LAUSR

The elderly population is the fastest growing segment of the population with the number of people over the age of 65 expected to double by the year 2060. Becausemany common colorectal conditions increase in prevalence with age, the number of people diagnosed with common colorectal conditions is expected to increase dramatically over the ensuing decades. This trend, commonly referred to as the “silver tsunami,” will result in a substantial increase in the number of colorectal surgery patients with accompanying comorbidities and complex surgical needs. Considering this ensuing trend, additional gains in quality improvement will hinge on preoperative optimization and risk reduction. Various preoperative optimization strategies have been described and are constantly evolving as new literature emerges. In this issue of Clinics in Colon and Rectal Surgery, entitled “Perioperative Assessment and Optimization in Major Colorectal Surgery,” the most important aspects of a comprehensive preoperative optimization program will be discussed by leading experts in the field. The evidence for assessment and optimization of anemia, malnutrition, hyperglycemia, and cardiopulmonary disease will be individually reviewed as will the efficacy and strategies of preoperative protocols aimed at smoking cessation and prehabilitation. Another area of focus is the prevention of surgical site infection through preoperative bacterial decontamination, including bowel preparation. The impact of health disparities on surgical outcomes and preoperative assessment tools available for identifying social determinants of health is an additional topic of focus. We will also explore the consent process and review frameworks for shared decision-making in facilitating a discussion around risk and possible adverse outcomes with high-risk patients. Finally, we will discuss the logistical and financial barriers along with implementation frameworks in the deployment of a successful preoperative optimization program. I am inspired by and thankful to my esteemed colleagues who contributed their expertise to the current issue and hope you will gain valuable information to improve your practice. Traci L. Hedrick, MD, MSc, FACS, FACRS