Every year on 17 September, World Patient Safety Day calls for global solidarity and action to make healthcare safer. The WHO theme for 2026 is Safe Care for Non-Communicable Diseases, under the slogan “Safe care for life”. It is a theme with deep implications for anaesthesia.
Non-communicable diseases (NCDs) account for around three-quarters of deaths worldwide, and the burden falls hardest on low- and middle-income countries. Obesity, diabetes, hypertension, cardiovascular disease, asthma and COPD are increasingly common in patients coming for surgery. To mark the day, the WFSA Safety and Quality Committee hosted a webinar called Safe Surgery Starts Before the Operating Room. It brought together anaesthesiologists from five continents, a patient advocate and the World Health Organization.
Moving patient safety upstream
Opening the session, WFSA President Dr Carolina Haylock-Loor put the message simply: “Safe surgery does not begin when the lights of the operating room come on. It begins with every decision we make before the patient ever reaches that door.”
This idea sits at the heart of the presidential theme, Anaesthesiology along the Patient Pathway. Our responsibility as anaesthesiologists does not begin at induction or end when surgery is over. Some of the most important safety decisions are made weeks earlier: understanding the patient, identifying risk and optimising chronic conditions. As Dr Haylock-Loor put it, preoperative optimising these conditions “is not an additional step in patient safety. It is patient safety.”
The only person present at every step
Dr Antonia Gama of the International Alliance of Patients’ Organizations (IAPO) gave the patient’s view. She is also a person living with multiple chronic conditions, and she offered a striking reminder: along the entire patient pathway, only one person is present at every step, and that is the patient.
Harm before surgery rarely looks like a single dramatic error, she explained. It builds up. One professional adjusts a medication, another isn’t told, and a third meets the patient for the first time on the day of surgery. Nobody holds the whole picture except the patient, yet what patients know is rarely treated as clinical information.
She pointed to the WHO Patient Safety Rights Charter. It sets out the right to information and supported decision-making, to timely care, to be heard, and to involve patients and families. Consent, she argued, should be real support in making a decision, not a signature to collect. Her closing challenge stayed with many in the audience: “Are we making this patient a partner in their care, or are we just telling them about it?”
Think continuum, think systems, think partnership
Dr Irina Papieva, Technical Officer in the Quality of Care and Patient Safety Team summed up the campaign message: when care is lifelong, safety must be lifelong. People with NCDs move through health systems repeatedly over years. Multimorbidity, polypharmacy, multiple providers and transitions of care combine with fragmented systems, and risks build up over time. A large share of preventable harm in this group involves medicines, which makes WHO’s Medication Without Harm challenge especially relevant to anaesthesia.
She stressed that asking individuals to “be more careful” will not fix unsafe systems. For anaesthesiologists, she set out responsibilities across the perioperative journey:
- Before anaesthesia: identify undiagnosed or poorly controlled NCDs, reconcile medicines, and involve patients and families in shared decisions.
- During surgery: anticipate risk and communicate well as a team.
- After surgery: hand patients back safely to primary and NCD care.
She invited every participant to pick one of three messages to act on in the coming year: think continuum, think systems, think partnership.
Condition by condition: practical preoperative optimisation
Four clinical talks turned these principles into practice.
Obesity. Dr Rafael Pantoja (Colombia) urged colleagues to look beyond BMI. Measure waist circumference, screen for metabolic syndrome, and screen for obstructive sleep apnoea using STOP-BANG. Where time allows, several weeks of CPAP, lifestyle measures and stopping smoking and alcohol can meaningfully improve a patient’s condition before surgery.
COPD and Asthma: Dr Bisola Onajin-Obembe (Nigeria) took the audience through three interactive cases. Her rule was “find the modifiable risk at the pre-op visit, not at the table.” That means delaying elective surgery after a recent respiratory infection, starting smoking cessation at least six weeks before surgery, and treating purulent sputum first. She also stressed matching the anaesthetic plan to the specific disease and rehearsing the rescue plan as a team.
Diabetes: Dr Benedikt Preckel (Netherlands) in his discussion on the impact of novel antidiabetic therapies he looked at SGLT2 inhibitors, GLP-1 receptor agonists and DPP-4 inhibitors. The evidence is changing fast. Automatically stopping SGLT2 inhibitors days before surgery may harm patients with heart failure, and euglycaemic ketoacidosis, though a real risk, is treatable when recognised early. GLP-1 agonists can leave residual gastric contents even after they are stopped. The key is individual risk assessment, tools such as gastric ultrasound, and an open discussion with the patient.
Hypertension and Cardiovascular Disease
Dr Le Shen (China) reminded colleagues that three-quarters of the world’s 1.4 billion people with hypertension are not adequately controlled. A single blood pressure reading should never decide whether surgery goes ahead. Look at trends, reversible causes and organ damage. Guidelines exist, he argued, but the real challenge is implementing them consistently, and well-designed systems, including AI tools, can help.
Optimise, but stay pragmatic
The Q&A showed the realities of practice around the world: when to postpone elective surgery, how to prepare patients who decline blood products, and how to move patients with severe obesity safely. The panel agreed on a recurring theme team work; team work; team work. Multidisciplinary discussion, involving anaesthesiologist; surgeons, physicians and the patient, is often the quickest route to a safe plan.
Educational resources
To keep learning on this theme, explore:
- Anaesthesia Online Learning Community, (AOLC) including Anaesthesia Tutorial of the Week and Update in Anaesthesia, with tutorials on preoperative assessment and anaesthesia for patients with obesity, diabetes, respiratory and cardiovascular disease.
- WFSA education programmes such as SAFE-OR and the SAFE courses, which build safe perioperative practice and teamwork.
- WHO World Patient Safety Day 2026 campaign materials, including the five goals for healthcare facilities.
- WHO Patient Safety Rights Charter and the Global Patient Safety Action Plan 2021–2030.
- WHO Medication Without Harm, focused on polypharmacy, high-risk situations and transitions of care.
- WHO Surgical Safety Checklist, which can be adapted locally to include NCD-specific checks.
- Clinical guidance referenced by speakers, including the 2024 ACC/AHA perioperative cardiovascular guideline, ERAS Society guidance on bariatric surgery, and recent guidance on perioperative management of SGLT2 inhibitors and GLP-1 receptor agonists.
Take one idea into action
The webinar recording is available through the WFSA’s Anaesthesia Online Learning Community (AOLC) and YouTube channel. Watch it, share it with your team, and choose one change to make in your own setting. Safe surgery does begin before the operating room, and every one of us can help move patient safety upstream.
