Perioperative medicine is an emerging field that focuses on improving outcomes for patients after surgery. The majority of the 10 million patients who undergo surgery in the NHS each year do so without complications, however as surgery is offered to older and sicker patients there is a growing group of higher risk patients who have multiple medical conditions and are more vulnerable to complications after surgery.
Rather than the traditional model of perioperative care being delivered by surgeon and anesthetist, perioperative medicine improves outcomes for these patients by creating a multidisciplinary team of doctors from other relevant specialties including cardiologists, renal physicians and geriatricians along with specialist nurses and allied health professionals such as physiotherapists.
The perioperative medicine team can be involved in patients care before, during and after surgery.
Epidemiological studies have demonstrated variation in both the way surgical care is delivered in hospitals as well as in outcomes such as postoperative complications. This suggests that care to surgical patients can be improved and this could benefit patients.
Dr Mike Gillies, Dr Naz Lone and Mr Euan Harrison have used large, high quality patient datasets, collected across Scotland and linked to patient’s records from intensive care, surgery and death registries. They have used this data to examine patient and hospital factors which might influence short and long term survival after surgery and what factors might influence the need for readmission to hospital after surgery.
Selecting the patients who need to go to intensive care after surgery is one intervention which varies between type of surgery and hospital. Intensive care is a limited and expensive resource, but patients who develop postoperative complications after being discharged to the ward and need emergency admission to intensive care have increased risk death. Research carried out using this data has identified patient and surgical factors which are associated with increased short and long term death and hospital readmission and this could help doctors predict which patients need intensive care following surgery in the future.
Dr Gillies also conducts clinical research in to whether other interventions can reduce complications after surgery: in particular whether blood transfusions influence the likelihood of heart attack after emergency hip fracture surgery and whether using fluids and cardiac monitoring reduces complications after major abdominal surgery.