Peri‐operative care Summit II: building on the principles and framework identified at Summit I

The Summit was initially conceived by Professor Guy Ludbrook, a Professor of Anaesthesia at the Royal Adelaide Hospital and University of Adelaide, to highlight the pandemic of postoperative harm. The goal of the summit was to bring awareness and initiate dialogue among stakeholders and thereby trigger a shift in perioperative care to save lives, reduce hospital stay and ultimately save valuable health dollars.1 The concept was regular Summits, bringing together stakeholders from every corner of surgical healthcare delivery, including healthcare professionals and their representative bodies, government agencies, private and public healthcare providers, payers, and consumers, to brainstorm ideas and workshop real-world actionable solutions to the unfolding crisis facing the delivery of safe high-quality surgical care. An over-arching strategy would be developed, and individuals identified at local and national levels to take plans and actions forward in an accountable fashion. Thus far, two Summits have been held. The first was in 2020, attended by 85 key experts from around Australia and New Zealand, with invited guests from the USA and the UK. Opened by the Honourable Greg Hunt and Honourable Stephen Wade, then the Federal and South Australian Health Ministers, respectively, and facilitated by Dr Norman Swan. Summit I produced a draft set of Principles to guide a high-value system's approach2 and to identify priority areas.1, 3 After delays from COVID-19 restrictions, Summit II was held in 2023 to re-visit the challenges and principles generated, to share views on high-priority solutions, and to explore how these might be best progressed in a coordinated manner. The scope and breadth of focus has increased from post-operative complications to peri-operative care more broadly, recognizing that the issue to be addressed begins at patient referral with a potentially surgically treatable disease. The leadership and membership continue to be expanded to broaden representation from the major areas above, and global stakeholders. A third and expanded Summit, partnered with ANZCA's Peri-operative Medicine Special Interest Group meeting, with substantial global representation, is scheduled for 22–24 November 2024, in Melbourne.4 The main problem pertains to the rapidly increasing burden of surgical illness and complications. Death within 30 days of surgery is the third most common cause of death globally5 with complications occurring an order of magnitude more frequently,6, 7 at unsustainable cost.8, 9 It is estimated that the incidence of postoperative complications will increase by around 10% annually over the next 30 years.10 This is mainly driven by the ageing population along with higher rates of long-term conditions including diabetes, obesity, heart, and kidney disease in the population needing surgery.11 Managing this burden will not be sustainable,11 and cannot be dealt with within existing resource allocation: radical solutions need to be identified and implemented as a matter of urgency, or surgical care will become inaccessible to more and more of our population. Pre-operative phase Intra-operative phase Post-operative phase The burden of surgical care and complications is rapidly outstripping available resources. In the likely absence of fundamental massive resource increase, there is an urgent need to develop and implement innovative solutions. We propose some principles and a framework to guide these, and urge all stakeholders to get involved. A paper accompanying this article addresses priority issues identified at Summit II and the key issue of improved healthcare economics and the delivery of the value proposition in healthcare. The "Hidden Pandemic" Summit series was designed to highlight the pandemic of postoperative harm. The goal was to bring awareness and initiate dialogue among stakeholders and thereby trigger a shift in peri-operative care to save lives, reduce hospital stay and ultimately save valuable health dollars. A series of meetings have taken place in Australia over the last 4 years to focus on identifying solutions to the challenge of delivering sustainable high-quality peri-operative care (https://www.hiddenpandemicsummit.com). Open access publishing facilitated by The University of Adelaide, as part of the Wiley - The University of Adelaide agreement via the Council of Australian University Librarians. Tarik Sammour: Conceptualization; formal analysis; investigation; methodology; writing – original draft; writing – review and editing. David A. Watters: Conceptualization; project administration; supervision; writing – review and editing. Ben Harris: Conceptualization; formal analysis; writing – review and editing. Michael P. W. Grocott: Conceptualization; validation; visualization; writing – review and editing. Guy L. Ludbrook: Conceptualization; formal analysis; project administration; resources; supervision; writing – review and editing.