South Auckland Clinical School

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.

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.

Optimising perioperative care after colorectal surgery

Perioperative fluid therapy in major colorectal surgery

Perioperative use of statins in elective colorectal surgery

Lead Researcher: Dr Parry Singh

High vs low urine output targets in surgical patients: a randomised assessor-blinded clinical trial

Lead Researcher: Dr Jevon Puckett

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/hr. This trial aims to question the relevance of this target in elective, healthy patients and to evaluate the safety of a lower urine output target.

Physical activity in postoperative patients: effects in muscle mass and function

Lead Researcher: Dr Sid Trivedi

Perioperative NSAIDs and anastomotic dehiscence after bowel surgery: a meta-analysis of randomised trials

Lead Researcher: Dr Tom Burton

The Abdominal Surgery Impact Scale in colorectal surgery: A prospective validation study against SF-36 Acute

Lead Researcher: Dr Manuel Barberio

Genetic, neural and behavioural predictors of acute postoperative pain after major colorectal surgery

Lead Researcher: Dr David Rice

Top

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.

Evidence-based general surgery

The role of rehabilitation in bariatric surgery

Lead Researcher: Dr Daniel Lemanu

Enhanced recovery after surgery in elective hip and knee arthroplasty

Lead Researcher: Dr Renus Stowers

Enhanced Recovery After Surgery (ERAS) 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.

Top

Paediatric Surgery

Acute appendicitis is a common surgical disease in children that can progress to serious intra-abdominal infections. Surgical removal of the infected appendiceal tissue forms part of the treatment but does not eliminate established infection in the peritoneal cavity. The following studies look at how to improve clinical care in acute appendicitis.

For an overview on complicated appendicitis in children: a stepwise approach to improving patient outcome view the presentation Starship Children’s Hospital Paediatric Update, 27 March 2013

Determining duration of systemic antibiotic therapy for children with appendicitis-related peritonitis

This study aims to determine whether a set of clinical criteria can safely guide the duration of adjuvant broad-spectrum systemic antibiotics for appendicitis-related peritonitis.