DoctorIanthe Boden

Project Total: $1,244,761; In Australia there are approximately 180,000 major abdominal surgical operations each year, predominately for treatment of cancer. This surgery is not without risk. The estimated incidence of postoperative complications is reported to be about 20-40%. With an ageing population with increased co-morbid disease and increasing use of chemoradiotherapy before surgery, those with increased surgical risk will grow three-fold over the next 30 years, adversely impacting both patient outcomes and healthcare budgets if this problem is not addressed. The physiological challenge of major surgery has been likened to running a marathon. In both cases, preparation is critical. Yet, many patients embark on major surgery without understanding the consequences of surgery and are not prepared physically or psychologically for major surgery. This proposal is for a randomised hybrid trial (STTARRS) that measures both efficacy and implementability for delivering telehealth based multidisciplinary allied health and nursing preoperative education for all patients scheduled for colorectal surgery at several centres across Australia; Surgery School?. This preoperative intervention is not currently standard of care, nor is it included in the colorectal cancer optimal care pathway. We will measure complication rates, length of hospital stay as well as implementation outcomes (eg acceptability, scalability). Positive results are expected from this low cost, low risk intervention which will improve outcomes, increase capacity of allied heath clinicians, reduce healthcare costs, be easily scalable and embed new health interventions into clinical practice. The STTARRS trial addresses an evidence gap by providing the first evidence of the effects of multidisciplinary prehabilitation (education) intervention for improving surgical outcomes with an economic analysis in major abdominal cancer surgery. Funded by: Medical Research Future Fund - Grant-Clinician Researchers - Nurses Midwives &..; University of Melbourne; University of Tasmania.

Project Total: $574,120; Postoperative pulmonary complication (PPCs), such as pneumonia, can occur in one third of all patients undergoing major abdominal or cardiothoracic surgery. PPCs are strongly associated with increased morbidity and mortality. My previous research determined that preoperative physiotherapy (preop physio) halves PPC rates after major abdominal surgery and is cost-effective, however, significant gaps in knowledge remain. There is little data on contemporary PPC incidence rates nor the hospital and patient costs of a PPC, specifically within the Australian healthcare context. The COVID-19 pandemic has also caused hospitals to limit non-urgent face-to-face patient contact, including preoperative clinics. There is an urgent need to develop online/telehealth methods that are acceptable to patients and equally effective in preparing patients before surgery. This research program aims to answer the following questions: 1. What is the incidence of PPCs after major surgery? 2. What are the costs of a PPC to the patient and the hospital? 3. What interventions prevent PPCs? 4. Does online preop physio have similar treatment fidelity as face-to-face physio? by; a. Combining existing trial databases (4 trials, n=6840, 36 hospitals, 5 countries) that I lead with new data acquisition of episode of care hospital costings and analysis quality of life measures. b. A systematic review and meta-analysis of the evidence for interventions to prevent PPCs c. Co-designed development of online materials to educate and prepare patients for surgery d. A clinical trial comparing face-to-face preop physio to online content. This work will provide world-first international multicentre data on the incidence and cost of PPCs from both the hospital and patient perspective, new meta-analysis to inform clinical practice, and novel digital technology to improve the accessibility of evidence-based expert-delivered respiratory prehabilitation to millions of patients awaiting major surgery every year. Funded by: National Health & Medical Research CouncilNational Health & Medical Research Council - Fellowship-Investigator Grant ($1,148,240); University of Tasmania ($375,272).

Project Total: $19,989; Colorectal cancer is one of the most common cancers in Australia. The Northern Adelaide Local Health Network (NALHN) is the busiest Colorectal unit in South Australia and has the 4th highest colorectal cancer caseload in Australia and New Zealand. Despite advances in surgical and perioperative care, postoperative complications occur in around 30% of patients. Surgical patients are becoming increasingly complex with multi-morbidity and frailty. Prehabilitation is a structured, multi-modal preventative program that incorporates exercise, psychological and nutritional support to prepare a patient for major surgery. Prehabilitation in adult cancer surgery patients is associated with improved functional status, and reduction in hospital length of stay, however, the impact of higher risk subgroup, frail population is not well-studied. There is little data on the feasibility of implementing prehabilitation within pragmatic real-life contexts outside a clinical trial and this has made adaptation into routine surgical cancer care difficult. Our study, firstly, intends to prospectively describe the prevalence of preoperative frailty and functional status in the NAHLN adult (> 18 years) colorectal surgery patient cohort. Secondly, this study aims to assess the feasibility of providing a supervised multi-modal prehabilitation program that includes both an respiratory and exercise component to pre-frail and frail patients in all ages in a real-life context that has not been previously explored. This project will inform the re-designing of the NALHN perioperative care pathway and will also provide crucial baseline data to a subsequent phase 2 study This preliminary work will provide us insight into what a South Australian colorectal surgery prehabilitation program should look like. A subsequent multi-centre study intends to incorporate pre-operative comprehensive geriatric assessment to our refined prehabilitation. This study will be a prospective, mixed-methods, feasibility observational cohort study divided into 3 individual components. Part A: Describe the prevalence of frailty in all patients >18 years of age referred for major colorectal surgery at NALHN. Part B: Preoperative functional status and frailty measures in participants with CFS 4 Part C: Feasibility and acceptability of prehabilitation in participants with CFS 4 Dr Ianthe Bodens (UTAS) participation I have been collaborating with Dr Bianca Wong (CIA) for the past 3 years on the HEROES study conceptualisation and design. I have provided academic support in developing the study protocol and grant applications. I have provided content expert knowledge on prehabilitation and trial methodology. This study will comprise part of my collaborative research activities within my NHMRC Investigator Grant work 2023-2028. For HEROES I have already completed Lyall McEwin Hospital staff training of specific components of intervention delivery by local hospital staff (preoperative physiotherapy) in an HoS approved trip to Adelaide in 2023 as part of my NHMRC Investigator Grant activities. Once this study is completed I will provide assistance in data analysis, interpretation, and manuscript preparation Funded by: Northern Adelaide Local Health Network - Divisional and Directorate Research Grant; University of Tasmania.