Innovative approaches to preoperative care including feasibility, efficacy, and ethical implications: a narrative review

Background and Objective: In the face of advancing technologies and a greater understanding of human physiology and psychology, preoperative care is on the cusp of a paradigm shift. Healthcare is moving towards an emphasis on holistic care and technologies such as those of artificial intelligence (AI) are being implemented rapidly. This review aimed to explore innovative approaches and discuss their implications to preoperative care. Ultimately, a concise summary of feasible and effective strategies is provided for clinicians and health systems to consider adopting. Methods: A literature search was performed in multiple databases including PubMed, Scopus, Web of Science, and Cochrane Library, spanning from September 2013 to August 2023. English-language peer-reviewed articles, clinical trials, reviews, and meta-analyses relevant to innovative strategies in preoperative care were sought and reviewed. Key Content and Findings: Two themes of innovative approaches were recognized—personalized holistic care and technological integration. Personalized holistic care consisted of non-surgical specialty input, psychological interventions, prehabilitation, patient education, and genetic/epigenetic profiling. Technological integration consisted of the use of virtual reality (VR) and augmented reality (AR), telemedicine, AI and machine learning and finally three-dimensional (3D) printing. Conclusions: The amalgamation of pharmacogenomics to tailor pain management strategies, along with the use of patient-reported outcome tools indicate a shift towards personalized medicine. Emerging technologies like epigenetic marker technologies, AI, and telemedicine offer significant promise but come with a complex array of challenges that span ethics, cost-effectiveness, and quality of care. It is imperative to address these challenges through multidisciplinary research and ethical governance.