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U of L Magazine, Spring 2004

Cost-free change may reduce post-surgery complications

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Dr. Daniel Sessler. Photo by John Lair.

The Gheens Foundation announced in December that it will provide $1 million to support surgical wound infections research conducted by U of L’s Outcomes Research Institute.

The study is being directed by Drs. Ozan Akca and Daniel Sessler in the U of L Department of Anesthesiology.

The Outcomes Research Institute has already proven that increasing administered oxygen concentration halves the risk of surgical wound infection by providing extra oxygen to the tissues fighting infection.

The investigators have also shown that increasing blood carbon dioxide concentration also increases tissue oxygen concentration. Carbon dioxide concentration can be increased simply by slowing the respiratory rate during surgery. The purpose of the proposed study is to confirm that the increase in tissue oxygen that results from increased carbon dioxide concentration reduces infection risk.

Wound infections are among the most common serious complication of anesthesia and surgery. Infections are especially likely and dangerous in the elderly—who now constitute half of all surgical patients.

Jim Davis, executive director of the Gheens Foundation, says this study was particularly appealing to the foundation because of its interest in aging. In 2000 the foundation created the Gheens Center for Research on Aging at the University of Louisville with a gift of $2.5 million, and in 2001, Dr. Eugenia Wang became director of the center and the Gheens Foundation Inc. Chair in Aging Research.

Davis says the foundation was also interested because of the pragmatic approach of the Outcomes Research Institute. "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."

"This grant will allow us to test the hypothesis that a simple and cost-free change in anesthetic practice will reduce the risk of a devastating and expensive complication," says Sessler, the School of Medicine vice dean for research, Lolita S. and Samuel D. Weakley Endowed Research Chair, and distinguished university professor of Anesthesiology and Pharmacology. The study will include up to 2000 patients in four countries.

The Outcomes Research Institute is a nonprofit group composed of 50 investigators in 10 countries. The group works on a broad array of projects, but their focus is testing simple, low-cost, and low-risk interventions that may markedly improve how patients fare. Many of their recommendations have become industry standards. Because of their work, for example, the standard of care is now to keep patients warm during surgery.

"Our research focuses on procedures that cost between zero and $10 per patient, but that have substantial potential to reduce complications and improve outcomes," Sessler says. He notes that there is no cost associated with elevating carbon dioxide levels in the blood during surgery. "It’s just a matter of turning a knob on the ventilator."

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.

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