Anaesthesia and Perioperative Care

The clinical benefits and cost-effectiveness and safety of haematopoietic interventions for patients with anaemia following major emergency surgery: a phase IV, multicentre, multi-arm randomised controlled trial: Peri-op Iron and EPO Intervention Study - POP-I

Addressing one of the top 10 priorities: NIHR research in progress

Each year over 100,000 people over 60 years of age in the UK are admitted to hospital for lifesaving emergency operations. Two of the most common emergency operations are for hip fracture and severe abdominal problems. Many of these people have anaemia (a reduced number of red blood cells). Anaemia increases the risk of dying after surgery and those that do survive have a slower recovery, more complications, and therefore spend more time in hospital. Anaemia can be treated with drugs such as iron, but whether this improves survival and the general health of people who require an emergency operation is not known. The aim of this research is to improve outcomes for people who are anaemic following emergency surgery, and to determine the cost-effectiveness of drug treatment for anaemia compared with usual care.

Prehabilitiation: Living with and beyond cancer

A cross-programme NIHR call for research was advertised to researchers. Applications addressing research priorities identified through the JLA PSP in Living With and Beyond Cancer PSP were particularly encouraged, and the call has resulted in the following two studies which also address priorities from the Anaesthesia and Perioperative Care PSP:

Fit4Surgery 2: A randomised controlled trial to investigate an App-based, motivation-theory grounded, personalised, comprehensive, prehabilitation programme versus usual care to enhance recovery of physical function and reduce complications after lung cancer surgery

Addressing one of the top priorities: NIHR research in progress

Evaluation of PeRsOnalised PrEhabilitation in acute myeloid Leukaemia (PROPEL)

Addressing one of the top priorities: NIHR research in progress

Mapping and Identifying Quality and Inequality in Prehabilitation for Cancer Surgery: Evidence for Improvement

Addressing one of the top priorities: NIHR research in progress

'Fit for surgery' or 'fit for life'? Exploring the potential of using the perioperative encounter to promote regular exercise and physical activity: an expanded evidence synthesis

Addressing one of the top 10 priorities: NIHR research in progress

Every year, over 4 million people need surgery in England alone. They visit several different health professionals (such as local GPs, hospital staff, and social care teams) before, during, and after their planned surgery. Research has shown that the fitter people are before their operation, the faster they recover from it. Because of this, people are sometimes encouraged to make changes to improve their health before surgery. This may be an ideal time to encourage lots of people to start, and continue, regular exercise and therefore improve their general health. However, we do not know the best way of encouraging people to do this. This study will find out how people have been encouraged to exercise (through regular physical activity) when surgery is planned, whether it was successful and why it was successful.

The impact of REstrictive versUs Liberal Transfusion strategy on cardiac Injury in patients undergoing surgery for Hip Fracture (RESULT-HF)

Addressing two of the top 10 priorities: NIHR research in progress

Hip fracture is the most common serious injury in older people. Doctors looking after these patients commonly prescribe a blood transfusion around the time of surgery. Research suggests that 30-40% of these patients have a blood transfusion around the time of operation. These patients often already have anaemia before surgery and lose more blood during their operations. Although some research has been done in this area, doctors are still unsure of when to prescribe blood transfusions to these patients. In particular, we are not sure about how low the blood count can safely be before a blood transfusion is ordered. Current guidelines recommend prescribing at a lower blood count, but there is research which suggests that this level is too low in patients undergoing surgery for a fractured hip, particularly if the patient has a history of heart disease. In these patients, transfusion at a higher blood count level may be better to prevent heart attacks and similar complications. This research team plans to compare blood transfusion at two different levels of anaemia to see which is best for patients.

VolatIle vs Total intravenous Anaesthesia for major non-cardiac surgery: a pragmatic randomised controlled triaL (VITAL)

Addressing one of the top 10 priorities: NIHR research in progress

More than 1.5 million patients require general anaesthesia for major surgery each year in the NHS. General anaesthesia is most commonly maintained with inhalational anaesthesia where the patient breathes anaesthetic gas through a breathing tube whilst asleep. However, some patients receive an alternative called total intravenous anaesthesia, or 'TIVA'. During a TIVA anaesthetic, the patient breathes oxygen through a breathing tube but is kept asleep by drugs given into a vein. Many anaesthetic doctors believe patients recover more quickly after TIVA, and small studies suggest patients prefer this technique. Some anaesthetists are enthusiastic about TIVA because very early research suggests better survival for patients undergoing cancer surgery. However, this has not been proven and others are worried about possible risks including excess deaths and waking up during surgery. The evidence for TIVA has been positive so far but the clinical trials were very small and the results are not reliable. This trial aims to find out which technique is better in terms of getting patients home earlier, patient survival and avoiding any accidental awareness under anaesthesia.

A Randomised Controlled Trial to investigate the clinical and cost-effectiveness of Paravertebral Blockade compared with Thoracic Epidural Blockade in reducing Chronic Post-Thoracotomy Pain (TOPIC 2)

Addressing one of the top 10 priorities: NIHR research in progress

Surgery through the side of the chest (thoracotomy), usually to treat lung cancer, can cause pain post-operatively that can last months or years in up to half of patients. This Chronic Post-Thoracotomy Pain (CPTP) can be severe and debilitating to patients, leading to more frequent GP visits, anxiety, depression, time off sick and unemployment. This study is trying to find out which of two common pain relief techniques results in less incidence of chronic pain at six months after surgery.

Sugammadex for preventIoN oF pOst-operative pulmoNary complIcAtions (SINFONIA)

Addressing one of the top priorities: NIHR research in progress

This large clinical trial aims to compare two drugs used to improve recovery from general anaesthesia and prevent lung complications in patients undergoing major surgery.