South Auckland Clinical Campus


Auckland Enhanced Recovery After Surgery Group

Enhanced Recovery After Surgery (ERAS) is centred on patient knowledge and involvement, and driven by a multi-disciplinary approach to reduce the psychological and physiological stress of undergoing surgery. This is achieved by providing pre-surgery education alongside a revision of traditional surgical care practice, optimising all aspects such as pain relief, nutrition, fluid therapy and early mobilisation.

Goals


The AERAS group conducts high quality research that informs clinical practice and medical education both nationally and internationally. The group's goals include:

  • Implementation of comprehensive enhanced-recovery programmes for colorectal surgery and other types of major surgery, targeting improved clinical outcomes.
  • Investigations of perioperative physiology, both mechanistic and therapeutic, in order to improve outcomes.
  • Investigation of postoperative fatigue and recovery, and ways to improve it.
  • Research-based initiatives to assess and improve ERAS protocols.
  • National and international clinical and research collaborations.
  • National and international education efforts in ERAS care.

Current projects


Colorectal surgery

Major colorectal surgery is associated with considerable morbidity and a prolonged recovery process. The Auckland Enhanced Recovery After Surgery Group has improved clinical outcomes for patients undergoing major colonic resection through the implementation of optimised perioperative care. The following are a series of studies which pertain to this endeavour.

Defining a biomarker profile in predicting anastomotic leak after colon surgery

Anastomotic leakage is one of the worst complications following colorectal surgery. It is associated with longer hospital stays, increased cancer recurrence, and reduced long-term survival. This research will provide clinicians with a greater understanding of predictive biomarkers for anastomotic leak after colorectal surgery. An accurate and reliable biomarker for the occurrence of leak will significantly enhance a clinician’s judgement allowing more prompt diagnosis and earlier initiation of treatment resulting in better patient outcomes.

The two wound hypothesis

Two wounds are created after abdominal surgery. The first is the skin wound and the second is the intra-abdominal disruption from the surgical dissection. Both of these wounds, via their connections to the brain by the nervous system, are important contributors to both pain and fatigue. While it is possible to almost completely abolish the skin wound with laparoscopic surgery little attention has been paid to the intraabdominal wound. This research aims to determine if patients undergoing colorectal surgery will recover more quickly if the nerves sending information to the brain from the abdominal cavity are anaesthetised using a sustained-action local-anaesthetic delivery system.

Perioperative local anaesthetic

This research aims to optimise postoperative pain and functional recovery after major abdominal surgery. A randomised clinical trial will determine the analgesic benefit of intra-abdominal local anaesthetic compared to intravenous local anaesthetic. This has the potential to decrease the burden illness has on the individual, the health care system and enables the individual to return to their family and work in a more timely manner.

High vs low urine output targets in elective surgical patients: a randomised controlled safety trial

Fluid therapy is one of the most commonly prescribed medications in peri-operative care. In current practise, extra fluid is often prescribed to maintain the traditional urine output of 0.5ml/kg/h. This randomised controlled trial aims to question the relevance of this target in elective, healthy patients and to evaluate the safety of a lower urine output target.

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General surgery

General surgeons are involved in the care of patients suffering from many different diseases. These clinical situations provide many opportunities to address a question with a scientific study with the aim of ultimately improving patient care. This has been achieved through a number of studies.

Better Outcomes after Bariatric Surgery – The BOBS study

The overall goal of the BOBS study is to optimise outcomes after bariatric surgery. The study will engage providers and patients to develop an evidenced-based pathway for follow-up after bariatric surgery that is appropriate to all stakeholders.

Māori perspectives of bariatric surgery

Bariatric surgery in New Zealand is steadily on the rise to meet the obesity epidemic. It is recognised as the gold standard treatment modality for morbid obesity where all other methods of weight loss are unsuccessful. Ethnic disparities in obesity rates exist in New Zealand with Māori and Pacific people having 3-5 times higher rates than all other ethnic groups. This research will investigate the health outcome disparities for Māori – describe rates of publically funded bariatric surgery by self-identified ethnicity; compare health outcomes between Māori and NZ Europeans who have undergone bariatric surgery through the public health system; and a Kaupapa Māori qualitative study exploring perceptions and experiences of Māori who have undergone bariatric surgery.

Development and application of a risk prediction tool for emergency lapartomy

Emergency laparotomy is a commonly performed surgical procedure with a high mortality and morbidity. Several different operations can be classified as an emergency laparotomy and it is commonly performed on acutely unwell patients as a lifesaving procedure. Predicting outcomes preoperatively is paramount for patient information, planning of perioperative care and deciding on palliative therapies. This study aims to develop a reliable easy to use predictive score based on preoperative patient state. The score will be developed using a New Zealand wide multicentre prospective cohort. The risk assessment score will be introduced into a clinical pathway for emergency laparotomy patients. The clinical pathway will provide appropriate level care for high risk patients to reduce overall mortality and morbidity.

Post-operative pain following haemorrhoidectomy

Haemorrhoids are a common disorder with a widespread prevalence in the adult population. Haemorrhoidectomy is a common surgical operation for advanced grade symptomatic haemorrhoids but is associated with considerable post-operative pain and discomfort. This project will investigate several novel adjuncts to treatment which proposes to reduce pain following haemorrhoidectomy. A prospective multicentre, blinded, randomised placebo-controlled trial will be performed across several New Zealand District Health Boards over two years comparing topical metronidazole, cholestyramine, statin, local anaesthetic and liposomal bupivacaine in an evidence-based pain management pathway. This project would study several potentially beneficial therapies to reduce pain, complications and encourage an earlier return to normal activity. It will also contribute to the development of an optimised pathway to manage post-haemorrhoidectomy pain.

 

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Orthopaedic surgery

Enhanced recovery after surgery in elective hip and knee arthroplasty

Enhanced Recovery After Surgery protocols of standardised and optimised patient care surrounding elective surgery have shown to be safe, cost effective and demonstrate better health outcomes for patients. This study will evaluate the implementation of an ERAS protocol for elective hip and knee joint replacement at a surgical centre.

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