title: Perioperative Systems as a quality model of perioperative medicine and surgical care.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong. annalee@cuhk.edu.hk
authors.forename: Anna
authors.initials: A
authors.lastname: Lee
authors.forename: Ross K
authors.initials: RK
authors.lastname: Kerridge
authors.forename: Po Tong
authors.initials: PT
authors.lastname: Chui
authors.forename: Chun Hung
authors.initials: CH
authors.lastname: Chiu
authors.forename: Tony
authors.initials: T
authors.lastname: Gin
mesh_terms: D001315:Australia; D005060:Europe; D019317:Evidence-Based Medicine; D006801:Humans; D017146:Models, Organizational; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000592:standards; D019990:Perioperative Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D014481:United States