Outcomes research

摘要

Anesthesia clinical research has changed tremendously over the pastyears. While 20 years ago most anesthesia research focused on immediateperioperative outcomes, mainly testing safety of anesthetics,there is increasing evidencethat intraoperative anesthetic managementhas long-term consequences, affecting patients months andyears after surgery.This is especially exciting considering that most patients are underour care only for a very restricted time period. It also highlights theimportance of large, randomized, controlled trials, which are thegold standard for providing clinical evidence. outcomes researchseeks to understand the end results of particular health care practicesand interventions.Outcomes include effects that people experience and care about,such as change in the ability to function. In particular, for individualswith chronic conditions - where cure is not always possible - endresults include quality of life as well as mortality. By linking thecare people get to end effects, outcomes research has become key todeveloping better ways to monitor and improve the quality of care.Outcomes Research Consortium. The outcomes Research Consortiumwas formed in 1990 at the University of California in Sanfrancisco and is now a department of the Cleveland Clinic’s AnesthesiologyInstitute. We have two decades of experience with clinicalresearch.The Consortium is not a society, foundation or companybut rather an international academic collaboration of approximately70 university-based investigators with a common interest in anesthesia-related clinical research. An advantage of this broad collaborationis that we have access to every surgical and critical carepopulation. The Consortium is currently involved in more than 100clinical studies, including large multicenter outcome trials.The Consortium publishes about 50 full papers each year, and consortiumpapers are cited more than 1,100 times each year.Members of the Consortium have trained more than 80 researchfellows and dozens of medical and graduate students (each for atleast a full year). Most fellows have graduated to positions in academicinstitutions and four subsequently chaired anesthesia departments.Current Research Themes. Surgical treatment outcomes have improvedconsiderably within the last decades in large part due toadvances in anesthesia, surgical technique and perioperative care. More recently, dedicated anesthetic interventions were found tohave a major impact on short-term and long-term patient out-come.our studies focus on generating evidence-based knowledge in regardto perioperative interventions likely to improve patient outcome.Perioperative Inflammation. Surgery and the associated tissue injuryevoke myriad endocrine and metabolic changes collectively consideredthe surgical stress response.This systemic inflammatory response is associated with numeroussystemic postoperative complications (cardio-pulmonary, neurological,gastro-intestinal), but also fatigue, mood disturbances, ileus, fever,hypercoagulability and hyperalgesia. Various perioperative interventionsameliorate the surgical stress response and might thereforeimprove patient outcome. Interventions currently under investigationby our group (in a number of studies in different patient populations)are perioperative tight glucose control (nCT 00524472),depth of anesthesia, alpha agonists (nCT 00561678) lidocaine (nCT00840918) and steroid administration. outcomes of interest include30-day postoperative morbidity, atrial fibrillation, myocardial ischemia,post- operative delirium and cognitive dysfunction, functionalstatus and chronic pain.Wound Complications. Complications associated with wound infection and inadequate healing are common and serious consequences of anesthesia and surgery. oxidative killing by neutrophils is the primary defense against surgical pathogens; good tissue oxygenation also improves scar formation. Treatments that increase tissue oxygen and perfusion might therefore reduce the risk