Nothing here is a new idea. It is an unimplemented one.

Audits of elective surgery in Australia and internationally repeatedly find that a large share of cancellations on or near the day of surgery are attributable to preventable clinical or administrative causes — not to genuine clinical change. The information needed to prevent them usually existed at the time of booking.

Preoperative anaemia is associated with transfusion, postoperative complications and longer length of stay across major surgery. Correction with iron takes weeks rather than days, which is precisely why detection at pre-admission clinic is often too late to act on.

Combined exercise, nutritional and psychological preparation before major abdominal and other high-risk surgery shows benefit in functional recovery and complication rates. The consistent limitation in the literature is delivery: programmes work when patients are enrolled early enough and followed up.

Systematic frailty screening changes perioperative decisions — including whether to operate at all — when it happens early enough to inform consent and planning. Ad hoc screening finds the obvious cases and misses the borderline ones, which are the cases where the decision is genuinely difficult.

Across the perioperative literature, the barrier is rarely knowledge of what should be done. It is that the anaesthetist, surgeon, general practitioner and pre-admission nurse hold different versions of the patient, and no one owns the interval between listing and theatre.