Practice setting shapes perioperative medicine involvement among French anaesthesiologist–intensivists

BACKGROUND: Perioperative medicine (POM) has become a core mission of anaesthesiology in France, but the impact of practice setting on its implementation remains unclear. METHODS: A 31-item national online survey was disseminated via SFAR and CNP-ARMPO networks (Nov 2024-Jan 2025). Responses from 540 Anaesthesiologist-Critical Care Physicians (ACCPs) were analyzed according to practice setting (public vs. private). RESULTS: Among the 540 respondents, 35% worked in private institutions and 65% in public hospitals. Almost all (99%) recognized that POM begins preoperatively and includes postoperative care (90%). A structured POM program was implemented in 36% of centers, without a difference between types of hospitals. Marked contrasts appeared in postoperative organization: systematic postoperative visits on POD 1-2 were reported by 45% of private ACCPs vs. 14% of public practitioners (p < 0.001). Pain and sepsis management were more often ACCP-led in private facilities (53% vs. 38% and 47% vs. 28%, respectively). Barriers differed by hospitals: workforce shortage predominated in public hospitals (79%), while lack of financial recognition was the main issue in private practice (26%). CONCLUSION: Although the conceptual importance of POM is unanimously acknowledged, its practical implementation-particularly postoperative involvement-is strongly shaped by institutional context. Addressing human resource and economic barriers could harmonize perioperative engagement across hospitals.