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Novel patient centred outcome measures after surgery

Professor Velandai Srikanth, Professor Paul Myles, Diana Heggie, David Anderson, Dr Tim Williams and Dr Nathan Pinskier at the oration.

Professor Paul Myles gave the annual Jeremy Anderson Oration at Peninsula Health as part of Research Week earlier this month.

The Director of the Department of Anaesthesia and Perioperative Medicine at the Alfred Hospital and Monash University spoke about his research into novel patient centred outcome measures after surgery.

“All anaesthetic research was focused on drugs,” explains Professor Myles.

“It struck me that what patients were going through pre, during and post-surgery was far more important.”

Professor Myles started to ask himself – what makes a good anaesthetic,, and what is the best way to measure it?

“Back in 1994 I was a young researcher reading journal article after journal article about all the things we measure in our research.”

“What means something to patients is when they feel so terrible. So I thought why don’t we measure how terrible they feel rather than some bio marker in the blood stream?”

 “Some researchers are focused on an outcome measure that bears little relevance to the patient and their family, which I think moves us away from patient centred care.”

For example when patients come in with a severe brain injury, usually after a car accident, there are two options – surgery, or staying in the Intensive Care Unit (ICU).

When you compare outcomes for people who had a Surgical Decompression Craniotomy and people who stayed in the ICU, initially the outcomes are better for people who have had surgery, as more people survive. However when you measure quality of life further down the track, people who stayed in the ICU and didn’t have surgery have a better outcome, as far less of them go from being normal, to severely disabled.

Professor Myles spoke to lots of surgeons and consultants, theatre, recovery, surgery and ward nurses about how to measure improved outcomes after surgery.

“What we ended up with was the quality of recovery score. The first few questions are emotional or psychological, others relate to pain and discomfort,” explains Professor Myles.

“We’ve done lots of studies with that tool.”

During his research Professor Myles has looked at many evaluation tools which measure quality of life recovery, wellbeing and disability 12 months after surgery.

“At the end of the day the one tool that was far superior to others and told us everything we needed to know was the World Health Organisation 12 point survey using the WHODAS scale.”

“It is simple and free to use.”

Professor Myles say we need to use patient centre outcome measures to inform decision making about medical care moving forward.

“We cannot sustain the quality of the healthcare we are providing now. We need to decide what is effective and what is wasteful healthcare.”

“We need to know what the weight of the pros and cons are. Patient centred outcome data is the most important to improve all of our decisions.”