Purpose of review: There is an increasing need to improve the economic efficiency in perioperative processes without compromising patient outcome. In perioperative care, optimization of resource use and costs are far from optimal and in this respect, there may be great differences between institutions.
Recent findings: Fast-track or enhanced recovery programs that use a multimodal approach have shown benefits in several surgical specialties, although the reports so far mainly come from single centers. Benchmarking with others is beneficial but requires case-mix adjustment. Methods to standardize patient populations, and to measure outcome and resource use, have been introduced in some surgical specialties, such as colorectal and cardiac surgery. There is a lot of evidence that centralization of surgical interventions results in improvements in risk-adjusted outcome and resource use.
Summary: There is a lot to do to achieve feasible quality indicators and methods for intrainstitutional and interinstitutional benchmarking. Using appropriate tools that are based on multicenter databases, resource use, outcome and effects of new treatment modalities could be more objectively estimated.