This issue will cover novel approaches to demonstrating value by anesthesiologists. Articles will include Value from the Patient and Payer Perspectives, Perioperative Surgical Home, Demonstrating Value: A British perspective, Demonstrating value: A case study of enhanced recovery, Acute Pain Management/Regional, Measuring Outcomes as Demonstrating Value and many more!

How society will pay for health care is an issue that deserves attention. For example, according to the US Congressional Budget Office the federal deficit is on an unsustainable fiscal path leading to crushing deficits in coming decades mostly due to soaring federal expenditures for Medicare and Medicaid. The projections are that if healthcare costs continue to grow as rapidly over the next four decades as they did over the past four decades, Medicare and Medicaid would rise from 4.5 percent of the economy today to 20 percent by 2050. In fact, their budgets would equal the entire size of the federal government today. Many observers have noted that the federal government is increasingly becoming a health insurance firm with various different side businesses. This issue of Anesthesiology Clinics explores the relationship between the costs of anesthetic management strategies and the value of this care as reflected by patient outcomes and satisfaction. The goal is to provide a viewpoint from a variety of anesthesia subspecialties as to how to provide the best patient outcomes at the lowest practical costs. This includes administrative and organizational support for an efficiently functioning operating room.

This issue of Anesthesiology Clinics focuses on Anesthesia Out of the Operating Room. Editors Mark Weiss and Wendy Gross have assembled an expert team of authors on topics such as: A Changing Landscape: Demands of Integrated Care Delivery: Interventional Medicine and Anesthesiology: Engineering Challenges and Interdisciplinary Teamwork; Organizational Infrastructure: Attaining and Teaching Clinical Excellence. Improvement across specialties by implementing an “Institute mentality in the clinical arena; Quality: Who’s rules apply?; Electronic Health Records; Monitoring; Interventional Radiology (NOT RADIATION): (Safety/Tumor Ablation/Adult radiology/ equipment); Approaches to Vascular Disease; Cath Lab: Structural Heart Disease, Devices and TAVR; EP Lab; Cardioversions and TEEs; Upper GI EGD and new procedures; Colonoscopy and new procedures anesthesiologist and GI person; Endoscopic Surgery, repair of surgical procedures, bariatric procedures; Interventional Pulmonology; Pediatrics; Market Evaluation; Finances, Bundled Payments and ACOs; Competitive Strategy or Joint Venture Finance: potential threats and likely future scenarios.

This issue on sex and gender comes at an opportune time, as the DSM-IV is being revised, and in particular sex and gender issues are being reconsidered. This issue focuses on research in the area of gender variant children and transgender adolescents, assessment of several scenarios and clear information on practice parameters. Therapy for gender variant children and transgender adolescents is discussed in detail, as well as parents' perspectives, ethical legal, and non-discrimination issues, and education on these subjects. International standards of care are also discussed.

In this issue of Anesthesiology Clinics, guest editors Drs. Zdravka Zafirova and Richard D. Urman bring their considerable expertise to the topic of Preoperative Patient Evaluation. Top experts in the field discuss this important opportunity to identify co-morbidities that may lead to patient complications during the anaesthetic, surgical, or post-operative period, including anticoagulation preop management and regional anesthesia recent updates/guidelines; marijuana use and vaping; enhanced recovery pathways: preoperative considerations in children; management of preoperative anemia; and more. Contains 17 relevant, practice-oriented topics including what’s new in preop cardiac testing; virtual preoperative evaluation process: a new paradigm; newer hypoglycemic medications; new therapies for heart failure and pulmonary hypertension; preoperative management of the adult patient with cancer; and more. Provides in-depth clinical reviews on preoperative patient evaluation, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

This issue of Anesthesiology Clinics, edited by Dr. Nabil Elkassabany and Dr. Edward Mariano, focuses on Regional Anesthesia, with topics including: Current evidence related to regional analgesia and hip surgery; Updates on billing and coding and establishing an acute pain service in private practice; Establishing a home catheter program for orthopedic surgery in pediatric patients or more broadly: updates on regional anesthesia for pediatric orthopedic surgery; Enhanced recovery after shoulder arthroplasty; Perioperative management of patient on opioid agonist antagonist therapy; Outcome metrics to be considered for regional anesthesia and acute pain medicine; Updates on multimodal analgesia (intransal ketorolac, IV acetmenophen, newer NSAIDS) for orthopedic surgery; Updates in enhanced recovery pathway for knee replacement versus updates outpatient knee replacement; Updates on new technology for regional anesthesia (peripheral nerve stimulators and cryotherapy); and Regional anesthesia and analgesia for the poly trauma patients.

The volume of elderly patients requiring anesthesia and surgery is growing rapidly. Thirty-five percent of surgeries are performed on patients older than 65 years, and in general, these patients have higher morbidity and mortality rates after anesthesia compared with their younger counterparts. One of the major challenges of treating elderly patients is the heterogeneity of the geriatric population—and the need to individualize care for each patient to provide the best outcome.