Improving perioperative outcomes: my journey into risk, patient preferences, guidelines, and performance measures: Ninth Honorary FAER Research Lecture.

AS a clinical anesthesiologist and health services researcher, my goal is to improve patient outcomes both on an individual and a population level through direct patient care and research. In recent years, I have had the privilege of being involved in the development of numerous guidelines. Guidelines are a set of recommendations for patient management that identifies a specific or range of management strategies based on the evidences. Guidelines are usually developed and promulgated by a specialty medical society or government agency (i.e., National Institutes of Health or Agency for Healthcare Research and Quality). It is important to recognize that guidelines are the culmination of both research and expert opinion and that application of guidelines can improve care, but if done incorrectly, it can lead to worse outcomes. It is within this context that I would like to review my perspective on the research that underlies both guidelines and their implementation into clinical practice. The goal of improving perioperative outcomes comes under the general rubric of outcomes research. The agency for healthcare research and quality defines outcomes research as: