Authors: Bernstein WK et al.
Source: Anesthesia & Analgesia, 142(1):76–84, January 2026, 10.1213/ANE.0000000000007629
Enhancing anesthetic preoptimization represents a major opportunity to improve patient outcomes while advancing value-based perioperative care, particularly in regions with limited or uneven access to health care resources. This comprehensive review from the ASA Committee on Innovation outlines how anesthesiologists are uniquely positioned to lead preoperative optimization efforts beyond traditional day-of-surgery assessments. Drawing on over two years of work, the authors examine critical comorbid conditions—obstructive sleep apnea, hypertension, anemia, food insecurity and nutrition, diabetes, and cognitive and brain health—that significantly influence perioperative morbidity and mortality and are often poorly addressed in standard care models.
The article emphasizes that escalating costs, shortages of primary care physicians, and lessons learned during the COVID-19 pandemic necessitate a systems-based approach to perioperative medicine. Anesthesiologists, through expanding roles in perioperative surgical homes, ERAS pathways, preoperative clinics, and prehabilitation programs, can intervene earlier to mitigate risk, prevent complications, and improve long-term outcomes. The review highlights how innovations such as telemedicine, wearable and remote monitoring devices, artificial intelligence–assisted decision support, and mobile health platforms can extend preoptimization strategies to rural, underserved, and low-resource settings.
Across conditions, the authors contrast high-resource and low-resource approaches. In well-resourced systems, precision medicine, AI-driven analytics, continuous monitoring, and personalized therapy dominate innovation. In contrast, low-resource settings benefit most from scalable, cost-effective solutions such as simplified screening tools, mobile health education, community-based interventions, and affordable diagnostics and therapies. Importantly, the paper argues that meaningful gains in perioperative safety can be achieved even without advanced technology when early identification and targeted intervention are prioritized.
The review also addresses limitations, acknowledging that expanding anesthesiologists’ involvement in preoperative optimization may strain existing workforce capacity and out-of-OR responsibilities. Nevertheless, the authors argue that shifting care upstream—before the day of surgery—offers substantial benefits by improving physiologic and cognitive resilience, reducing postoperative complications, and lowering overall health care expenditures. Ultimately, the paper frames anesthetic preoptimization not as scope creep, but as a necessary evolution of perioperative medicine to meet modern patient and system demands.
Key Points
• Anesthesiologists are uniquely positioned to lead preoperative optimization in value-based perioperative care models.
• Early identification and management of OSA, hypertension, anemia, malnutrition, diabetes, and cognitive vulnerability can significantly reduce perioperative morbidity and mortality.
• Digital health tools, AI-assisted monitoring, and telemedicine expand preoptimization opportunities in both high- and low-resource settings.
• Cost-effective, scalable interventions can meaningfully improve outcomes even in resource-constrained environments.
• Shifting care earlier in the perioperative timeline improves patient resilience, reduces complications, and enhances system-level efficiency.
Thank you to Anesthesia & Analgesia for allowing us to summarize and discuss this important work.