The Quality Of Surgical Care Project: Quality Assurance, Clinical Audit And Outcomes Evaluation In Western Australia
Funder
National Health and Medical Research Council
Funding Amount
$346,018.00
Summary
The Quality of Surgical Care Project (QSCP) is a unique quality assurance program in Australia which promotes best practice in surgical and procedural care. The objectives of the QSCP are to evaluate the outcomes of surgical procedures in Western Australia (WA) and to compare them with international standards. The QSCP was established in 1996, as a collaborative venture among the Royal Australasian College of Surgeons (RACS), the Department of Public Health, (UWA) and the Health Department of WA ....The Quality of Surgical Care Project (QSCP) is a unique quality assurance program in Australia which promotes best practice in surgical and procedural care. The objectives of the QSCP are to evaluate the outcomes of surgical procedures in Western Australia (WA) and to compare them with international standards. The QSCP was established in 1996, as a collaborative venture among the Royal Australasian College of Surgeons (RACS), the Department of Public Health, (UWA) and the Health Department of WA. The QSCP is only possible because of the unique population-based record linkage available in this state and is consistent with priorities identified in the National Health Information Development Plan in the areas of record linkage and health outcomes, as well as with the monitoring of interventions recommended by the Taskforce on Quality in Australian Health Care. The surgical procedures reviewed are selected to include a broad range of surgical specialties on the basis of national priority, in consultation with the RACS and with input from the Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S). This application proposes to continue the core program in promoting best practice in procedural care by reviewing selected procedures including the outcomes of laparoscopic and endoscopic procedures, and endoluminal stenting surgery due to their rapid proliferation during the 1990's. This second stage of the QSCP proposes the introduction of two new quality assurance themes. Firstly, to promote the clinical safety and post-implementation surveillance of new surgical interventions and other medical technology by establishing the WA Registry and Surgical Audit of New Surgical Interventions. Secondly, to comprehensively and independently audit all surgical mortality at a population level. A dissemination strategy will be established to 'complete the loop' in the evaluation and audit processes.Read moreRead less
Randomised Controlled Trials Of Laparoscopic Techniques For Antireflux Surgery
Funder
National Health and Medical Research Council
Funding Amount
$1,031,381.00
Summary
Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some co ....Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some continue to experience symptoms. Surgery is the only treatment which will cure reflux. It has a clear role in the treatment of patients with ongoing symptoms, those who don t want to take tablets, and patients with a large hiatus hernia in whom symptoms occur due to the relocation of the stomach from the abdomen into the chest. Approximately 5,000 Australians per year undergo surgery for reflux. The standard operation achieves a good outcome in approximately 90%, although some patients are troubled by side effects. To reduce the risk of this, the original procedure has been modified. However, the evidence supporting modifications has until recently been limited. The best way to compare different operations is in randomised trials. The majority of the largest and best trials addressing this area have been undertaken in Adelaide. We have already entered 504 patients into 5 randomised trials, 4 conducted entirely in Adelaide, and one across multiple sites with the cooperation of 15 Australasian surgeons. These trials have provided a more reliable evidence base for surgeons undertaking surgery for reflux. However, long term follow-up is required to ensure that conclusions drawn are valid at late follow-up. In addition we are establishing 2 new randomised trials, which will determine how best to perform surgery for reflux, and how best to repair a large hiatus hernia. These studies will be undertaken in collaboration with more than 25 other surgeons throughout Australia.Read moreRead less
Randomised Controlled Trial Of Surgical Skin Preparation For Prevention Of Superficial Wound Complications In Prosthetic Hip And Knee Replacement Surgery
Funder
National Health and Medical Research Council
Funding Amount
$403,128.00
Summary
The demand for prosthetic joint replacement surgery will double over the next decade. Complications involving the surgical wound are a devastating complication of this surgery. This randomised controlled trial aims to investigate whether skin cleansing prior to surgical incision with alcoholic iodine reduces the number of patients with superficial wound complications when compared to alcoholic chlorhexidine. The study will be performed in patients undergoing orthopaedic joint replacement surgery ....The demand for prosthetic joint replacement surgery will double over the next decade. Complications involving the surgical wound are a devastating complication of this surgery. This randomised controlled trial aims to investigate whether skin cleansing prior to surgical incision with alcoholic iodine reduces the number of patients with superficial wound complications when compared to alcoholic chlorhexidine. The study will be performed in patients undergoing orthopaedic joint replacement surgery: a high volume, high cost surgery.Read moreRead less
Prospective Evaluation Of A Model To Predict Outcomes Following Endovascular Aortic Aneurysm Repair
Funder
National Health and Medical Research Council
Funding Amount
$1,098,901.00
Summary
Once present, abdominal aortic aneurysms tend to enlarge over time resulting in an increased risk of death if they rupture. Endovascular aneurysm repair may be used to fix the aneurysm but this procedure can result in complications over time. We developed a model that uses pre-operative information to predict the chance of an individual having poor results.This study aims to assess whether the model is a good predictor of outcomes and whether extra information will improve its accuracy.
Developing In Vivo Methods Of Adipose Tissue Engineering
Funder
National Health and Medical Research Council
Funding Amount
$374,703.00
Summary
Surgical repair and replacement of soft tissues after tumour removal or to repair existing damage requires fat tissue with a good blood supply. Tissue engineering allows us to create new fat grafts for replacement tissue without causing unnecessary pain or trauma to the patient. We have developed a method for growing fat tissue using a chamber to maintain a space for the tissue to grow into, a blood vessel to supply nutrients to the growing tissue, cells or tissue from the host to encourage cell ....Surgical repair and replacement of soft tissues after tumour removal or to repair existing damage requires fat tissue with a good blood supply. Tissue engineering allows us to create new fat grafts for replacement tissue without causing unnecessary pain or trauma to the patient. We have developed a method for growing fat tissue using a chamber to maintain a space for the tissue to grow into, a blood vessel to supply nutrients to the growing tissue, cells or tissue from the host to encourage cell growth and migration and a matrix or scaffold to support the developing tissue and guide it to form the type of tissue we want (fat, muscle etc). We have shown that the tissue graft may cause fat to grow due to causing an inflammatory reaction and confirmed this by adding a mild inflammatory compound to the chamber instead of a tissue graft. This compound caused the chamber to grow fat tissue. The aim of this project is to determine which of the growth factors or other signaling factors released by the inflammation process is responsible for causing fat tissue production and to identify what cells are being attracted to the chamber to help grow the fat, so that we can further improve our engineering of fat tissue. Understanding the pathways which mediate or stimulate fat growth will provide new opportunities for improving fat growth and allow the engineering of larger fat grafts in larger animals and eventually human clinical application. Beyond that, inflammation is involved in many disease processes (eg. obesity, metabolic syndrome, diabetes, cancer), and these fields of study will also benefit from our research.Read moreRead less
Predicting Response To Chemoradiotherapy In Patients With Advanced Rectal Cancer.
Funder
National Health and Medical Research Council
Funding Amount
$461,605.00
Summary
Many cancer patients receive expensive and unpleasant therapies that actually do not benefit them. This project will use a new technology that can simultaneously assess the level of expression of thousands of genes. We will test if the pattern of gene expression in tumours can predict the patients' response to therapy. Success will significantly improve the clinical management of advanced cancer patients and provide a rational basis upon which to tailor individualized treatment regimes.
Association Between Obesity, TGFb, Thrombospondin And Small Abdominal Aortic Aneurysm Progression.
Funder
National Health and Medical Research Council
Funding Amount
$514,777.00
Summary
Abdominal aortic aneurysm (AAA) is an important cause of mortality in middle aged and elderly Australians. The incidence of AAA continues to increase despite improvements in the medical management of atherosclerosis. We postulate that obesity is important in the progression of AAA. In a community screening study we found that waist-hip ratio was independently associated with AAA. In this project we investigate the mechanisms underlying this association between obesity and AAA.
Intelligent Freeform Bio-fabrication for Customised Anatomical Structures for Reconstructive Surgery. This project contributes towards the ARC priority goal on advanced materials and frontier technologies by developing an intelligent freeform biofabrication facility to produce accurate anatomical biocompatible replica structures and implants for reconstructive surgery. The products, produced from patient's CT or MRI scan data, will contribute to complex surgical procedure planning and patient ed ....Intelligent Freeform Bio-fabrication for Customised Anatomical Structures for Reconstructive Surgery. This project contributes towards the ARC priority goal on advanced materials and frontier technologies by developing an intelligent freeform biofabrication facility to produce accurate anatomical biocompatible replica structures and implants for reconstructive surgery. The products, produced from patient's CT or MRI scan data, will contribute to complex surgical procedure planning and patient education. The proposed facility will be based on multifunctional freeform fabrication process supported by intelligent software tools and database of biocompatible materials. The prospective outcomes are likely to have an excellent commercial and patenting potential that may help Australia become a leader in biomanufacturing technology.Read moreRead less
Perioperative Beta-blockade To Prevent Cardiac Morbidity In High-risk Patients Undergoing Surgery (The POISE Study)
Funder
National Health and Medical Research Council
Funding Amount
$189,625.00
Summary
Non-cardiac surgery is associated with significant risk of complications and death, particularly in elderly patients who are known to have heart disease, or who have risk factors for it (ie smoking, high blood pressure). About 11% of the Australian population are currently taking medications for heart disease or high blood pressure and about 80% have at least one risk factor for heart disease. As more than 2 million Australians have general anaesthesia for non-cardiac surgery every year, a subst ....Non-cardiac surgery is associated with significant risk of complications and death, particularly in elderly patients who are known to have heart disease, or who have risk factors for it (ie smoking, high blood pressure). About 11% of the Australian population are currently taking medications for heart disease or high blood pressure and about 80% have at least one risk factor for heart disease. As more than 2 million Australians have general anaesthesia for non-cardiac surgery every year, a substantial group of patients are therefore at risk of an adverse outcome following surgery. Despite the magnitude of this problem, however, few studies have established treatments to decrease the risk of complications and death following surgery. Beta-blockers are a group of drugs which have been used for decades in the treatment of heart disease and high blood pressure. Beta-blockers are known to improve the way the heart copes with the stress of surgery. They decrease the heart rate, make the heart more efficient at using energy and reduce the likelihood of imbalance between oxygen supply and demand. Some previous studies showed that beta-blockers may reduce the risk of heart attack and death for up to 2 years after surgery. However, other studies have shown no effect of beta-blockers on outcome. These previous studies have involved small numbers of patients who may not represent the broader population having surgery. We therefore propose to undertake a large trial to definitively answer the question about whether beta-blockers improve the outcome after non-cardiac surgery in patients with, or at risk of, heart disease. Even if the effect of beta-blockers is relatively modest, because such large numbers of patients with heart disease have surgery, the overall effect on the rate of complications and death in the population could be very significant. The results of this study could have major implications for the success of, and cost of, surgery worldwide.Read moreRead less