Responsibility cannot be abdicated: a mandate for Patient-Centred Precision Care in perioperative brain health

The perioperative period represents both a major driver of healthcare costs and a substantial source of largely preventable neurological harm. Postoperative delirium affects up to 50-70% of specifically vulnerable surgical cohorts, but adoption of physiologically aligned, low-cost preventive strategies is often delayed until supported by large definitive trials. In contrast, reactive and costly treatments are frequently implemented despite weaker evidentiary standards. This inverted evidence hierarchy creates perverse economic incentives that perpetuate patient harm and inefficient resource utilisation. Patient-Centred Precision Care seeks to address this gap by integrating evidence-based protocols with real-world outcome verification through the Safe Brain Initiative's structured framework. Shifting from reactive treatment to proactive prevention is not only ethically imperative, but also economically necessary for the long-term sustainability of healthcare systems.