Enhanced care units provide a tailored and scalable solution to managing postoperative pathophysiology

Postoperative complications increase morbidity and mortality. With an ever-increasing number of older and more frail patients requiring surgery, the demand for effective postoperative care is escalating. Currently, there is a notable disparity between postoperative ward-based care and the care provided in high dependency units (HDUs) and intensive care units (ICUs). This gap exposes intermediate-risk patients, with limited access to HDU/ICU facilities, to an increased risk of postoperative morbidity and mortality and has significant health economic implications. Mounting evidence supports preventive approaches, including the use of specialised, anaesthesia-led postoperative care delivered in enhanced care units (ECUs) which can bridge this gap effectively. Anaesthetists have a critical role in delivering enhanced perioperative care and are ideally positioned to lead this transformative approach. Current traditional ward-based approaches identify patient deterioration after it has occurred, exposing patients to avoidable hypotension and hypoxia and potentially non-specific treatment modalities such as intravenous fluid therapy for hypotension and low-flow nasal oxygen for hypoxia. Strategies for reducing early postoperative morbidity and mortality following surgery must focus on implementing policies which enhance perioperative care systems tailored to the unique pathophysiology of the postoperative period. Appropriate effector responses ideally would treat these perturbations before they occur or rapidly after identification using tailored therapeutic strategies specific to an individual patient's physiology. In this commentary, we highlight key aspects of postoperative pathophysiology that support the call for increasing access to appropriate postoperative care facilities, and offer ECUs as one scalable solution.