Speakers
Prof. Sophia CHEW
Senior Consultant
Singapore General Hospital
Singapore
Dr Sophia Chew obtained her MBBS from the National University of Singapore and subsequently trained to be an anesthesiologist. She obtained the MMED(Anaesthesia) from the National University of Singapore and the Fellowship of the Australian and New Zealand College of Anaesthestists. She did a fellowship training in cardiac anaesthesia at the Duke University Medical Centre in the United States of America.
Dr Chew currently practises at the Singapore General Hospital and is the Deputy Vice-Chair of Research, Anaesthesia Academic Program, Singhealth and the Director of Research at the Department of Anaesthesiology. Her research Interests include safety outcomes after cardiac surgery, airway management and perioperative medicine. She has published several peer reviewed papers in highly acclaimed journals. Dr Chew has oversight over research within the department as well as train medical students in research from both the Yong Loo Lin School of Medicine and Duke-NUS Medical School. Several of her research students have won international awards including the Best Paper at the IARS.
Dr Chew is the current President of the Singapore Society of Anaesthesiologists. She is also the Assistant Bursar, Council, Academy of Medicine, Singapore. She previously served as President of the College of Anaesthesiologists, Academy of Medicine. She chaired the Sedation Guidelines Committee, Ministry of Health.Despite advances in cardiac surgery, postoperative complications including cardiac surgery associated acute kidney injury (CSA-AKI) and atrial fibrillation (AF) remain significant clinical problems. This is especially important with cardiac surgical patients presenting at an advanced age with more comorbidities and advanced disease. The PEGASUS project followed a cohort of more than three thousand patients who underwent cardiac surgery at the two main national heart centres in Singapore.
The incidence of CSA-AKI and postoperative AF was 29.1% and 17.3% respectively. An AKI risk score and an AF risk score were developed to better quantify risks of these complications. A biorepository was also used to delineate genomic factors which may improve risk stratification.
During a mean follow-up of 4.4±2.8 years, 0.9% of the cardiac surgical cohort developed end stage renal disease (ESRD) requiring dialysis. Patients with CSA-AKI after cardiac surgery had a 7-fold higher risk of developing ESRD in the intermediate term and a 2-fold increased mortality.
Stroke occurred in 7.8% of patients in this cohort during the mean postoperative follow-up period of six ± two years. Patients with postoperative AF (including patients with pre-existing AF and those who developed new onset AF postoperatively) had a higher incidence of stroke compared to those without. Of interest is new-onset atrial fibrillation which was identified as an independent risk factor for postoperative stroke and associated with shorter survival.
Our study adds to the emerging evidence that CSA-AKI and postoperative AF in the cardiac surgical patients are not transient phenomena but may lead to ominous sequelae in the longer term.
In our ongoing project, we explored the role of continuous monitoring of delivery of oxygen and predictive algorithms for early detection of CSA-AKI and postoperative AF with the aim of deploying them in the clinical setting to improve outcomes after cardiac surgery.
