Trauma Anesthesia Contributions to the Acute Care Anesthesiology Model and the Perioperative Surgical Home

Emergency surgery is associated with increased postoperative complications and mortality. Few patients are more poorly prepared for surgery than those who come to the operating room from the emergency department or trauma bay, in need of an urgent operative procedure. The physiology of these patients may be abnormal upon presentation due to multiple etiologies such as volume loss (through hemorrhage, vomiting, diarrhea, or insensible losses as seen with fever), tachycardia, tachypnea, and/or hypotension. There is no time for ‘prehabilitation,’ preoperative evaluation, or optimization of existing disease states. The art of acute resuscitation now incorporates multiple guidelines based on extensive scientific data. As with other anesthesiology sub-specialties, maintaining the knowledge and competence to treat the specialized field of trauma and acute care requires experts who can either manage these patients or serve as expert consultants to their colleagues. Creating a perioperative surgical home (PSH) model may improve patient-flow, inpatient care, and transition to rehabilitation or home, and contribute to improved long-term outcomes.