Project to improve perioperative care for older people receives NHMRC Partnership Project grant

Professor Janet Anderson

Professor Janet Anderson from the School of Translational Medicine has received a National Health and Medical Research Council 2023 Partnership Projects PRC2 grant to lead a research project that will develop comprehensive geriatric assessments to improve perioperative care for older people.

The research aims to establish the effectiveness, cost effectiveness and implementation pathways for comprehensive geriatric assessments (CGA) in Australian health services for older people having elective hip and knee replacements. An implementation roadmap for Australian health services will also be developed through a hybrid Type I effectiveness-implementation trial incorporating a stepped wedge randomised controlled trial with an embedded process evaluation.

Over 310 million people undergo major surgery worldwide annually, including over 2 million in Australia, and a significant proportion of these patients are aged over 65 years. Osteoarthritis affects 15 per cent of the older population, causing pain and disability. Although daily exercise and, to a lesser extent, simple analgesics are effective treatments, joint replacement remains the main treatment option for advanced cases.

Older people presenting for surgery have increasingly complex health problems and experience poorer outcomes, including complications, re-admissions and longer lengths of stay. One reason for poorer outcomes in older people having surgery is the lack of routine expert geriatric assessment in their pre and post-surgical care. Although there is growing evidence internationally of the benefits of CGA, its adoption in Australia has been slow. This is due to a lack of evidence for its effectiveness in elective knee and hip replacements, and the absence of an implementation framework to guide health organisations in different settings to effectively plan, manage and integrate it into their services.  Successful models of care in other surgical contexts, such as elective abdominal surgery, involve shared decision-making between key disciplines, guided by CGA, and focus on outcomes most relevant to patients.

As knee and hip joint replacements are the most common surgical procedures for older patients in Australia, and demand is projected to increase significantly, addressing their specific needs becomes crucial in managing health budget, resources, and accessibility. The research team’s ultimate objective is to enhance evidence-based practices in surgery and perioperative care for knee and hip joint replacements, leading to reduced complications, shorter hospital stays, more healthy days at home, and improved disability-free survival for older people having surgery.

The Chief Investigators on the multidisciplinary research team include:

  • Professor Velandai Srikanth, Director of the National Centre for Health Ageing
  • Professor Ian Harris, Professor of Orthopaedic Surgery at UNSW, Honorary Professor at the School of Public Health and Institute for Musculoskeletal Health at the University of Sydney, and Director of the Whitlam Orthopaedic Research Centre within the Ingham Institute for Applied Medical Research
  • Professor Paul Myles, Head of Alfred Health and Monash University's Department of Anaesthesiology and Perioperative Medicine
  • Professor Tracey Bucknall, Alfred Deakin Professor at Deakin University, and the Foundational Professor of Nursing and Director of Nursing Research at Alfred Health.
  • Associate Professor Natasha Brusco, rehabilitation stream lead in the Rehabilitation, Ageing and  Independent Living (RAIL) Research Centre at Monash University
  • Associate Professor Darshini Ayton from the School of Public Health and Preventive Medicine,  a transdisciplinary implementation researcher, with a focus on  consumer and community involvement in research and practice and improving health and social care  for older Australians
  • Professor Andrew Forbes - Professor of Biostatistics at Monash University. He is the head of  the Division of Quantitative Research Methods in the School of Public Health and Preventive  Medicine.
  • Professor Guy Ludbrook - Professor of Anaesthesia at the University of Adelaide and Royal Adelaide Hospital.
  • Dr Margot Lodge - geriatrician and PhD candidate

Professor Anderson was pleased to receive the National Health and Medical Research Council grant. “We are hopeful that the research project will have a highly positive impact on patient outcomes and healthcare costs, and produce the necessary guidance for healthcare organisations to introduce CGA effectively” she said. “I look forward to working with our talented multidisciplinary team to improve care for older surgical patients.”

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