Perioperative Medicine Expands Beyond the Operating Room

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The evolution of perioperative medicine described in this editorial reflects a broader historical shift in how the surgical patient is understood. For much of the twentieth century, the anesthesiologist’s mandate was largely confined to the intraoperative period: maintaining physiological stability, providing adequate anesthesia, and ensuring the patient emerged from surgery alive and intact. That mandate, while foundational, treated the surgical encounter as a discrete event with clear boundaries. The modern conception, by contrast, treats surgery as a physiological insult whose consequences ripple across weeks and months, and whose outcome can be shaped by interventions that begin well before the first incision and continue long after discharge. This reframing has practical consequences. It means that the preoperative clinic is no longer merely a screening checkpoint but a therapeutic opportunity, and that the post-anesthesia care unit is no longer the end of the anesthesiologist’s responsibility but a waypoint in a continuum that includes ward care, rehabilitation, and the transition home.

The emphasis on physiological reserve highlighted in the editorial deserves particular attention. Cardiopulmonary exercise testing has long been used in preoperative assessment, but traditional protocols require patients to exercise to maximal capacity, which can be difficult, unsafe, or simply uninformative in elderly or frail populations. Submaximal testing approaches attempt to extract meaningful measures of cardiopulmonary reserve without pushing patients to their physiological limits. If such measures can reliably identify patients at risk of intraoperative hemodynamic instability, as the exploratory work cited in this collection suggests, they would fill an important gap. Intraoperative hemodynamic instability is associated with organ injury, postoperative complications, and increased mortality, yet it is often unpredictable with conventional risk scoring. A physiological measure that captures the integrated function of the cardiovascular, respiratory, and metabolic systems may outperform demographic variables precisely because it probes the reserve capacity that determines how a patient responds to the stresses of anesthesia and surgery.

The observation that established risk models may not transfer equally across populations is a recurring lesson in clinical prediction research. Risk models for postoperative nausea and vomiting, like many perioperative prediction tools, were typically derived in specific patient populations and validated in similar cohorts. When applied to populations with different demographic composition, comorbidity profiles, or care contexts, their discrimination and calibration can degrade substantially. The veteran-centered analysis highlighted in this Research Topic is a reminder that the generalizability of a prediction model is an empirical question, not an assumption. This has particular relevance as perioperative medicine moves toward precision approaches: a model that performs well in one population may systematically overestimate or underestimate risk in another, leading to misallocation of prophylactic resources. The solution is not necessarily to abandon existing models but to test them in the populations where they will be used, to recalibrate them when needed, and to develop population-specific tools where the mismatch is large enough to matter clinically.

The focus on postoperative nausea and vomiting within this collection is fitting, because this complication illustrates several themes of modern perioperative medicine at once. Although often dismissed as a minor discomfort, nausea and vomiting are among the most common and most distressing surgical complications, affecting patient satisfaction, delaying discharge, and occasionally causing dehydration, wound dehiscence, or aspiration. The multimodal approach described in the editorial, combining optimized antiemetic prophylaxis, neuraxial techniques, and opioid reduction, reflects a mechanistic understanding that nausea and vomiting arise from multiple pathways, including emetic center stimulation, vestibular input, and opioid receptor activation. No single antiemetic agent blocks all of these pathways, which is why combination prophylaxis outperforms monotherapy. Similarly, reducing opioid exposure addresses one of the principal drivers of nausea while simultaneously advancing the broader goal of opioid-sparing analgesia, a priority given the ongoing attention to opioid stewardship in surgical care.

The philosophy underlying these care bundles is the same that animates enhanced recovery pathways more generally. Enhanced recovery after surgery protocols, first developed in colorectal surgery and since extended across surgical specialties, rest on the observation that individual interventions often produce modest benefits in isolation, but that coordinated bundles of preventive measures can produce substantial cumulative improvements. The bundle approach requires organizational commitment: standardized protocols, multidisciplinary coordination, and audit of compliance and outcomes. The contributions on multimodal care described in this collection, while requiring further validation as the editorial notes, exemplify the incremental process by which pathway medicine advances, through careful testing of individual bundle components before they are scaled into comprehensive programs.

The review on family engagement addresses a dimension of perioperative care that has historically been underemphasized in clinical research. Surgical care is traditionally organized around the patient as an individual, yet recovery occurs largely in the context of the family and home. Caregivers manage medications, monitor for complications, coordinate follow-up appointments, and provide the emotional support that influences adherence and psychological recovery. Structured caregiver involvement, as the editorial describes, promotes communication, education, and shared participation in care. The evidence base for family-centered interventions spans preoperative education, intraoperative communication with family members, and postoperative involvement in recovery planning. As surgical populations age and as more care shifts to ambulatory settings where the postoperative period unfolds at home, the role of the family in the perioperative continuum will only grow, making this line of inquiry increasingly central rather than peripheral to the specialty.

The prospective study from Ghana on intra-abdominal hypertension among critically ill patients extends the perioperative continuum into the intensive care unit and, importantly, demonstrates the global relevance of this research agenda. Intra-abdominal hypertension, defined as sustained elevation of intra-abdominal pressure, is a recognized driver of organ dysfunction in critically ill patients, and its progression to abdominal compartment syndrome carries high mortality. The condition is often under-recognized because its signs are nonspecific and because routine pressure measurement is not universally practiced. The high burden documented in this study supports the editorial’s call for targeted surveillance in high-risk populations, which is particularly consequential in resource-limited settings where diagnostic capacity may be constrained and where simple, inexpensive monitoring strategies can have outsized impact. Beyond its specific findings, the study illustrates the continuity of care theme: the surgical patient who develops intra-abdominal hypertension in the intensive care unit is the same patient whose perioperative trajectory began in the operating room, and the anesthesiologist’s awareness of this risk extends across that entire pathway.

The survey on attitudes toward artificial intelligence in healthcare captures a moment of transition for the specialty. Anesthesiology has long been at the forefront of technology adoption, from monitoring standards to decision-support systems, and the current wave of AI applications, including predictive analytics, automated documentation, and image interpretation, is likely to touch perioperative care substantially. The finding that physicians and patients hold generally positive attitudes, particularly when AI is framed as supporting rather than replacing clinical judgment, aligns with a consistent pattern in the literature: acceptance depends on the perceived role of the technology. Framing AI as an augmentation of human expertise, rather than a substitute for it, preserves the trust and accountability that underpin the therapeutic relationship. The editorial’s identification of trust and the human dimensions of care as a defining challenge of the next era is well founded, because the benefits of algorithmic prediction and decision support can only be realized if clinicians and patients are willing to engage with them.

Taken together, the seven articles gathered in this Research Topic map the breadth of contemporary perioperative medicine: physiological assessment and precision risk prediction, preventive bundles and enhanced recovery, family-centered care, critical care surveillance, and digital innovation. What unites them is the conviction that surgical outcomes are not fixed at the moment of operation but are shaped by decisions and interventions distributed across the entire perioperative journey. The editorial’s authors, drawing on their institutional perspectives from Montreal, Liège, and Houston, frame this as an expanding vision of anesthesiology, one in which the specialty’s traditional mastery of intraoperative physiology becomes the foundation for a larger mandate: anticipating risk before it materializes, personalizing care to the individual patient’s reserve and population characteristics, and improving recovery in all its dimensions, physical, psychological, and experiential. The trajectory suggested by this collection indicates that the coming years will see perioperative medicine continue to move beyond the operating room, guided by evidence that spans the continuum from preoperative optimization to long-term patient outcomes.

Subject of Research: Perioperative medicine

Article Title: Editorial: Editors' showcase: perioperative medicine

Article References: Schricker, T., Rousseau, A.-F., & Turan, A. (2026). Editorial: Editors' showcase: perioperative medicine. Frontiers in Anesthesiology, 5, Article 1961356. https://doi.org/10.3389/fanes.2026.1961356

Image Credits: AI Generated

DOI: 10.3389/fanes.2026.1961356

Keywords: perioperative medicine, anesthesiology, artificial intelligence, enhanced recovery, intensive care, Editorial, Editors', showcase, perioperative, medicine, scientific research