Maximising the safety and effectiveness of major surgery through better peri-operative care

Background Far from being replaced by developments in drug therapy, surgery is now offered to more than 2 million NHS patients each year and 230 million patients worldwide. In particular, high-risk patients who are older and have significant chronic disease are more likely to be offered major surgery today than 20 years ago. Adverse events caused by failures in surgical or anaesthetic technique are infrequent, but for most patients some degree of morbidity results from the physiological and inflammatory changes associated with the tissue injury of surgery. For some patients, the burden of post-operative morbidity will result in a recognised diagnosis, such as pneumonia, myocardial infarction or acute kidney injury whilst many others will experience non-specific injury to one or more organ systems without developing a defined complication. Estimates of post-operative mortality vary, but assuming a low figure for hospital mortality of 1%, surgery will be associated with 20,000 deaths amongst NHS patients each year (2.3 million deaths worldwide) and complication rates up to ten times this figure. Patients who survive complications in the short term, commonly experience functional limitations and reduced long-term survival. Peri-Operative Medicine is an emerging concept of patient care with huge potential to improve public health by making surgery a safer treatment for millions of patients each year. Aims Undertake a major programme of peri-operative medicine research Develop a national strategy to raise awareness of Peri-Operative Medicine research amongst key stakeholders, to improve funding and promote infrastructure development Establish a UK Peri-Operative Medicine Trials Group to co-ordinate and deliver large scale recruitment to clinical trials Establish a public audit of all in-patient surgery, creating an open environment where the clinical effectiveness of surgery is fully understood Address my personal development and local infrastructure needs to ensure aims 1-4 are feasible Plan of investigation Complete three major peri-operative medicine research projects currently in the early phases and develop high quality proposals for three more studies to commence during the course of the award Work with national stakeholder groups, in particular the National Institute of Academic Anaesthesia Health Services Research Centre (HSRC), to raise awareness of the need for high quality evidence in peri-operative medicine, educating key stakeholders about the potential impact of such evidence Provide strong national research leadership through the HSRC to convene a UK Peri-Operative Medicine Trials Group Apply learning from international models of best practice in surgical audit, in particular the US National Surgical Quality Improvement Programme and the newly created Swedish Peri-Operative Registry, to develop national audit of one-year survival following in-patient surgery for NHS England Further develop my leadership skills and recruit senior and junior academic staff to build capacity within my group Potential benefit to patients and NHS Specific research outputs will provide strong clinical evidence to change healthcare policy and clinical practice, making surgery safer and more cost effective. Strong research infrastructure will ensure major peri-operative medicine research projects are deliverable. Public audit of post-operative survival will provide a transparent, blame-free environment in which to discuss the effectiveness of surgery, creating a driving force for wider NHS engagement in improving surgical outcomes. These initiatives will allow patients to make better informed decisions about surgical treatments. Patients who undergo surgery can choose a hospital they have confidence in, knowing that if they develop complications, effective treatments will be provided in the short and long term to minimise harm. Ultimately, the clinical effectiveness of surgical treatments will be improved whilst the human and economic cost of post-operative complications will be reduced. Because of the huge volumes of surgery performed in the NHS, the impact of these changes will be significant.