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IMPACT, Easing the Pain, Spring 2004

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U of L anesthesiology researcher Daniel Sessler says remarkably simple and low-cost steps, including a little extra carbon dioxidde in the blood during surgery and a heated blanket afterward, can do amazing things for patient recovery. Photo by John Lair.

Something as simple and cheap as a heated blanket can boost recovery times for surgery patients. Anesthesiologist Daniel Sessler says that’s just one of many easy, low-cost ways to help post-surgical healing.

First they found that keeping patients warm during surgery could reduce both their recovery time in the hospital and the risk of surgical wound infection.

Then they found that giving patients increased oxygen during and immediately following surgery halves the incidence of postoperative nausea and vomiting.

Now they’re thinking that even greater rates of recovery are possible if you increase carbon dioxide levels in the blood.

These are just a few of the low-cost or even cost-free changes being developed by the Outcomes Research Institute that may reduce post-surgery complications for patients. The institute, a nonprofit group made up of 65 investigators in 10 countries, is hosted by the University of Louisville and led by Dr. Daniel Sessler, the School of Medicine vice chair for research. Sessler founded the institute while he was a researcher at the University of California-San Francisco. He came to U of L in 2000, recruited under the state’s "Bucks for Brains" program that helps bring top scientists to Kentucky universities.

Although Outcomes Research is not restricted to anesthesiologists—practitioners from a variety of medical specialties participate—it is one of the most productive anesthesia groups in the world in terms of peer-reviewed papers published. Collectively, Outcomes Research investigators work on a broad array of projects, particularly the testing of simple interventions that may markedly improve how patients fare. Many of their recommendations, such as keeping patients warm during surgery, have become industry standards.

Sessler received the 2002 Excellence in Research Award from the American Society of Anesthesiologists—the society’s highest honor—for his groundbreaking work on the effects of patient temperature variations during and after surgery. As an anesthesiologist he was curious about how and why the body temperature of anesthetized patients changed. So he began investigating.

He learned to his surprise that a drop of a just few degrees in body temperature did "terrible things," such as tripling the risk of surgical wound infection, increasing blood loss by interfering with the clotting process and prolonging the amount of time it took patients to revive from the anesthesia itself.

He also found the solution was simple—a disposable blanket and a forced-air heating device kept patients warm and led to big improvements in their health.

"Keeping it simple" is Outcome Research’s mantra.

"Our research focuses on procedures that cost $0 to $5 per patient but that have dramatic effects on patient recovery rates," says Sessler, who is also U of L’s Lolita S. and Samuel D. Weakley Endowed Research Chair in Anesthesiology.

That’s one reason why much of his research focuses on wound infections. Wound infections are the most common serious complication of anesthesia and surgery, Sessler says. They are especially likely and dangerous in the elderly, who now constitute half of all surgical patients.

In his latest study Sessler is testing his theory that post-surgical infections can be reduced by increasing the carbon dioxide concentration in the blood during surgery. Carbon dioxide is a mild stimulant that increases how hard the heart pumps, which then increases the amount of blood available in the tissue.

And, he notes, there is no cost associated with elevating carbon dioxide levels in the blood during surgery. "It’s just a matter of turning the knob on the ventilator."

The Gheens Foundation announced in December that it will provide $1 million to test Sessler’s hypothesis on 2,000 patients around the world.

Jim Davis, the foundation’s executive director, says the study was particularly appealing because of its potential impact on research about aging. In 2000 the foundation created the Gheens Center for Research on Aging at U of L with a gift of $2.5 million. In 2001, Eugenia Wang—another "Bucks for Brains" recruit—became director of the center and the Gheens Foundation Inc. Chair in Aging Research.

Davis says the foundation also was interested because of Sessler’s pragmatic approach.

"It’s good, cutting-edge research that will help people and is directly tied to treatment. If I go to the hospital, for example, I will directly benefit from this research. This research is good for patients and good for Louisville."

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