Perioperative Surgical Home and the Integral Role of Pain Medicine.

Abstract

Many criticisms surround the current management of the surgical experience. These include the fragmented nature of care delivered perioperatively with multiple transitions, the high costs of many common procedures, and the sometimes disappointing outcomes given the monetary and human investments made in surgical care ⇓. Modeled in some ways after the concept of the patient-centered medical home, the American society of anesthesiologists has articulated a definition of the perioperative surgical home (PSH) as “a patient-centered and physician-led multidisciplinary and team-based system of coordinated care that guides the patient throughout the entire surgical experience” ⇓. Though, we do not yet fully understand the potential benefits of the PSH model, a recent review suggests that the quality of care is often improved, and costs are reduced ⇓. At the core of the PSH concept is the notion that various groups of health care specialists should work together to provide optimal care. Complementary to that notion, and particularly relevant to reducing fragmented treatment as well as improving the patient's experience, is the recognition that the seamless longitudinal management of specific aspects of care may facilitate optimal outcomes. Pain management in the immediate postoperative period is already one of the better developed components of the PSH, and one on which further expansion of the model can be based ⇓. As our understanding of factors predisposing patients to excessive acute postoperative pain, persistent postoperative pain, poor functional outcomes, and the prolonged use of opioids grows, so too will our ability to contribute to the perioperative management of surgical patients. Figure ⇓ displays a roadmap of key goals for comprehensive pain management in the perioperative setting. Figure 1 A roadmap of pain management in perioperative pain care. In this model pain management issues are addressed at several points in the PSH process. The goals …