Perioperative Optimisation in Major Surgery / Prehabilitation

Anaesthesiology is more than securing a patient's survival from induction of anaesthesia to recovery room, and surgery is more than performing an operation. Perioperative care starts with contemplation of surgery, continues with ideal preparation of the patient fostering psychological and physiological reserves and ends after optimised intra- and postoperative care with full recovery and return home. This whole pathway is covered by perioperative medicine. Perioperative medicine has moved to the centre of attention in the last decades in view of rising health care costs and its potential to reduce perioperative complications, shorten length of hospital stay and improve cost efficiency. These enormous requirements can only be met by a multidisciplinary team delivering excellent performance.

Aim of our research group is to optimise patients' conditions by investigating and implementing a multidisciplinary, multimodal prehabilitation program for patients undergoing urological and other major surgery. The second goal is to further improve the already implemented enhanced recovery after surgery (ERAS) program by determining amount and composition of optimal perioperative fluid management. Third aim is to facilitate postoperative recovery by developing guidelines for optimal postoperative analgesia and minimising postoperative nausea and vomiting in high-risk patients.

To pave the way, we perform 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, University Hospital Bern, and are in the process of setting up international collaborations.

We understand that making patients fit for surgery - especially multimodal optimisation of old and frail patients - is essential for improving postoperative results. Dominique Engel is designated to spend a year at the McGill University, Montreal, Canada, where he will concentrate on identifying patients with malnutrition, determining the impact on functional capacity and modulating risk stratification with targeted personalized anabolic interventions. We are supported by the FNSNF with an IICT grant for our PREHABIL trial. In this randomized controlled trial, we hypothesize that a multimodal prehabilitation program will result in less complications after major surgeries in old and frail patients.

Another field of interest is standardisation and optimisation of complication reporting, based on established reporting systems. During his fellowship at the Royal Melbourne Hospital, 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).

Based on his post-anaesthesia and intensive care experience, Christian Beilstein’s aim is to improve perioperative and peri-interventional outcomes by lowering incidence of postoperative nausea and vomiting in high risk bariatric patients in collaboration with the University Obesity Centre of Berne. Additionally, he aims to make a highly efficient form of therapy safer for the patients by preventing agitation and delirium after electroconvulsive therapy using medical- and non-medical interventions in collaboration with the University Hospital of Psychiatry, University of Bern. A further long-term goal is to investigate interventions reducing 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.

Research group members

Lukas M. Löffel, PD Dr. med., MD

E-Mail: lukas.loeffel@STOP-SPAM.insel.ch

PubMed

Dominique Engel, Dr. med., MD

E-Mail: dominique.engel@STOP-SPAM.insel.ch

PubMed

Marc Furrer, Dr. med.

E-Mail: marcalain.furrer@STOP-SPAM.insel.ch

PubMed

Christian M. Beilstein, Dr. med, MD

E-Mail: Christian.Beilstein@STOP-SPAM.insel.ch

PubMed

John-Patrick Burkhard, Dr. Dr. med., MD, DMD

 E-Mail: JP.Burkhard@STOP-SPAM.insel.ch

PubMed

Collaborations

  • Prof. F. Burkhard and Prof. G. Thalmann, Department of Urology, Inselspital, University Hospital Bern
  • PD. Dr. med P. Nett, Obesity Centre of Berne, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern
  • Prof. S. Walter, University Hospital of Psychiatry, University of Bern
  • Prof. B. Schaller, Department of Cranio-Maxillofacial Surgery, Inselspital, University Hospital Bern
  • Prof. RG Hahn, Research Unit, Södertälje Hospital, Södertälje, Karolinska Institutet at Danderyds Hospital, Stockholm, Sweden
  • Department of Urology, Royal Melbourne Hospital, Australia
  • Prof Dr med M Willhelm Präventive Kardiologie und Sportmedizin , Inselspital, University Hospital Bern
  • Prof. Z Stanga Department of Diabetes, Endocrinology, Nutrition, Inselspital, University Hospital Bern
  •  M Verra Institute for Physiotherapy, Inselspital, University Hospital Bern

External funding