Outcomes Research Consortium

Outcomes Research

Type	Non-profit organization
Genre	Clinical Research
Founder(s)	Dr. Daniel I. Sessler
Headquarters	Cleveland, OH
Number of locations	Louisville, Dublin, Tel Aviv, Vienna, Melbourne, Tokyo, and Dallas
Key people	Daniel I. Sessler MD and Andrea Kurz MD
Website	http://or.org

The Outcomes Research Consortium is an international clinical research group that focuses on the perioperative period (during and after surgery), along with critical care and pain management ^[1][2]. The Consortium’s aim is to improve the quality of care for surgical, critical care, and chronic pain patients and to “Provide the evidence for evidence-based practice.” ^[3] Members of the Consortium are especially interested in testing simple, low-risk, and inexpensive treatments that have the potential to markedly improve patients’ surgical experiences^{[citation needed]}.

History

The Outcomes Research Group was formed in 1990 at the University of California San Francisco. The Consortium now includes more than 100 university-based investigators at more than 20 hospitals in 10 countries. Its administrative center is the Department of Outcomes Research in the Anesthesiology Institute at the Cleveland Clinic in Cleveland, Ohio, U.S.

Research highlights

The Consortium coordinates more than 100 clinical trials, including large multi-center outcome studies. The results of these studies are disseminated in peer-reviewed medical journals and, with time, may be incorporated into medical practice. Since 2009 Consortium members published more than 125 full research papers, mostly related to anesthetic management.^[4]

Temperature Regulation During Surgery

A long-standing interest of the Consortium is temperature regulation during and after surgery. Body temperature is normally tightly regulated to about 37 °C (98.6 °F), with women being slightly warmer than men^[5]. But anesthetic drugs profoundly impair normal control^[6]. Impaired temperature control, combined with a cold operating room environment, makes most unwarmed surgical patients hypothermic by 1-3 °C^[7]. Randomized trials have shown that just a 1-2 °C reduction in body temperature triples the risk of serious heart problems^[8], triples the risk of wound infection^[9], prolongs recovery ^[10] and hospitalization ^[9], increases blood loss and transfusion requirement ^[11], and slows drug metabolism^[12]. Because hypothermia causes so many serious complications, The Surgical Care Improvement Project (SCIP) and Physicians Quality Forum have each made perioperative normothermia an outcome measure for hospital quality.^[13] Consortium thermoregulatory research has been covered by the Cleveland Plain Dealer ^[14], the Philadelphia Inquirer, Reuters Health, and United Press International.

Red Hair and Anesthesia

150 years after their discovery, how anesthetic gases work remains unknown. They work well in all mammals, rodents, insects, worms, fish, bacteria, and even plants^{[citation needed]}. The dose required in various species doesn’t differ much from the dose in humans. In non-human species, there are distinct genetic characteristics that clearly influence anesthetic sensitivity. But until recently, no genetic factors were known to influence anesthetic requirement in humans. In a series of studies, Consortium members have shown that the effective dose of anesthetic gases is about 20% greater in natural redheads than in people with other hair colors^[15]. Red hair results from a mutation of the melanocortin-1 receptor. The Consortium’s results thus indicate that something about this receptor influences anesthetic action. Red hair was the first phenotype (physically apparent characteristics linked to a genetic mutation) linked to anesthetic requirement in humans, and remains the only one. Consortium research on red hair and anesthetic requirement has been covered by the San Francisco Examiner ^[16], The Globe and Mail ^[17], and Readers Digest ^[18]. In further research, members of the Consortium found that redheads are resistant to local anesthetics^[19]. Consequently, they are more likely to suffer pain during dental procedures — and are therefore reluctant to receive needed dental care^[20]. Consortium research on red hair and dental avoidance has been covered by Macleans, the Boston Herald, and The New York Times^{[citation needed]}.

Blood Transfusion

A study published by Consortium members in 2008 identified a strong association between the age of transfused blood and complications after cardiac surgery. Transfusion of red blood cells stored for more than two weeks also increased the risk of death after cardiac surgery by 30% — an increase that was still apparent more than two years after surgery^[21]. These results call into question current blood banking practices, and underscore the need to prevent deterioration of stored blood and improve blood donation and transfusion strategies. The group is currently conducting several studies of transfusion practices^[22][23]. Consortium transfusion research has been covered by the Boston Globe [Smith, Stephen (2008-03-20). "Older donated blood tied to heart surgery risk". Boston Globe. Retrieved 2009-02-10] and the Los Angeles Times [Maugh, Thomas (2008-03-20). "Older Blood Is Linked To Deaths"].

Other Research Interests

Major ongoing initiatives for the consortium include acute and chronic pain management, fluid management, control of the surgical stress response, and cardiovascular outcomes. A particular interest of the group is long-term outcomes of anesthetic management. While the effects of anesthesia have traditionally been considered to dissipate within hours of surgery, there is increasing evidence that anesthetic management may alter patient outcomes weeks, months, or even years after surgery^[24].

Additional Sites

Site directors administer the most active Consortium affiliates at universities in Louisville, Dublin, Tel Aviv, Vienna, Melbourne, Tokyo, Buenos Aires, and Dallas.

See also

• Clinical Research

References

1. ^ Knight, Will (2002-10-15). "Red heads suffer more pain". New Scientist. Reed Business Information Ltd.. Archived from the original on 2008-05-09. http://web.archive.org/web/20080509034636/http://www.newscientist.com/article/dn2923-red-heads-suffer-more-pain.html. Retrieved 2010-06-01. 
2. ^ Park, Madison (2009-07-31). "Study: Redheads' extra pain may cause fear of dentists". CNN Health. Cable News Network. http://edition.cnn.com/2009/HEALTH/07/30/redhead.pain.dentist/. Retrieved 2010-06-01. 
3. ^ "Outcomes Research Consortium: About". Outcomes Research Consortium. http://www.or.org/about.htm. Retrieved 2010-06-01. "By linking the care people get to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care." 
4. ^ Outcomes Research Articles
5. ^ Lopez M, Sessler DI, Walter K, Emerick T, Ozaki M. (April 1994). "Rate and gender dependence of the sweating, vasoconstriction, and shivering thresholds in humans.". Anesthesiology 80 (4): 780–8. doi:10.1097/00000542-199404000-00009. PMID 8024131. http://journals.lww.com/anesthesiology/Abstract/1994/04000/Rate_and_Gender_Dependence_of_the_Sweating,.9.aspx. 
6. ^ Sessler DI (August 2008). "Temperature monitoring and perioperative thermoregulation.". Anesthesiology 109 (4): 318–38. doi:10.1097/ALN.0b013e31817f6d76. PMC 2614355. PMID 18648241. http://journals.lww.com/anesthesiology/Fulltext/2008/08000/Temperature_Monitoring_and_Perioperative.21.aspx. 
7. ^ Sessler DI.; Todd, Michael M. (February 2000). "Perioperative Heat Balance.". Anesthesiology 92 (2): 578. doi:10.1097/00000542-200002000-00042. PMID 10691247. http://journals.lww.com/anesthesiology/Abstract/1994/04000/Rate_and_Gender_Dependence_of_the_Sweating,.9.aspx. 
8. ^ Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C. (April 1997). "Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinical trial.". JAMA 227 (14): 1127–34. doi:10.1001/jama.1997.03540380041029. PMID 9087467. http://jama.ama-assn.org/cgi/reprint/277/14/1127?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Perioperative+maintenance+of+normothermia+reduces+the+incidence+of+morbid+cardiac+events%3A+A+randomized+clinical+trial.&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT. ^{[dead link]}
9. ^ ^{a b} Kurz A, Sessler DI, Lenhardt RA. (April 1996). "Study of wound infections and temperature group. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization.". N Engl J Med 334 (19): 1209–15. doi:10.1056/NEJM199605093341901. PMID 8606715. http://www.nejm.org/doi/pdf/10.1056/NEJM199605093341901. 
10. ^ Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Sessler DI, Narzt E, Lackner F. (December 1997). "Mild intraoperative hypothermia prolongs postanesthetic recovery.". Anesthesiology 87 (6): 1318–23. doi:10.1097/00000542-199712000-00009. PMID 9416715. http://journals.lww.com/anesthesiology/Fulltext/1997/12000/Mild_Intraoperative_Hypothermia_Prolongs.9.aspx. 
11. ^ Rajagopalan S, Mascha E, Na J, Sessler DI. (January 2008). "The effects of mild perioperative hypothermia on blood loss and transfusion requirement: a meta-analysis.". Anesthesiology 108 (1): 71–7. doi:10.1097/01.anes.0000296719.73450.52. PMID 18156884. http://journals.lww.com/anesthesiology/Fulltext/2008/01000/The_Effects_of_Mild_Perioperative_Hypothermia_on.13.aspx. 
12. ^ Heier T, Caldwell JE. (May 2006). "Impact of hypothermia on the response to neuromuscular blocking drugs.". Anesthesiology 104 (5): 1070–80. doi:10.1097/00000542-200605000-00025. PMID 16645461. http://journals.lww.com/anesthesiology/Fulltext/2006/05000/Impact_of_Hypothermia_on_the_Response_to.25.aspx. 
13. ^ Hypothermia
14. ^ Kaye Spector (23 March 2010). Warm wakeup from surgery has roots. Cleveland doctor. http://www.cleveland.com/healthfit/index.ssf/2010/03/warm_wakeup_from_surgery_has_r.html. Retrieved 2010-09-19 
15. ^ Liem EB, Lin CM, Suleman MI, Doufas AG, Gregg RG, Veauthier JM, Loyd G, Sessler DI. (August 2004). "Anesthetic requirement is increased in redheads.". Anesthesiology 101 (2): 279–83. doi:10.1097/00000542-200408000-00006. PMC 1362956. PMID 15277908. http://journals.lww.com/anesthesiology/Fulltext/2004/08000/Anesthetic_Requirement_Is_Increased_in_Redheads.6.aspx. 
16. ^ http://www.or.org/news/sfe_10_2002.htm
17. ^ http://www.or.org/news/gam_10_2002.htm
18. ^ http://www.or.org/news/rd_1_2003.htm
19. ^ Liem EB, Joiner TV, Tsueda K, Sessler DI. (March 2005). "Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads.". Anesthesiology 102 (3): 509–14. doi:10.1097/00000542-200503000-00006. PMC 1692342. PMID 15731586. http://journals.lww.com/anesthesiology/Fulltext/2005/03000/Increased_Sensitivity_to_Thermal_Pain_and_Reduced.6.aspx. 
20. ^ Binkley CJ, Beacham A, Neace W, Gregg RG, Liem EB, Sessler DI. (July 2009). "Genetic variations associated with red hair color and fear of dental pain, anxiety regarding dental care and avoidance of dental care.". J Am Dent Assoc 140 (7): 896–905. PMC 2740987. PMID 19571053. http://jada.ada.org/cgi/content/full/140/7/896. 
21. ^ Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, Blackstone EH. (March 2008). "Duration of red-cell storage and complications after cardiac surgery.". N Engl J Med 358 (12): 1229–39. doi:10.1056/NEJMoa070403. PMID 18354101. http://www.nejm.org/doi/full/10.1056/NEJMoa070403. 
22. ^ Red Cell Storage Duration and Outcomes in Cardiac Surgery - Full Text View - ClinicalTrials.gov
23. ^ Transfusion Strategies in Cardiac Surgery - Full Text View - ClinicalTrials.gov
24. ^ Sessler DI. (July 2009). "Long-term consequences of anesthetic management (editorial).". Anesthesiology 111 (1): 1–4. doi:10.1097/ALN.0b013e3181a913e1. PMID 19512884. http://journals.lww.com/anesthesiology/Fulltext/2009/07000/Long_term_Consequences_of_Anesthetic_Management.2.aspx. 

External links

• Outcomes Research Consortium
• Cleveland Clinic Department of Outcomes Research