Grant: Foundation Grant

Bio-Bank Study; Cardiac Surgery; Hip Fractures; Imaging Study; Noncardiac Surgery; Perioperative Vascular Medicine; Prevention Of Perioperative Vascular Medicine; Prospective Cohort Study; Randomized Controlled Trial; Risk Prediction

<html> <body> <p> <b>Program direction:</b> Worldwide &gt;230 million adults undergo major surgery annually,¹ of whom millions suffer a major vascular (often fatal) complication.² Over the next 7 years, my research program will make major advances in enhancing clinicians&rsquo; abilities to predict and prevent major vascular complications after surgery. I will undertake 4 major international studies, three focusing on noncardiac surgery, one (NTproBNP Study&ndash;5000 patient cohort) will determine the prognostic capabilities of a preoperative biomarker, NTproBNP; two will assess novel interventions (POISE-3&ndash;10,000 patient factorial randomized controlled trial [RCT] evaluating the impact of a statin and tranexamic acid; HIP ATTACK &ndash; 1200 patient RCT evaluating the impact of accelerated surgery in patients with a hip fracture); and a fourth (VISION Cardiac Surgery Study&ndash;15,000 patient cohort) will establish the relationship between postoperative high-sensitivity Troponin I (hsTI) and the 30-day risk of death in patient undergoing cardiac surgery.<br> </p> <p>I will also undertake 4 preliminary studies that will inform the future direction of my program. Three focusing on noncardiac surgery, one (EVAR&ndash;300 patient cohort) will assess the feasibility of obtaining troponin measurements after hospital discharge in order to estimate the incidence of myocardial injury in patients discharged the day after <u>E</u>ndo<u>V</u>ascular <u>A</u>neurysm <u>R</u>epair surgery; one (RAM&ndash;200 patient RCT) will determine the feasibility of a trial of <u>r</u>emote <u>a</u>utomated continuous non-invasive hemodynamic and ST-segment <u>m</u>onitoring among patients on surgical floors; and one (NeuroVISION&ndash;1500 patient cohort) will assess whether perioperative covert stroke impacts cognitive function at 1 year. A fourth study (VISION Cardiac Surgery Biobank&ndash;5000 patient cohort) will establish a biobank of pre and postoperative biological samples in patients undergoing cardiac surgery.<br> </p> <p> <b>Program impact:</b> The 4 major international studies are addressing important perioperative questions and will directly impact global care. The RCTs will also inform whether specific pathways impact vascular complications, thus influencing the selection of future interventions for evaluation. The 4 preliminary studies will determine the feasibility, appropriateness, and priority of new lines of research. I will seek other funding sources to advance the most promising ideas emerging from these preliminary studies.<br> </p> <p> <b>Expertise:</b> I have conducted international perioperative studies (e.g., RCTs, observational studies, bio-bank studies, imaging studies) that have included &gt;64,000 patients. I have established an international perioperative research group of &gt;200 centres in 30 countries, comprised of leaders in anesthesia, cardiology, emergency medicine, hospital administration, intensive care, internal medicine, knowledge translation (KT), laboratory medicine, imaging, nursing, stroke, and surgery.<br> </p> <p> <b>Training and mentoring:</b> I will train 7 new perioperative vascular researchers during the course of this grant. Each will take the role of Project Officer for a major study, providing a unique opportunity to obtain firsthand experience in running a study. Students will enrol in MSc or PhD programs run by our Department of Clinical Epidemiology and Biostatistics, in which I play a major role. I will also mentor at least 5 independent investigators who have a major focus on perioperative vascular complications, applying individual formal mentoring plans to ensure their successful career development.</p> </body> </html>