Enhancing Anesthetic Preoptimization: Promising Opportunities for Innovation in Economically Diverse Regions.

The escalating costs of perioperative care are unsustainable, necessitating the identification of high-impact investment opportunities to enhance both quality and cost-effectiveness of perioperative processes. In both rural and urban areas with less access to health care resources, a sustainable health care system must focus on delivering value-based care and prioritizing population health, promoting efficiency, preventing complications, and optimizing outcomes. Given the shortage of primary care physicians, and the lessons learned from the COVID-19 pandemic, which emphasized the importance of a systems-based approach, as well as the evolving roles in the perioperative surgical home and ERAS pathways, anesthesiologists are in a prime position to contribute to these essential value-based objectives. They can achieve this by playing a more active role in the preoperative evaluation and optimization of patients.This paper presents a comprehensive review of pertinent perioperative medical conditions (obstructive sleep apnea, hypertension, anemia, food insecurity and nutrition, diabetes, cognitive and brain health) that can be optimized before surgery. It highlights the latest research and innovations in preoperative management that can significantly alter intraoperative anesthetic management of these conditions leading to reduced morbidity and mortality among surgical patients. Furthermore, this paper highlights existing gaps in preoperative management, particularly in the optimization of comorbid medical conditions.