Prof. Bernhard RIEDEL
Director of the Department of Anaesthesia
Perioperative and Pain Medicine Peter MacCallum Cancer Centre
Bernhard is an academic anaesthesiologist, the Director, Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, and Professorial appointment at the University of Melbourne in Australia. Prior appointments include Professor and Deputy Chair, Anesthesiology and Intensive Care, M.D. Anderson Cancer Centre (USA); Professor of Cardiothoracic Anesthesiology, Vanderbilt University (USA); Consultant Anaesthetist, Royal Brompton & Harefield NHS Trust (UK). To address the ‘hidden pandemic’ of morbidity and death after surgery, his research is focused on improving outcomes after major surgery through enhanced preoperative risk stratification and optimization of modifiable risk. Specific to cancer surgery, he investigates the interaction of perioperative adrenergic-inflammatory response and anaesthetic technique on tumour-progression/recurrence. His research program has resulted in research grants (>$14M), >200 peer-reviewed scientific publications (including: Lancet, New England Journal Medicine, JAMA, Cancer Research, Nature Reviews, British Journal Anaesthesia), and has been cited >3,000 times. He has edited three books (including ‘Acute Care of the Cancer Patient’). Bernhard has delivered >200 lectures at national/international conferences and effective mentorship has resulted in numerous awards to team members for clinical service, quality improvement, and research.
Disturbingly, one in four people suffer complications after surgery. Death within 30 days after surgery is the 3rd leading cause of death worldwide (after death from ischaemic heart disease and death from stroke). Even mild complications, such as postoperative lung complications (occurring in as much as one in three patients after major surgery), associate with increased postoperative death. Aside from increasing mortality, postoperative complications also increase hospital length of stay, re-admission rates, increased healthcare expenditure, and delay the timely return to adjuvant therapy for cancer patients and thereby impact their cancer survival. It is increasingly recognised that unchecked modifiable preoperative risk (e.g., deconditioning from poor fitness [functional capacity], malnutrition, etc.) is a key driver of postoperative complications. The physiological challenge of major surgery is likened to running a marathon—in both cases, preparation is critical. Yet, many patients with cancer embark on major cancer surgery in a deconditioned state. Prehabilitation allows preparation for major surgery by improving the physiologic capacity of patients to withstand the stressor of major surgery. Prehabilitation is delivered as a multimodal intervention bundle tailored to the individual and focuses on patient education, exercise, nutrition and psychological support provided before surgery. The benefits of prehabilitation are promising, albeit within the limitations of small RCTs, with a significant reduction in complications after general abdominal surgery. Current recommendations are to provide stepped, individualised interventions based on risk assessment, with the therapy delivered as universal (all patients), targeted or specialist prehabilitation.