The present review examines the trends and controversies on how perioperative care can influence outcome after anesthesia and surgery.Recent studies indicate that anesthesia and perioperative care may have a major impact on long-term postoperative mortality and major complications in surgical patients by decreasing the rate of individual decisions. The use of a surgical checklist in the operating room improves postoperative mortality by decreasing the rate of individual decisions and facilitating communication between anesthesiologists, surgeons and intensivists. Antiplatelet therapy should not be discontinued routinely before elective surgery in patients with coronary or vascular occlusive disease. Attenuation of the surgical stress response by beta-blockers decreases long-term major adverse cardiac events, but may increase the incidence of postoperative stroke. The long-term impact on outcome of tight glycemic control and intraoperative hemodynamic optimization requires further investigation.The use of a surgical checklist may reduce postoperative mortality and complications in surgical patients. The optimal dosing and timing of perioperative beta-blockade should decrease the incidence of postoperative stroke. However, to date, the long-term risk:benefit balance of attenuation of the perioperative stress response remains controversial. Red cell transfusion is unavoidable in some cases, but is associated with worsened outcome in various surgical situations. Future research should focus on the risk:benefit balance of anesthesia and surgery. This will contribute to promoting the role of anesthesiologists as physicians of the perioperative period.