Despite modern advances in patient care, postoperative complications remain a significant clinical challenge, and organ failure is a leading cause of death after surgery and during critical care. Duke Anesthesiology’s Center for Perioperative Organ Protection is pioneering new clinical standards for patient care and innovative translational research in perioperative and critical care settings.
On average, Americans undergo 9.2 surgical procedures during their lifetime. Perioperative mortality is defined as any death, regardless of cause, that occurs within 30 days after surgery in or out of the hospital. Despite modern advances in critical care, perioperative mortality for overall inpatient surgical procedures accounts for nearly 200,000 deaths each year in the United States alone. This represents the third leading cause of death only after heart disease and cancer. This challenge is even more dramatic after major surgical procedures; 15 – 17 percent of these patients suffer major postoperative complications. Nearly one in seven patients hospitalized for a major surgical procedure is readmitted to the hospital within 30 days after discharge, and if patients develop postoperative critical illness, mortality rates reach up to 20 percent. Development of a significant postoperative complication in the first 30 days after surgery is associated with up to a 20 percent increase in mortality over the subsequent 10 postoperative years.
Organ dysfunction is central to the complications seen in perioperative medicine, and multiple organ dysfunction occurs in up to 50 percent of patients who experience postoperative critical illness. During surgery, both non-infectious (aseptic, trauma) and infectious (sepsis) stimuli trigger immunologic responses that are critical for healing and controlling infections. However, these immunologic responses can become more dangerous than the original infection and cause systemic inflammatory response syndrome (SIRS), cardiovascular disorders and organ dysfunction, including acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and acute gut injury (AGI). Future approaches to reduce perioperative morbidity and mortality will require ongoing efforts to 1) better understand mechanisms of immune responses in healing vs organ injury, 2) discover ways to prevent organ injury, and 3) fine-tune the healing response to promote early return of organ function after surgery.
Duke Anesthesiology’s CPOP strives to prevent organ injury and improve recovery through individualized optimization of preoperative, intraoperative and postoperative care by:
- Strengthening relationships among researchers and providers through local and international collaborations (such as the Morpheus Consortium)
- Identifying gaps in clinical management therapies and services
- Developing an interdisciplinary, evidence-based approach to integrative perioperative medicine
- Evaluating the efficacy of new drugs/medical devices
- Exploring factors that contribute to organ injury
- Studying cellular and genetic modifiers of postoperative organ dysfunction
- Identifying individual characteristics that enable or disable progression to organ dysfunction
- Using big-data and machine learning to study organ dysfunction in perioperative and critical care settings