Perioperative Systems as a quality model of perioperative medicine and surgical care

Objectives: There has been a recent widespread international 'paradigm shift' to new Perioperative Systems for surgical patient care. These new systems are based on a multidisciplinary team providing an integrated process of care from the time a decision is made that a patient should have an operation until the patient has recovered from surgery. The objectives of this review were to outline the rationale for new Perioperative Systems, synthesize the evidence supporting these new systems and consider the current state of Perioperative Systems and its future development. Methods: A systematic review of studies that focus on preoperative management practices to improve patient preparation for surgery and anaesthesia, with restriction to study designs with the highest levels of evidence for the synthesis of evidence. Results: Perioperative Systems are regarded as the standard model of care in Australia, New Zealand, North America and increasingly in Europe. The benefits of Perioperative Systems include: increased surgical volume and flow (20-35%), shorter preoperative length of stay (-0.2 to -1.3 days), fewer cancellations of surgery (absolute reduction 1-8%), relative reduction in the number (23-55%) and cost (40-59%) of preoperative investigations and a lower risk of wound infection (relative risk 0.30, 95% CI 0.12-0.78) compared to the traditional system. The mean reduction in the total cost per patient associated with a Perioperative System was 8-18%. Future developments include offering health promotion activities in the weeks before surgery to improve long term patient outcomes after surgery. Conclusion: There is evidence of quality benefits for patients, clinicians and health administrators associated with new Perioperative Systems. Despite this, these systems are yet to be fully developed in many jurisdictions. (C) 2011 Elsevier Ireland Ltd. All rights reserved.