complex medical needs.
Perioperative care is a focus of growth that is starting to develop the type of a collaborative culture at the bedside which has proved so successful in critical care. In some institutions, physicians now lead perioperative care, for example, of elderly patients with hip fractures.
The perioperative physician is a qualified medical practitioner with an appropriate portfolio of competencies whose patient interaction is temporally defined by the index surgical admission. From the decision to operate, which may be before hospital admission, to hospital discharge and beyond, the role allows us to use every opportunity to maximize patient benefit.
The perioperative physician may come from one of various base specialities, including anaesthesia, surgery, acute medicine, cardiology, and care of the elderly but sits at the centre of a web of relevant specialists. This individual will have undergone a programme of appropriate education, training, and certification to arm them with the necessary competencies, either essential, such as evaluating perioperative risk, or desirable, for example, echocardiography, to fulfil a defined scope of practice, the limits of which will require clarification.From this perspective, the anaesthetist is defined as the individual administering anaesthesia. Anything beyond this narrow definition spills into the role of the perioperative physician.
Implicitly, most anaesthetists practice perioperative medicine to some extent.