The Economics Of Surgery: Using Routine And Registry Data To Improve Policy, With Particular Reference To Congenital Heart Disease (the Fontan Procedure) And Prosthetic Surgery (hip And Knee Replacements)
Funder
National Health and Medical Research Council
Funding Amount
$86,073.00
Summary
My research will use economics to help improve surgery outcomes. Clinical and policy recommendations in surgery often come from a relatively low evidence base. I will make use of detailed data registries of previous recipients of hip and knee surgery (St. Vincent’s Hospital Melbourne) and Fontan heart surgery (Royal Children’s Hospital Melbourne) to develop advanced economic models of surgery outcomes. My aim is to use these models to improve real-world health policies in surgery.
Creating A Culture Of Safety And Respect: A Controlled, Mixed Methods Study Of The Effectiveness Of A Behavioural Accountability Intervention To Reduce Unprofessional Behaviours
Funder
National Health and Medical Research Council
Funding Amount
$875,978.00
Summary
Unprofessional behaviours among health professionals are common and are associated with increased patient dissatisfaction and medicolegal risk. Addressing these behaviours is a national issue. Ethos is a structured accountability system involving a process of early, non-punitive and tiered intervention and will be introduced across four Australian hospitals. This research will be the first controlled study to assess the effectiveness of the Ethos program to improve patient safety in Australia.
Low back pain affects one in four people in Australia and is responsible for over $8 billion spent on treatments and work loss every year. Surgery is a popular treatment approach for this multifactorial condition but we still lack high quality science to support the role of surgery for low back pain. We also lack research capacity in this field. In my fellowship, I propose to conduct high quality studies to generate and implement scientific knowledge in this field.
The Arthroplasty And Bariatric Surgery (ABS) Study: A Randomised Controlled Trial Of Laparoscopic Adjustable Gastric Banding Prior To Total Knee Arthroplasty
Funder
National Health and Medical Research Council
Funding Amount
$664,149.00
Summary
Knee replacement is a common surgical procedure in Australia (40,000 per year). More than 60% of this group are obese and this is associated with higher early (clinical) and long term (implant) survival complications. Laparoscopic adjustable gastric banding (LAGB) is an effective and safe means of achieving sustained weight loss. This study compares the outcomes of total knee replacement in groups of obese patients who have and have not undergone pre-knee replacement LAGB.
Economic Evaluation And Optimisation Of Services For The Preoperative Assessment And Management Of High Risk Surgical Patients
Funder
National Health and Medical Research Council
Funding Amount
$399,406.00
Summary
Medical co-morbidities in surgical patients affect post-surgical recovery, resulting in higher health service costs and poorer patient outcomes. Preliminary data indicate reduced post-surgical length of stay for patients with modifiable risk factors who attended a specialist preoperative clinic. This project will analyse existing data to identify patient sub-groups with the greatest capacity to benefit from specialist preoperative assessment, and evaluate new service pathways for these patients.
Evaluation Of Long-Term Clinical And Health Service Outcomes Following Coronary Artery Revascularisation In Western Australia: Future Implications
Funder
National Health and Medical Research Council
Funding Amount
$638,412.00
Summary
Heart attacks occur when arteries of the heart become blocked, and current treatment involves unblocking the affected vessel by inserting a stent fed through a leg artery or using bypass surgery. There are different types of stents and whether they offer better outcomes than surgery in the long-term is currently undecided. We will evaluate whether patients who receive stents have better outcomes after 5 years than patients who have surgery, and what the various costs are to the health system.
PREOPERATIVE RISK FACTORS, ADVERSE OUTCOMES AND EFFECTS OF EPIDURAL AND SPINAL ANAESTHESIA
Funder
National Health and Medical Research Council
Funding Amount
$66,110.00
Summary
Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. P ....Anaesthesia and major surgery in patients with coexisting important medical problems present a major challenge to health professionals to avoid and minimise life threatening complications of such surgery. Accurate prediction of which patients are likely to fare badly, and therefore need more intensive peri-operative care and supervision, and knowing definitively whether epidural techniques really do improve the outcome of surgery are issues of central importance in the practice of anaesthesia. Providing clear answers to both questions requires careful analysis of large amounts of data in which systematic and random errors have been minimised. Databases from well-designed and supervised clinical trials represent an invaluable resource in this regard because they have been compiled through the rigorous application of unambiguous definitions and protocols during the process of recording, coding and entering the information. By bringing together the resources and expertise of the MASTER Trial group and the Collaborative Overview of Randomised of Trials of Regional Anaesthesia (CORTRA), both of which are major international projects led from the Australasian region, we have a unique opportunity to provide exceptionally robust answers to some of the most challenging issues in anaesthesia. The combined study of two large international databases will provide a more precise quantitative analysis of the components of preoperative risk and their relationship to life threatening post operative complications, and the possible role of epidural and spinal anaesthesia in minimising risk by reducing the frequency of these complications.Read moreRead less
Outcomes Of The Arterial Switch Operation: A Multi-centre Study
Funder
National Health and Medical Research Council
Funding Amount
$86,733.00
Summary
The arterial switch operation is the surgery of choice for children born with transposition of the great arteries, a congenital heart defect where the main two vessels of the heart arise from wrong pumping chambers of the heart. There are very few studies looking at adults after this operation. We aim to study all patients who have had an arterial switch. The results of this study will further increase our knowledge of the long term consequences of having the arterial switch operation.
Superior Surgical Fixation Using A Novel Orthopaedic Expandable Fastener
Funder
National Health and Medical Research Council
Funding Amount
$414,076.00
Summary
Surgeons repair bone fractures using metal plates and screws. Sometimes the screws loosen and the surgery needs to be repeated. Expandable screws are stronger, but more difficult and sometimes impossible to remove. The research team will test a new type of screw that holds the bones together with greater strength (our current work shows 40% stronger) but can be removed easily if necessary. This grant will allow extensive mechanical testing in preparation for a first-in-human clinical trial.