Grant: CIHR New Investigator

More than 10 million people have major medical problems after surgery every year. I am leading 2 studies to help prevent these problems. The first study will help better identify people with poor fitness before surgery. It is believed that such people are at risk for heart attacks, difficulty breathing or other problems after surgery. At present, doctors judge fitness by asking patients about what activities they can do. For example, patients may be asked if they can climb stairs. However, this method (called "subjective assessment") is not good at identifying patients who have problems after surgery. I lead a study (called the METS Study) of 1312 patients in Canada, Australia, New Zealand, and the UK to compare subjective assessment against 3 other methods to measure fitness. These other methods are an exercise test (called CPET), a questionnaire about physical activities (called DASI), and a blood test (called NT pro-BNP). Before surgery, each patient will undergo a subjective assessment of their fitness, complete the exercise test, answer the questionnaire, and undergo the blood test. We will then follow them for 1 year after surgery to determine which method is best at identifying people who have problems after surgery. The second study will compare hospitals in Ontario to identify ones where fewer people having problems after surgery. I will compare these "high-performing" hospitals against others to understand how they take care of patients differently before, during and after surgery. By learning this information, these high-performing hospitals can serve as examples for other hospitals to learn from, both in Ontario and other regions. If other hospitals can learn to take care of patients in the same way, their patients may also have fewer problems after surgery. By helping to better identify high-risk patients before surgery and organize their care for surgery, these studies will make surgery safer for millions of people around the world every year