Perioperative care and collaboration between surgeons and anaesthetists – it's about time

In hospital care, arguably nothing comes closer than the working relationship between the surgeon and anaesthetist. Their joint endeavour to keep patients alive and well, while they undergo surgery, creates a bond that is strong and rewarding. Initially this working relationship focused on the surgical procedure itself but, as time has passed, it has become obvious that optimal care also requires careful preoperative patient assessment and good postoperative care. The roles of the surgeon and anaesthetist have expanded to cover this perioperative interval in many and varied ways. This initiative, a single special issue on perioperative care spread across two journals, BJS and Anaesthesia, showcases collaborative work between surgeons and anaesthetists. It celebrates their achievements in improving perioperative care, but also highlights current and ongoing research to optimize the care of patients undergoing surgery. The editors have invited experts in the field to contribute state-of-the-art leaders and reviews, and also included a number of articles submitted following specific calls in the journals and on social media. Both journals have produced special issues that are entirely free to download and enjoy. In the modern era, anaesthetists are becoming more and more involved in perioperative care, expanding their role to assessing and optimizing patients before surgery and also looking after them during recovery from surgery. These aspects of care may be somewhat controversial, but there is little doubt that collaborating together over the perioperative interval will improve outcomes. The past 20 years has seen an explosion of interest in improving outcomes after surgery, and enhanced recovery after surgery (ERAS) has become almost the norm during elective surgery, with surgeons and anaesthetists embracing the package of care in their practice. The godfather of ERAS, a surgeon from Copenhagen, Professor Kehlet1, presents an update and discussion on the future of ERAS in this supplement. He argues that future research in ERAS should focus on the inflammatory and neurohormonal surgical stress response, fluid management, mechanisms of orthostatic intolerance, postoperative cognitive dysfunction, and mechanisms and prevention of postoperative ileus. Foss and Kehlet2 go further, and discuss research and implementation of ERAS in emergency laparotomy. Access and admission to ICU after emergency surgery is reviewed by Onwochei and co-workers3. Safety is, and should be, a major focus of surgical and perioperative care, and Marshall and Touzell4 review the importance of human factors and teamwork in the operating theatre. A team that communicates well, defines the roles of its members and is aware of their limitations will provide safe patient care3. Charlesworth and Pandit5 argue that an efficient operating theatre is a safe one, and describe metrics that can be used to drive improvement. There is no doubt that the mode of anaesthesia can affect surgical outcomes, and Morley and colleagues6 describe the emerging evidence. Likewise, effective postoperative pain relief improves both outcomes and patient experience. There are several examples in this special issue, including a network meta-analysis7 of analgesia after colorectal surgery. Reduction in postoperative complications, such as delirium, so common in the elderly, can also drive outcome improvement. Dexmedetomidine is a promising agent in this regard8. Finally, variations in use of the Surgical Safety Checklist and other aspects of safe perioperative care differ around the world, which is a challenge of critical importance to all healthcare workers9,10. We hope you enjoy this special issue, which is a unique collaboration between two leading journals in surgery and anaesthesia. We have been unable to find other examples of collaboration between surgical and anaesthetic journals, and many will agree that it's about time that this happened. This is true because, in practice, surgeons and anaesthetists work together in the operating theatre, but also in research. Surgeons and anaesthetists need each other to do good research and must not forget the role of the anaesthetic or the surgery in each other's studies. Patient-centred outcomes should be the focus of clinical research, and this necessitates involving surgeons and anaesthetists in planning and performing clinical research in perioperative and surgical care, as well as the patients themselves. Surgeons and anaesthetists need to talk, and perhaps also read each other's journals. Positive evidence that specialisms can work together to the benefit of patients will attract attention and cooperation from the wider multidisciplinary team. A.A.K. is Editor-in-Chief of Anaesthesia and J.J.E. is Editor-in-Chief of BJS. Disclosure: The authors declare no conflict of interest.