Predictors of analgesic response to sympathetic blockade in complex regional syndrome type 1: no conclusive answers but best to get standard medical therapy right first.

preoperative medical consultations; hence, reducing unnecessary consultations among low-risk patients while potentially increasing consultations among high-risk individuals. Notably, the existing variability in preoperative consultation practice may actually be helpful in designing initiatives to improve the appropriateness of preoperative medical consultations. Specifically, in characterizing preoperative consultation practices at centers with superior postoperative outcomes, we may be able to identify specific practices that can be implemented more widely at other centers. As suggested in the accompanying editorial, improved prospective databases will be critical for any such effort to use existing practice variation for identifying “optimal” perioperative practices. Once there is better understanding of which patients should be appropriately referred for preoperative medical consultation, anesthesiologists must take a leadership role in developing preoperative evaluation processes that better target appropriate patients for such specialized preoperative care. The goal for these improved processes should be to simultaneously improve clinical outcomes and patient satisfaction, while reducing healthcare system costs and practice variability.