BJA/RCoA Career Development Grant: 2012

Chair's Report

Ten applications were received for the BJA/RCoA Career Development grant in total. Independent external review and scoring against set criteria took place in the weeks prior to the panel meeting on 4 December 2012 at the Royal College of Anaesthetists. Panel members were:

Professor Monty Mythen, Chair, University College London
Professor George Hall, St George's Hospital, London
Mr David Hepworth, Patient Liaison Group Representative, RCoA
Professor Phil Hopkins, University of Leeds, BJA
Professor John Myburgh, University of New South Wales, Sydney
Professor John Norrie, University of Aberdeen
Professor Nigel Webster, University of Aberdeen, BJA

In attendance:
Miss Clare Bunnell, NIAA Administrator
Miss Mary Casserly, RCoA Education & Research Manager

Following the presentation of each grant and detailed discussion by the panel on the day, it was agreed that the strongest candidates were Dr Rupert Pearse and Dr Chris Snowden. This was unanimous and consistent with the rankings based on the scores from the external reviewers.

It was an honour and a privilege to chair the committee and I am very grateful to all the independent reviewers, panel members and administrators. In particular, I would like to thank Mr David Hepworth (Patient Liaison), Professor John Norrie (Aberdeen) and Professor John Myburgh (Sydney) who generously gave up their time to help us on the day. The standard of applications was extremely high and our external advisors were most complimentary about all aspects of the awarding process and the final result. The lay abstracts from the two successful candidates are shown below. Congratulations to them and good luck with the work.

Professor Monty Mythen, Chair

Lay Abstract from Dr Rupert Pearse

Project title: Measuring and reducing surgical risk

Over 230 million patients undergo major surgery each year. Previous work by our group has shown that more than 80% of patients who die after surgery could have been identified as high-risk beforehand. Over 170,000 high-risk surgical procedures are performed each year in the NHS, following which 100,000 patients develop complications resulting in over 25,000 deaths. Variations in mortality between hospitals and countries strongly suggest the potential to improve patient outcomes.

One in four patients who develop complications will die without leaving hospital whilst those who survive suffer reductions in functional independence and one year survival. The high-risk surgical population consists primarily of older patients, with associated medical problems, who undergo major surgery. Common complications include pneumonia, heart attacks and infection. Doctors frequently fail to identify these high-risk patients and to admit them to a critical care unit to provide enhanced care after surgery. Patients who choose to undergo surgery often do so without the information they need to make an informed decision. The overarching aim of this fellowship proposal is to define which patients are most in need of critical care after surgery and to investigate the benefits of this approach.


  • To develop a simple score which doctors and nurses can use before surgery to provide a broad but accurate estimate of a patient's risk of death after surgery
  • To assess the accuracy of exercise testing and blood tests (plasma biomarkers) in providing a detailed estimate of the risk of complications and death after surgery
  • To provide evidence of the effect of critical care admission on patient survival following surgery.

Plan of investigation

  • Analysis of an existing large patient database to create a simple bedside score to categorise patients as low, intermediate or high risk of death after surgery
  • Large, international study to evaluate the ability of blood tests and exercise testing to identify patients at high risk of complications and death after surgery
  • Analysis of three existing large patient databases to provide evidence of patient benefit from admission to a critical care unit after surgery.

Potential impact
This research will completely redefine current concepts of adequate care for patients undergoing major surgery and provide definitive evidence to ensure objective and meaningful assessment of risk is possible for every patient. Both doctors and patients will better understand the risks and benefits of surgery allowing informed joint decision making. A clearly defined high-risk surgical population will allow us to design and conduct large clinical trials to confirm the benefit of new treatments for this population. This work fits closely with research priorities set out in successive national reports and most recently by the National Institute for Health Research themed surgery call. The award of this fellowship will also allow the applicant to leverage high-level institutional support for an ambitious local academic development strategy freeing up his time to provide leadership for large scale clinical trials and health services research. This proposal is therefore closely aligned with the objectives which underlie the creation of this fellowship and should lead to the applicant's appointment as a new professor.

Funding awarded: £249,837

Progress Reports
 First year progress report from Dr R Pearse (63 KB)
 Second year progress report from Dr R Pearse (144 KB)

Lay abstract from Dr Christopher Snowden

Project title: Exercise Therapy for the Older Surgical Patient

As the general population ages, increasing numbers of older people are undergoing major surgical operations. Unfortunately, advancing age is often associated with an increased risk of complications after surgery when compared to the young. Any surgical complication reduces functional
independence and life expectancy.

However, our recent research has shown that this poor outcome is not simply due to being older. An important message is that age alone should not be a barrier to surgery. Other factors, associated with advancing age have more influence on outcome. Cardiorespiratory fitness (CRF), a product of heart, lung, vascular and muscle function, is one such factor. Low CRF before major surgery predicts poor outcome. Since CRF also declines in a consistent, nonlinear fashion as people age, we believe that CRF relates to excess surgical risk, considerably more so than being old.

There is good evidence that exercise therapy increases CRF across all age groups. Improving preoperative fitness is intuitively likely to improve postoperative outcome. However, it remains unknown whether exercise therapy is either feasible or acceptable before surgery, especially in older
people, those most likely to benefit.

This Fellowship will allow me to lead a collaborative research program to directly address this priority perioperative issue. Working with experts based in Newcastle BRC for Age-related chronic disease, I will design a preoperative exercise intervention. It will aim to fulfil both the real world needs of the older patient and provide clinical efficacy in the setting of major surgery. The focus will be on older patients and their care teams, providing support to allow coordinated, effective management of the individual and NHS burden of elective major surgery.

The overall program is designed to fulfil the requirements for a successful NIHR bid. To do this the Fellowship is divided into four interrelated work streams (WS):

WS 1: Defining Barriers To Exercise Therapy for Older People.
This investigation will provide information concerned with attitudes and beliefs around exercise therapy in older surgical patients and health professionals before, during and after a defined period of exercise therapy.

WS 2: Development of Exercise Intervention
I will lead development of a pathway for pre-surgical structured exercise therapy in older people. Analysis of preliminary data will direct focus and steering group optimisation of a clinical implementation platform.

WS3: Pilot Study. Exercise Intervention in Clinical Context
Testing of the optimised exercise therapy platform in older patients, will allow further refinement in clinically relevant surgical pathways.

WS4: Feasibility Study. To identify the efficacy and acceptability of the intervention in older patients, in predefined surgical setting(s). Combined with the physical response to exercise therapy and the relation to postoperative outcome, the information will aid design of a definitive, implementation trial. This will be the end point of the fellowship.

Overall Impact:
Combined, these four phases will deliver the UK's first pathway for perioperative exercise therapy, designed for and with older people. It will lead to robust organisation of a definitive trial to investigate the benefit of exercise therapy related to surgical outcome.

Funding awarded: £234,327

Progress Reports
 First year progress report from Dr C Snowden (129 KB)
 Second year progress report from Dr C Snowden.pdf (118 KB)