Boermeester M.A.: Abdominal infections and patient safety in surgery

Project Details

Description

ad 1. A multicenter trial (OPTIMA trial) investigated the optimal and cost-effective use of diagnostic imaging in patients with acute abdominal pain. Multimodality diagnostics work-up for patients with acute abdominal pain has been analysed based on decision tree modelling. Test accuracy of US and CT for acute appendicitis and diverticulitis has been compared in a meta-analysis of previously performed head-to-head comparison studies. A multicenter randomized trial (RELAP trial) compared cost-effectiveness of a more aggressive surgical management strategy (planned relaparotomy) with a more conservative, 'watchful waiting' strategy (relaparotomy on demand) in patients with secondary peritonitis. Endpoints were mortality, sepsis- and surgery-related morbidity, quality of life and prevalence of posttraumatic stress disorder (PTSD). A grant application for an implementation strategy and trajectory after RELAP is under evaluation at ZonMW. The OPTIMAP trial is evaluating accuracy of MRI compared to best evidence imaging (US and conditional CT) for suspected acute appendicitis. The DIABOLO trial compares in a randomized trial the cost-effectiveness of a conservative treatment strategy
(antibiotics and hospital admission) and a liberal treatment strategy (no antibiotics and selected admission) of mild acute diverticulitis. In peritonitis patients also compartimentalized activation of inflammatory responses are under investigation. Inflammatory mediator systems such as coagulation, fibrinolysis, cytokines, and activated neutrophils are examined and compared between compartments (blood, abdomen, lungs). Inflammatory response pattern are being compared between survivors and non-survivors. In a mouse model of polymicrobial peritonitis several therapeutic interventions have been tested. Research focus is on immunomodulation of compartimental coagulation and fibrinolysis with the use of various monoclonal antibodies. New biomarkers and genetic variants are being studied in patients with peritonitis or pancreatitis or esophageal cancer, in particular for the prediction of disease course and outcome. Surgical and medical treatment of acute pancreatitis is investigated (Dutch Pancreatitis Study Group: PANTER trial, PENGUIN trial). Clinical and animal studies in chronic pancreatitis determine the role of surgery in treatment of CP-related pain (CARE registry, ESCAPE
trial). Ad. 2 Patient safety in the peri-operative phase is the second subject of research in our group. Adverse events and safety risk events have been translated into items in a Surgical Patient Safety System (SURPASS) checklist. Currently is being investigated in clinical practice whether the checklist items are indeed preventable safety risk events, i.e. do the items cover the majority of the risk events and adverse events (adverse drug events are examined in the SUREPILL study). National grants:
1. ZonMW Health Care Efficiency Research Program 2002 ‘Planned versus on demand relaparotomy in secondary peritonitis: a multicenter randomized trial’. (RELAP trial) (project number 945-02-028).
2. ZonMW Health Care Efficiency Research Program 2004 ‘Optimization of diagnostic imaging use in patients with acute abdominal pain: cost-effectiveness analysis of imaging strategies (OPTIMA trial) (project number 945-04-308). The OPTIMA trial has received the ZonMW Health Care Efficiency Research Program Parel Award 2009 and has received further funding for implementation of results. The OPTIMA trial enrolled more than 1000 consecutive patients with abdominal pain >2 hours and
StatusActive
Effective start/end date1/11/2007 → …