Research in Perioperative Care
by Dr. Stavros Memtsoudis
The goal of perioperative outcomes research strives to make surgery safer by identifying patients who are at risk and evaluate interventions that may prevent issues from occuring. An example is a complex of studies we recently conducted to investigate if sleep apnea is a risk factor for complications in patients undergoing surgery and which kind of adverse events are most likely. These findings can then be used to design studies to look into the mechanisms of adverse events and the implementation and evaluation of interventions, such as advanced monitoring and airway therapies, that can influence outcome.
Unlike most people who intuitively try to avoid anything that has to do with complications, very early on in my career I developed an intense interest in the care of sick patients undergoing surgery and those who were unfortunate enough to developed complications during surgery. With this in mind I sought to find ways to identify at risk patients, design health care plans to diminish the chance of adverse events surrounding surgery and establish ways to treat those with complications if they occurred.
I soon realized that in order to achieve these goals I would have to become a clinician scientist, who would both be able to conduct research in this arena and be able to take care of patients with significant medical problems from the second they were referred to undergo surgery to the point when they overcame the associated stresses days thereafter.
Hence, I chose the specialty of anesthesiology and underwent additional advanced training in cardiothoracic anesthesia and critical care medicine, while also acquiring the skills of a researcher.
Needless to say this decision was one of the best I have ever made, as today I can see how the knowledge I’ve gained allows me not only to have a comprehensive understanding of the clinical problems at hand and address them, but also to have the tools to research them.
Today, I am fortunate to be part of a multidisciplinary team of surgeons, epidemiologists, internists and statisticians that is focused on making surgery safer for our own patients at HSS as well as for those having surgery anywhere else in the world. We do this by disseminating the knowledge gained here through peer reviewed publications, presentations at scientific meetings and talks given at many institutions.
For example, with population based-studies supplemented by clinical trials to further understand the mechanisms of complications we were able to improve the safety of bilateral joint replacement surgery by better judging their risk and treating our patients. While the biggest satisfaction comes from the notion that through research we can help many more patients beyond our immediate reach, I find encouragement to continue our work from the appreciative support provided by thankful patients, members of the public and the scientific community.
It must also be noted, however, that while pursuing this type of research requires dedication in the form of financial resources and time, the most essential part is provided by patients, who in one of the most stressful times in their lives will agree to participate in clinical trials with often unknown benefit to themselves, thus becoming active partners in this endeavor.
Dr. Stavros Memtsoudis is board-certified in both anesthesiology and critical care medicine. He specializes in the perioperative care of patients with advanced cardiovascular and pulmonary disease at Hospital for Special Surgery. Trained in perioperative transesophageal echocardiography, Dr. Memtsoudis is interested in the application of this technology outside the cardiac operating room.
