Re-engineered perioperative pathways open up opportunities for intervention before surgery including shared decision-making, comorbidity management and collaborative behavioural change. Individualised, risk-adapted, intra-operative interventions will result in more reliable and consistent care. Risk-adapted postoperative care has a significant role in improving value through perioperative medicine. Among physicians with the skills to work within perioperative medicine, anaesthetists are well positioned to lead the re-engineering of such pathways. Perioperative medicine has gained much attention in the last decades due to the aging of the surgical population accompanied by a steady rise of health care costs. This necessitates to direct our focus on reducing perioperative complications , thereby shortening length of hospital stay and improving cost efficiency. Optimal preparation for surgery, especially when multimodal and personalised to meet individual patient needs are complex in nature and are ideally delivered by a multidisciplinary, multi-professional team.
Global aim of our research group is to optimise patients' conditions by supporting their active participation in the time leading up to their major surgery, by investigating and implementing a multidisciplinary, multimodal prehabilitation program for elderly patients undergoing major cardiac and non-cardiac surgery. Participants of this program are thoroughly assessed and extensively prepared for surgery (PREHABIL-Study, https://www.prehabilitation.ch). This study focuses on patients with reduced functional capacity and aims to determine the impact of a targeted, personalised multimodal intervention of exercise, nutrition, medical optimization (e.g. diabetes control), patient blood management as well as smoking cessation on postoperative complications. In this randomized controlled trial, we hypothesise that patients in the intervention group will suffer from fewer complications after major surgery. After his clinical research fellowship at the McGill University, Montreal, Canada under the supervision of Franco Carli and Chelsia Gillis, Dr. Dominique Engel has taken the lead of PREHABIL study. This clinical trial is supported by the Swiss National Science Foundation with an IICT grant.
During surgery, optimal fluid management is an important part of achieving improved results and might help to further refine already established enhanced recovery after surgery (ERAS) programs. To determine amount and composition of optimal perioperative fluids, we currently perform a randomized clinical trial comparing the effects of intraoperative administration of 5% albumin or 20% albumin versus crystalloids alone in urologic surgery (VASCALB study). The primary aim is to compare the effect on plasma volume expansion and fluid recruitment of the different types of fluids during the haemorrhagic phase of cystectomy. Under the supervision of Prof. Wüthrich, Dr. François Jardot is conducting the VASCALB project.
Another aim is to facilitate postoperative recovery by developing guidelines and implementing a multimodal anaesthesia approach, thereby reducing the use of opioids, to accomplish optimal postoperative analgesia and minimising postoperative nausea and vomiting in high-risk patients. A piece of this puzzle, is the mechanistic research on the effect of analgesics and anaesthetics on the lower urinary tract (animal lab Prof F. Burkhard). To optimise perioperative care (risk stratification and attenuation) for patients undergoing open cystectomy and urinary diversion, we work intensively with the Department of Urology, Bern University Hospital, and are in the process of setting up international collaborations.
Another field of interest is standardisation and improvement of complication reporting, based on established reporting systems. After his fellowships at the Royal Melbourne Hospital and at the Guy’s Hospital (Guy's and St Thomas' NHS Foundation Trust) in London, Dr. Marc A. Furrer is managing world's largest multicentre register for complications in the field of urology, involving the most prestigious centres (https://www.camuscollaboration.com/steering-committee). We also optimise the Comprehensive Complication Index (CCI) for major urological surgery, and have implemented the Berne CCI (https://www.camuscollaboration.com/calculator).
Based on his extensive experience gained by working in the post-anaesthesia- and intensive care unit, Dr. Christian Beilstein aims to lower postoperative complications and thereby improve short term perioperative and peri-interventional outcomes. To lower incidence and severity of postoperative nausea and vomiting in high-risk patients undergoing bariatric surgery, we are currently investigating the effect of two doses of aprepitant versus placebo in collaboration with the University Obesity Centre of Berne (DDA-PONV-Trial). Additionally, he works to make electroconvulsive therapy, a highly efficient form of treatment for major depression or bipolar disorder, safer for the patients by preventing agitation and delirium. In this context, we investigate the effect of a premedication with clonidine versus placebo in collaboration with the University Hospital of Psychiatry, University of Bern (ECaTa-Trial). In addition, we are investigating the haemodynamic changes during electroconvulsive therapy by using non-invasive, continuous blood pressure monitoring in order to make this treatment available to patients with significant cardiovascular comorbidities. A further long-term goal is to investigate interventions able to reduce myocardial injury after non-cardiac, major surgery (MINS).
Finally, we are privileged that John-Patrick Burkhard (Cranio-Maxillofacial Surgery) has joined our group. His aim is to predict outcome of free flap surgery depending on perioperative fluid management and use of vasopressors.
- Prof. F. Burkhard and Prof. G. Thalmann, Department of Urology, Inselspital, Bern University Hospital
- PD Dr. med P. Nett, Obesity Centre of Berne, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital
- Prof. S. Walter, University Hospital of Psychiatry, University of Bern
- Prof. R.G. Hahn, Research Unit, Södertälje Hospital, Södertälje, Karolinska Institutet at Danderyds Hospital, Stockholm, Sweden
- Prof. Chelsia Gillis, Department of Anesthesia, McGill University, Montréal, QC, Canada, School of Human Nutrition, McGill University, McGill University, Montreal, QC, Canada.
- Prof. Francesco Carli, Department of Anesthesia, McGill University, Montréal, QC, Canada
- Chris Soleman, Department of Urology, Royal Melbourne Hospital, Australia
- Prof Dr med M. Wilhelm Präventive Kardiologie und Sportmedizin , Inselspital, Bern University Hospital
- Prof. Dr med Z. Stanga Department of Diabetes, Endocrinology, Nutrition, Inselspital, Bern University Hospital
- Prof. Dr med L.Bally Department of Diabetes, Endocrinology, Nutrition, Inselspital, Bern University Hospital
- PD M. Verra Institute for Physiotherapy, Inselspital, Bern University Hospital