The Perioperative Surgical Home: The New Frontier

  • Juhan Paiste
  • Daniel I. Chu
  • Thomas R. VetterEmail author


The Perioperative Surgical Home has been promoted as a novel, clinician-championed yet institution-supported, well-coordinated and very patient-centered, interdisciplinary model of care. Major forces are mandating a shift in the way providers and hospitals are paid from the traditional volume-based, fee-for-service contracts to one predominately linked to the value of the care. There are a number of drivers of health care value, which collectively represent a “burning platform” that will necessitate a fundamental change—a “New Frontier”— in perioperative care delivery and payment models in the USA. The highly collaborative Perioperative Surgical Home can consistently and effectively guide the patient through the entire surgical continuum, from the initial decision to undergo surgery to the post-hospital discharge and rehabilitation phase. The Perioperative Surgical Home essentially seeks to maximize health care value, defined as a quotient whose numerator includes perioperative quality, safety, and satisfaction and whose denominator is the total cost of perioperative care. There is an existing and a growing body of the literature supporting implementation and sustaining Perioperative Surgical Home model.


Perioperative Surgical Home Triple aim of health care Value-based health care Enhanced recovery after surgery Perioperative risk optimization and planning tool Patient-centered care Shared decision-making Perioperative quality Perioperative safety Perioperative satisfaction Perioperative costs 


  1. 1.
    Kain ZN, Vakharia S, Garson L, Engwall S, Schwarzkopf R, Gupta R, et al. The perioperative surgical home as a future perioperative practice model. Anesth Analg. 2014;118(5):1126–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Vetter TR, Goeddel LA, Boudreaux AM, Hunt TR, Jones KA, Pittet JF. The Perioperative Surgical Home: how can it make the case so everyone wins? BMC Anesthesiol. 2013;13:6.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27(3):759–69.CrossRefGoogle Scholar
  4. 4.
    Stiefel M, Nolan K. A guide to measuring the Triple Aim: population health, experience of care, and per capita cost. IHI Innovation Series White Paper. 2012. Accessed 30 Oct 2013.
  5. 5.
    Vetter TR, Boudreaux AM, Jones KA, Hunter Jr JM, Pittet JF. The perioperative surgical home: how anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesth Analg. 2014;118(5):1131–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Vetter TR, Ivankova NV, Goeddel LA, McGwin Jr G, Pittet JF. An analysis of methodologies that can be used to validate if a perioperative surgical home improves the patient-centeredness, evidence-based practice, quality, safety, and value of patient care. Anesthesiology. 2013;119(6):1261–74.CrossRefPubMedGoogle Scholar
  7. 7.
    Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. BMJ. 1998;316(7125):133–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010(3):Cd006632.Google Scholar
  9. 9.
    Casale AS, Paulus RA, Selna MJ, Doll MC, Bothe Jr AE, McKinley KE, et al. “ProvenCareSM”: a provider-driven pay-for-performance program for acute episodic cardiac surgical care. Ann Surg. 2007;246(4):613–21. discussion 21–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Varadhan KK, Lobo DN, Ljungqvist O. Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin. 2010;26(3):527–47. x.CrossRefPubMedGoogle Scholar
  11. 11.
    Ljungqvist O. ERAS-enhanced recovery after surgery: moving evidence-based perioperative care to practice. JPEN J Parenter Enteral Nutr. 2014;38(5):559–66.CrossRefPubMedGoogle Scholar
  12. 12.
    Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Vetter TR, Jones KA. Perioperative Surgical Home: perspective II. Anesthesiol Clin. 2015;33(4):771–84. doi:10.1016/j.anclin.2015.07.002. Review. PubMed PMID: 26610629.Google Scholar
  14. 14.
    Johnson J, Barach P. Quality improvement methods to study and improve the process and outcomes of pediatric cardiac surgery. Progr Pediatr Cardiol. 2011;32:147–53.CrossRefGoogle Scholar
  15. 15.
    Stabile M, Thomson S, Allin S, Boyle S, Busse R, Chevreul K, et al. Health care cost containment strategies used in four other high-income countries hold lessons for the United States. Health Aff (Millwood). 2013;32(4):643–52.CrossRefGoogle Scholar
  16. 16.
    Coronini-Cronberg S, Bixby H, Laverty AA, Wachter RM, Millett C. English National Health Service’s savings plan may have helped reduce the use of three ‘low-value’ procedures. Health Aff (Millwood). 2015;34(3):381–9.CrossRefGoogle Scholar
  17. 17.
    Thomson S, Schang L, Chernew ME. Value-based cost sharing in the United States and elsewhere can increase patients’ use of high-value goods and services. Health Aff (Millwood). 2013;32(4):704–12.CrossRefGoogle Scholar
  18. 18.
    Hesselink G, Zegers M, Vernooij-Dassen M, Barach P, Kalkman C, Flink M, et al. Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC Health Serv Res. 2014;14:389.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sisko AM, Keehan SP, Cuckler GA, Madison AJ, Smith SD, Wolfe CJ, et al. National health expenditure projections, 2013–23: faster growth expected with expanded coverage and improving economy. Health Aff (Millwood). 2014;33(10):1841–50.CrossRefGoogle Scholar
  20. 20.
    Health Care Cost Institute. Health care cost and utilization report: 2011/2012. Accessed 1 Oct 2013.
  21. 21.
    Cormier JN, Cromwell KD, Pollock RE. Value-based health care: a surgical oncologist’s perspective. Surg Oncol Clin N Am. 2012;21(3):497–506.CrossRefPubMedGoogle Scholar
  22. 22.
    Fry DE, Pine M, Jones BL, Meimban RJ. The impact of ineffective and inefficient care on the excess costs of elective surgical procedures. J Am Chem Soc. 2011;212(5):779–86.Google Scholar
  23. 23.
    Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477–81.CrossRefPubMedGoogle Scholar
  24. 24.
    Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Boston, MA: Harvard Business School Press; 2006.Google Scholar
  25. 25.
    Lee TH. Putting the value framework to work. N Engl J Med. 2010;363(26):2481–3.CrossRefPubMedGoogle Scholar
  26. 26.
    Stange KC, Nutting PA, Miller WL, Jaen CR, Crabtree BF, Flocke SA, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25(6):601–12.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Porter ME, Pabo EA, Lee TH. Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs. Health Aff (Millwood). 2013;32(3):516–25.CrossRefGoogle Scholar
  28. 28.
    Department of Health and Human Services. Better care. Smarter spending. Healthier people: paying providers for value, not volume [press release]. Baltimore, MD: Department of Health and Human Services; 2015.Google Scholar
  29. 29.
    Burwell SM. Setting value-based payment goals—HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Evans M. Major providers, insurers plan aggressive push to new payment models. Modern Healthcare. 2015.
  31. 31.
    Cassidy A. Health policy brief: bundled payments for care improvement initiative. Health Affairs. Accessed 23 Nov 2015.Google Scholar
  32. 32.
    Services CfMM. Bundled Payments for Care Improvement (BPCI) initiative: general information. Baltimore, MD: Department of Health and Human Services; 2015.
  33. 33.
    Centers for Medicare & Medicaid Services. CMS finalizes bundled payment initiative for hip and knee replacements. Washington, D.C.: U.S. Department of Health & Human Services; 2015.
  34. 34.
    Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA. 1998;280(11):1000–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Institute of Medicine (U.S.). Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. xx, 337 p.Google Scholar
  36. 36.
    Agency for Healthcare Research and Quality (AHRQ). Your guide to choosing quality health care. Rockville, MD; 2003. See
  37. 37.
    Birkmeyer JD, Reames BN, McCulloch P, Carr AJ, Campbell WB, Wennberg JE. Understanding of regional variation in the use of surgery. Lancet. 2013;382(9898):1121–9.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    McCulloch P, Nagendran M, Campbell WB, Price A, Jani A, Birkmeyer JD, et al. Strategies to reduce variation in the use of surgery. Lancet. 2013;382(9898):1130–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Skinner J, Fisher E. Reflections on geographic variations in U.S. health care. 2010. [1–21 pp.]. Accessed 13 Apr 2016.
  40. 40.
    Wennberg JE. Forty years of unwarranted variation—and still counting. Health Policy. 2014;114(1):1–2.CrossRefPubMedGoogle Scholar
  41. 41.
    Smith TJ, Hillner BE. Ensuring quality cancer care by the use of clinical practice guidelines and critical pathways. J Clin Oncol. 2001;19(11):2886–97.CrossRefPubMedGoogle Scholar
  42. 42.
    Kessler C, Williams MC, Moustoukas JN, Pappas C. Transitions of care for the geriatric patient in the emergency department. Clin Geriatr Med. 2013;29(1):49–69.CrossRefPubMedGoogle Scholar
  43. 43.
    Kirkpatrick DH, Burkman RT. Does standardization of care through clinical guidelines improve outcomes and reduce medical liability? Obstet Gynecol. 2010;116(5):1022–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Wood DL, Brennan MD, Chaudhry R, Chihak AA, Feyereisn WL, Woychick NL, et al. Standardized care processes to improve quality and safety of patient care in a large academic practice: the Plummer Project of the Department of Medicine. Mayo Clinic Health Serv Manage Res. 2008;21(4):276–80.CrossRefGoogle Scholar
  45. 45.
    Sanchez JA, Barach PR. High reliability organizations and surgical microsystems: re-engineering surgical care. Surg Clin North Am. 2012;92(1):1–14.CrossRefPubMedGoogle Scholar
  46. 46.
    Sanchez J, Barach P. High reliability organizations and surgical microsystems: re-engineering surgical care. Surg Clin North Am. 2012;92(1):1–14. doi: 10.1016/j.suc.2011.12.005.CrossRefPubMedGoogle Scholar
  47. 47.
    Nelson KM, Helfrich C, Sun H, Hebert PL, Liu CF, Dolan E, et al. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med. 2014;174(8):1350–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, McMurry TL, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220(4):430–43.CrossRefPubMedGoogle Scholar
  49. 49.
    Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014;118(5):1052–61.CrossRefPubMedGoogle Scholar
  50. 50.
    Wang H, Zhu D, Liang L, Ye L, Lin Q, Zhong Y, et al. Short-term quality of life in patients undergoing colonic surgery using enhanced recovery after surgery program versus conventional perioperative management. Qual Life Res. 2015;24(11):2663–70.CrossRefPubMedGoogle Scholar
  51. 51.
    Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157(6):417–28.CrossRefPubMedGoogle Scholar
  52. 52.
    Stevens GD, Shi L, Vane C, Nie X, Peters AL. Primary care medical home experience and health-related quality of life among adult medicaid patients with type 2 diabetes. J Gen Intern Med. 2015;30(2):161–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Schraagen JM, Schouten A, Smit M, van der Beek D, Van de Ven J, Barach P. A prospective study of paediatric cardiac surgical microsystems: assessing the relationships between non-routine events, teamwork and patient outcomes. BMJ Qual Saf. 2011;20(7):599–603. doi: 10.1136/bmjqs.2010.048983.CrossRefPubMedGoogle Scholar
  54. 54.
    Kash BA, Zhang Y, Cline KM, Menser T, Miller TR. The perioperative surgical home (PSH): a comprehensive review of US and non-US studies shows predominantly positive quality and cost outcomes. Milbank Q. 2014;92(4):796–821.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Walters TL, Howard SK, Kou A, Bertaccini EJ, Harrison TK, Kim TE, et al. Design and implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital. Semin Cardiothorac Vasc Anesth. 2016;20(2):133–40.CrossRefPubMedGoogle Scholar
  56. 56.
    Sewell JL, Velayos FS. Systematic review: the role of race and socioeconomic factors on IBD healthcare delivery and effectiveness. Inflamm Bowel Dis. 2013;19(3):627–43.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Groene RO, Orrego C, Sunol R, Barach P, Groene O. “It’s like two worlds apart”: an analysis of vulnerable patient handover practices at discharge from hospital. BMJ Qual Saf. 2012;21 Suppl 1:i67–75.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    World Health Organization. Exploring patient participation in reducing health-care-related safety risks. Copenhagen, Denmark: World Health Organization; 2013.Google Scholar
  59. 59.
    Aspden P, Institute of Medicine (U.S.). Committee on Data Standards for Patient Safety. Patient safety: achieving a new standard for care. Washington, DC: National Academies Press; 2004.Google Scholar
  60. 60.
    Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000. xxi, 287 p.Google Scholar
  61. 61.
    Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician’s guide to terminology, documentation, and reporting. Ann Intern Med. 2004;140(10):795–801.CrossRefPubMedGoogle Scholar
  62. 62.
    Institute for Healthcare Improvement (IHI). IHI announces that hospitals participating in 100,000 lives campaign have saved an estimated 122,300 lives. Cambridge: IHI. See:;
  63. 63.
    The Joint Commission. Improving America’s Hospitals: The Joint Commission’s annual report on quality and safety. 2007.Google Scholar
  64. 64.
    Pucher PH, Johnston MJ, Aggarwal R, Arora S, Darzi A. Effectiveness of interventions to improve patient handover in surgery: a systematic review. Surgery. 2015;158(1):85–95.CrossRefPubMedGoogle Scholar
  65. 65.
    Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9.CrossRefPubMedGoogle Scholar
  66. 66.
    Rozich JD, Howard RJ, Justeson JM, Macken PD, Lindsay ME, Resar RK. Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf. 2004;30(1):5–14.CrossRefPubMedGoogle Scholar
  67. 67.
    Kanji S, Singh A, Tierney M, Meggison H, McIntyre L, Hebert PC. Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults. Intensive Care Med. 2004;30(5):804–10.CrossRefPubMedGoogle Scholar
  68. 68.
    Swensen SJ, Meyer GS, Nelson EC, Hunt Jr GC, Pryor DB, Weissberg JI, et al. Cottage industry to postindustrial care—the revolution in health care delivery. N Engl J Med. 2010;362(5), e12.CrossRefPubMedGoogle Scholar
  69. 69.
    Cassin BR, Barach PR. Making sense of root cause analysis investigations of surgery-related adverse events. Surg Clin North Am. 2012;92(1):101–15.CrossRefPubMedGoogle Scholar
  70. 70.
    Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in the United States. N Engl J Med. 2008;359(18):1921–31.CrossRefPubMedGoogle Scholar
  71. 71.
    Hesselink G, Flink M, Olsson M, Barach P, Vernooij-Dassen M, Wollersheim H. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Qual Saf. 2012;21 Suppl 1:i39–49. doi: 10.1136/bmjqs-2012-001165.CrossRefPubMedGoogle Scholar
  72. 72.
    Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care. 2011;17(1):41–8.PubMedGoogle Scholar
  73. 73.
    Manary MP, Boulding W, Staelin R, Glickman SW. The patient experience and health outcomes. N Engl J Med. 2013;368(3):201–3.CrossRefPubMedGoogle Scholar
  74. 74.
    Shirley ED, Sanders JO. Patient satisfaction: implications and predictors of success. J Bone Joint Surg Am. 2013;95(10), e69.CrossRefPubMedGoogle Scholar
  75. 75.
    Elliott MN, Lehrman WG, Beckett MK, Goldstein E, Hambarsoomian K, Giordano LA. Gender differences in patients’ perceptions of inpatient care. Health Serv Res. 2012;47(4):1482–501.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Elliott MN, Zaslavsky AM, Goldstein E, Lehrman W, Hambarsoomians K, Beckett MK, et al. Effects of survey mode, patient mix, and nonresponse on CAHPS hospital survey scores. Health Serv Res. 2009;44(2 Pt 1):501–18.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Goldstein E, Elliott MN, Lehrman WG, Hambarsoomian K, Giordano LA. Racial/ethnic differences in patients’ perceptions of inpatient care using the HCAHPS survey. Med Care Res Rev. 2010;67(1):74–92.CrossRefPubMedGoogle Scholar
  78. 78.
    Lehmann M, Monte K, Barach P, Kindler C. Postoperative patient complaints as a maker for patient safety. J Clin Anesth. 2010;22(1):13–21.CrossRefPubMedGoogle Scholar
  79. 79.
    Vetter TR, Ivankova NV, Pittet JF. Patient satisfaction with anesthesia: beauty is in the eye of the consumer. Anesthesiology. 2013;119(2):245–7.CrossRefPubMedGoogle Scholar
  80. 80.
    Phelps G, Barach P. Why the safety and quality movement has been slow to improve care? Int J Clin Pract. 2014;68(8):932–5.CrossRefPubMedGoogle Scholar
  81. 81.
    Dexter F, Blake JT, Penning DH, Lubarsky DA. Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: a case study. Anesth Analg. 2002;94(1):138–42.PubMedGoogle Scholar
  82. 82.
    Macario A, Dexter F, Traub RD. Hospital profitability per hour of operating room time can vary among surgeons. Anesth Analg. 2001;93(3):669–75.CrossRefPubMedGoogle Scholar
  83. 83.
    Flink M, Hesselink G, Barach P, Öhlén G, Wollersheim H, Pijneborg L, et al. The key actor: a qualitative study of patient participation in the handover process in Europe. BMJ Qual Saf. 2012;21 Suppl 1:i89–96. doi: 10.1136/bmjqs-2012-001171. Epub 2012 Oct 30.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Weiss AJ, Elixhauser A, Andrews RM. Characteristics of operating room procedures in U.S. hospitals, 2011: statistical brief #170. Healthcare Cost and Utilization Project (HCUP) statistical briefs. Rockville, MD: Agency for Health Care Policy and Research; 2006.Google Scholar
  85. 85.
    Macario A. What does one minute of operating room time cost? J Clin Anesth. 2010;22(4):233–6.CrossRefPubMedGoogle Scholar
  86. 86.
    Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89(9):46–52. 4, 6–61.PubMedGoogle Scholar
  87. 87.
    Barnes AJ, Unruh L, Chukmaitov A, van Ginneken E. Accountable care organizations in the USA: types, developments and challenges. Health Policy. 2014;118(1):1–7.CrossRefPubMedGoogle Scholar
  88. 88.
    Deming WE. Out of the crisis. Cambridge, MA: MIT Press; 1986.Google Scholar
  89. 89.
    Kaplan RS, Witkowski M, Abbott M, Guzman AB, Higgins LD, Meara JG, et al. Using time-driven activity-based costing to identify value improvement opportunities in healthcare. J Healthc Manag. 2014;59(6):399–412.PubMedGoogle Scholar
  90. 90.
    Phillips CV, Goodman KJ. The missed lessons of Sir Austin Bradford Hill. Epidemiol Perspect Innov. 2004;1(1):3.CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Hesselink G, Zegers M, Vernooij-Dassen M, Barach P, Kalkman C, Flink M, et al. Improving patient discharge and reducing hospital readmissions by using intervention mapping. BMC Health Serv Res. 2014;14:389. doi: 10.1186/1472-6963-14-389.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Barach P. Addressing barriers for change in clinical practice. In: Guidet B, Valentin A, Flaatten H, editors. Quality management in intensive care: a practical guide. Cambridge: Cambridge University Press; 2016. 978–1-107-50386-1.Google Scholar
  93. 93.
    McLeod RS, Aarts MA, Chung F, Eskicioglu C, Forbes SS, Conn LG, et al. Development of an Enhanced Recovery After Surgery guideline and implementation strategy based on the knowledge-to-action cycle. Ann Surg. 2015;262(6):1016–25.CrossRefPubMedGoogle Scholar
  94. 94.
    Pearsall EA, Meghji Z, Pitzul KB, Aarts MA, McKenzie M, McLeod RS, et al. A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg. 2015;261(1):92–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Juhan Paiste
    • 1
  • Daniel I. Chu
    • 2
  • Thomas R. Vetter
    • 1
    Email author
  1. 1.Anesthesiology and Perioperative MedicineUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of SurgeryUniversity of Alabama at BirminghamBirminghamUSA

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