The thought of undergoing surgery triggers anxiety in many of us—whether it is the first time or one of many, a minor or complex operation. The reassuring news, says Holger Eltzschig, MD, PhD, is that surgery has become safer over the years thanks to refined surgical techniques and advancements in anesthesia.
“Since the 1950s, we went from one out of 1,000 to now one out of 200,000 people dying from causes related to anesthesia,” Eltzschig says. “This is because we developed better ways to monitor patients, safer drugs, and a specialty training for anesthesiologists.”
However, perioperative mortality—deaths related to the period after surgery—has remained unchanged.
“Patients often come out of the surgery actually quite healthy. The surgery goes well, but they develop some kind of perioperative organ injury,” explains Eltzschig. “It could be injury to the kidney, liver, heart, or lung. It’s really a problem.”
In fact, dying within 30 days following an operation is a leading cause of death in the United States and across the globe, resulting in at least 42 million deaths worldwide each year.
This inspired Eltzschig to establish the Center for Perioperative Medicine at McGovern Medical School at UTHealth. “UTHealth has a strong clinical enterprise, so we wanted to leverage this clinical environment in a highly collaborative way that is truly bench to bedside and then bedside to bench,” he explains.
The center, comprising of more than 100 members across McGovern Medical School, fosters collaboration between discovery scientists and clinicians to identify novel treatment approaches to improve the health of patients undergoing major surgery, which can lead to common complications such as multiple organ failure and systemic inflammatory response syndrome. The interdisciplinary center includes anesthesiologists, surgeons, critical care physicians, physician-scientists, and discovery scientists from the fields of cancer and kidney, liver, heart, and lung disease.
Beginning in 2018, the group meets monthly to foster communication and connections among members. Junior and senior members have the opportunity to present their research for critique to a panel, mimicking the process similar to review by the National Institutes of Health, which strengthens the research and helps educate the next generation of physician-scientists.
Co-Director of the center and discovery scientist Changqing (Cynthia) Ju, PhD, collaborates with clinicians to understand the inflammatory mechanisms of acute and chronic liver disease to help develop methods to protect vital organs from surgery complications. She believes her research into the inflammatory response of the liver following surgery has implications for other organs as well.
“Following surgery, the innate immune system is triggered and can create a cytokine storm,” says Ju. Cytokines are cell-signaling molecules involved in the immune response that rouse cells toward sites of inflammation, infection, and trauma. These cytokines can overact, causing flu-like symptoms, tissue injury, and cell death. “If we can figure out the cellular and molecular causes of inflammation, then we can develop treatments to prevent and overcome it.”
The symbiotic and collaborative nature of the center enables discovery scientists like Ju to integrate with physician-scientists, allowing physicians to ask clinically important questions in a discovery research environment and for discovery scientists to address questions from the laboratory in patients.
“We are still a young center, but we have been quite successful in getting people together to pursue collaborative research. Additional philanthropy will allow us to recruit exceptional research faculty to make a transformative impact on the patients who are getting care here,” explains Eltzschig. “We share one goal: We want to make surgery safer.”