Circulation 60,475 • Volume 13, No. 4 • Winter 1998

APSF Awards Two 1999 Research Grants

Jeffrey B. Cooper, Ph.D.

The Anesthesia Patient Safety Foundation announced two research grant awards for 1999 at its Annual Meeting in October in Orlando.

In this, the 13th year of the APSF grants program, 19 applications were submitted. Of these, eight received high enough initial scores to be considered in the second round of reviews, which was conducted on October 17 at the meeting of the APSF Scientific Evaluation Committee (SEC). Although there were many excellent ideas for research projects and the proposals were generally well written, the SEC this year only awarded two grants. Sufficient weaknesses, usually in methodology or experimental design, were identified in the other applications so that the committee decided not to award a third grant. This is the first grant cycle in which this has occurred; we hope that is an anomaly. As usual, summaries of the reviewers’ comments are provided to any applicant requesting one.

The two grants that were awarded represent very interesting and timely topics in anesthesia patient safety.

Karen B. Domino, M.D., MPH, Professor of Anesthesiology at the University of Washington, is the principal investigator of a grant entitled: “Outcomes of Anesthesia and Surgery in Rural Hospitals; Factors Associated with Mortality, Complications and Failure to Rescue.” The objective of the proposed research is to study outcome after anesthesia for surgery on the elderly in rural areas compared to urban areas. It is hypothesized that morbidity and mortality risks after complex surgery on the elderly are higher in small, rural hospitals than in urban hospitals. This would be due to a variety of hospital and practice characteristics, including low volume of surgery and low percentage of anesthesiologists. In contrast, Dr. Domino predicts that morbidity and mortality risks in the elderly after low complexity procedures are not increased in rural facilities. Using Medicare beneficiary data, the project will compute mortality, complications, and failure-to-rescue rates in the elderly after several procedures in urban and rural hospitals. The morbidity and mortality rates for each procedure will be adjusted for patient health status and compared in urban and rural locations. Although multiple factors will undoubtedly influence significant differences between urban and rural outcomes, it is expected that the data will provide insight for further study of the effects of the anesthesia provider. The results of the research should help determine what type of surgical care can be performed safely in rural hospitals.

Terri G. Monk, M.D., Professor of Anesthesiology at the University of Florida College of Medicine, will lead a “Prospective Study Evaluating the Relationship Between Age and Post-Operative Cognitive Dysfunction Following General Anesthesia.” Post-Operative Cognitive Dysfunction (POCD) has become recognized as a common occurrence in patients over the age of 60. It is generally assumed that this complication is confined to older patients, but there is little information on cognitive function after anesthesia in patients younger than 60 years. The hypothesis of this study is that POCD is rare in young adult patients and that its incidence increases with age. This study will evaluate a large sample of patients over 18 years of age undergoing general anesthesia lasting two or more hours. Equal numbers of patients will be enrolled in each of three age groups. All patients will undergo a neurocognitive evaluation 14 days prior to surgery, on the day of hospital discharge, and at two months post-operatively. If the patient exhibits moderate to severe changes in cognitive function at the two-month neurocognitive evaluation, the patient will be reevaluated at six months post-operatively. This study will use psychometric testing techniques that were recently validated in the multi-center international study of post-operative cognitive dysfunction (ISPOCD1) in the elderly. Expanding the power of the study, there will be a parallel study using identical psychometric testing at the Copenhagen University Hospital in Copenhagen, Denmark. The roots of this research can be traced to an earlier international study examining the usefulness of pulse oximetry The APSF was instrumental in providing support to that effort.

Congratulations to both of the APSF grant award winners and best wishes for success.

See the accompanying announcement of the Year 2000 APSF Grant Awards especially noting that the maximum award has been increased to $65,000.

Jeffrey B. Cooper, Ph.D., is Chairman of the APSF Scientific Evaluation Committee. He is Director of Biomedical Engineering, Partners Healthcare System, Inc., Director of the Center for Medical Simulation in Boston, Associate Professor of Anaesthesia, Harvard Medical School in the Department of Anesthesia and Critical Care, Massachusetts General Hospital and Chairman of the Research Program of the National Patient Safety Foundation.