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Title: Identifying risk and improving outcomes in major abdominal surgery
Author: Davies, Simon James
Awarding Body: University of Leeds
Current Institution: University of Leeds
Date of Award: 2012
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Dopexamine has been shown to reduce both mortality and morbidity in major surgery when it is utilised to increase perioperative oxygen delivery. A meta regression analysis of data from the dopexamine trials in major surgery has shown a significant improvement both in outcomes for low dose dopexamine (<1mcg/kg/min), however a meta-analysis of the same data showed no overall benefit, leaving an uncertainty as whether dopexamine confers an outcome benefit. The identification of high-risk patients is complex, however functional capacity has been shown to predict of outcomes after major surgery. Cardiopulmonary exercise testing (CPET) provides an objective measurement of cardiorespiratory fitness, and hence functional capacity, and a reduced oxygen uptake at the anaerobic threshold (AT) has been shown to confer a significant risk of mortality in patients undergoing major surgery. Measurement of outcomes after major abdominal surgery have focused on mortality, but the low incidence in elective surgery makes this a poor comparator. The Post Operative Morbidity Survey (PO MS) prospectively assesses shOli-term postoperative morbidity and may have clinical utility both as a core outcome measure in clinical trials. The oesphageal Doppler (ODM) is widely used to deliver goal directed therapy via stroke volume optimisation. New methods of stroke volume measurement are available with arterial waveform analysis, and fluid optimisation can be performed with measurements of preload responsiveness.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available