Long-Term Outcomes after Perioperative and Intensive Care – Max Bell research group

Our research

Around 50 000 patients are treated in Intensive Care Units and more than 800 000 patients undergo surgery and anesthesia in Sweden every year. With perioperative and intensive care offered to an elder and comorbid population complications increase, contributing to long-term morbidity. In the perioperative setting complications increase risk of death five-fold. Perioperative death, within 30 days following surgery, has been reported to be the 3rd leading cause of mortality, exceeded only by heart disease and cancer.

We have multiple ongoing projects regarding long-term mortality and morbidity after perioperative care; focusing on myocardial injury and -infarction, acute kidney injury as well as cognitive dysfunction and stroke. We are investigating intraoperative hypotension and other modifiable factors. For future interventional trials to be effective it is essential to focus on the right patients, those with the highest risk of adverse events; can we describe these at-risk-individuals? What are the perioperative risks of stroke, pneumonia and acute kidney injury? We also study potential effects of wireless monitoring of high-risk patients in the postoperative and post intensive care setting.

With regards to critical illness and multiorgan failure, we investigate the impact of acute kidney injury (AKI) and study both kidney injury biomarkers- and functional biomarkers and their association with long-term outcomes. Is it possible to detect patients at risk for further renal deterioration and can interventional programs minimize that risk?  

Selected publications

Risk factors for COVID-19-related death, hospitalization and intensive care: a population-wide study of all inhabitants in Stockholm
Hergens M P, Bell M, Haglund P, Sundström J, Lampa E, Nederby-Öhd J, Rotzén Östlund M, Cars T.
Eur J Epidemiol. 2022 Jan 27

Intraoperative Hypotension and Myocardial Infarction Development Among High-Risk Patients Undergoing Noncardiac Surgery: A Nested Case-Control Study.
Hallqvist L, Granath F, Fored M, Bell M
Anesth Analg 2021 Feb;():

Renal resistive index is associated with acute kidney injury in COVID-19 patients treated in the intensive care unit.
Renberg M, Jonmarker O, Kilhamn N, Rimes-Stigare C, Bell M, Hertzberg D
Ultrasound J 2021 Feb;13(1):3

Biomarker-guided management of acute kidney injury.
Kane-Gill SL, Meersch M, Bell M
Curr Opin Crit Care 2020 12;26(6):556-562

Heart Failure in Patients Undergoing Elective and Emergency Noncardiac Surgery: Still a Poorly Addressed Risk Factor.
Faxén UL, Hallqvist L, Benson L, Schrage B, Lund LH, Bell M
J Card Fail 2020 Dec;26(12):1034-1042

Feasibility of renal resistive index measurements performed by an intermediate and novice sonographer in a volunteer population.
Renberg M, Kilhamn N, Lund K, Hertzberg D, Rimes-Stigare C, Bell M
Ultrasound J 2020 May;12(1):28

Myocardial infarction after noncardiac surgery in Sweden: a national, retrospective observational cohort study.
Hallqvist L, Granath F, Bell M
Br J Anaesth 2020 07;125(1):47-54

The impact of patient sex on intensive care unit admission: a blinded randomized survey.
Zettersten E, Jäderling G, Larsson E, Bell M
Sci Rep 2019 10;9(1):14222

Days at Home after Surgery: An Integrated and Efficient Outcome Measure for Clinical Trials and Quality Assurance.
Bell M, Eriksson LI, Svensson T, Hallqvist L, Granath F, Reilly J, Myles PS
EClinicalMedicine ;11():18-26

Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors.
Rimes-Stigare C, Ravn B, Awad A, Torlén K, Martling CR, Bottai M, Mårtensson J, Bell M
Crit Care Res Pract 2018 ;2018():7698090

Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery: An observational study.
Hallqvist L, Granath F, Huldt E, Bell M
Eur J Anaesthesiol 2018 04;35(4):273-279

Superiority of Serum Cystatin C Over Creatinine in Prediction of Long-Term Prognosis at Discharge From ICU.
Ravn B, Prowle JR, Mårtensson J, Martling CR, Bell M
Crit Care Med 2017 Sep;45(9):e932-e940

• Innovationsfonden, SLL
   
• Stockholm County Council
   
• Hjärt-Lung-fonden
   
• Baxter Medical

Group members

Our research focuses on mortality and morbidity following major surgical procedures and critical illness.

Approximately 50,000 patients are treated in intensive care units, and over 800,000 patients undergo surgery and anesthesia in Sweden each year. When perioperative and intensive care are provided to an older and sicker population, the risk of complications increases, contributing to elevated long-term mortality. Perioperative complications quintuple the risk of death. Perioperative mortality within 30 days after surgery has been reported as the third leading cause of mortality, surpassed only by heart disease and cancer.

Our group has several ongoing projects examining long-term risks of death and morbidity after perioperative care, with a focus on heart injury and infarction, acute kidney injury, as well as cognitive dysfunction and stroke. We investigate intraoperative blood pressure drops and other modifiable factors. To make future interventional studies effective, it is essential to identify high-risk patients, those with the greatest risk of complications; can we characterize this population? What are the perioperative risks for stroke, pneumonia, and acute kidney injury? We also explore the potential benefits of wireless monitoring of vital parameters for postoperative and post-intensive care patients.

Concerning critical illness and multi-organ failure, we study acute kidney injury (AKI) and how kidney injury and function markers can predict long-term outcomes. Can we detect patients at risk of future kidney function impairment, and can interventional programs reduce that risk?

Our research focuses on mortality and morbidity following major surgical procedures and critical illness.

Approximately 50,000 patients are treated in intensive care units, and over 800,000 patients undergo surgery and anesthesia in Sweden each year. When perioperative and intensive care are provided to an older and sicker population, the risk of complications increases, contributing to elevated long-term mortality. Perioperative complications quintuple the risk of death. Perioperative mortality within 30 days after surgery has been reported as the third leading cause of mortality, surpassed only by heart disease and cancer.

Our group has several ongoing projects examining long-term risks of death and morbidity after perioperative care, with a focus on heart injury and infarction, acute kidney injury, as well as cognitive dysfunction and stroke. We investigate intraoperative blood pressure drops and other modifiable factors. To make future interventional studies effective, it is essential to identify high-risk patients, those with the greatest risk of complications; can we characterize this population? What are the perioperative risks for stroke, pneumonia, and acute kidney injury? We also explore the potential benefits of wireless monitoring of vital parameters for postoperative and post-intensive care patients.

Concerning critical illness and multi-organ failure, we study acute kidney injury (AKI) and how kidney injury and function markers can predict long-term outcomes. Can we detect patients at risk of future kidney function impairment, and can interventional programs reduce that risk?

Groupmembers: 

• Max Bell - Senior Lecturer/Consultant, Research Group Leader 
• Linn Hallqvist - Postdoctoral Researcher 
• Daniel Herzberg - Postdoctoral Researcher 
• Anna Milton - Postdoctoral Researcher 
• Bo Ravn - Postdoctoral Researcher 
• Claire Rimes-Stigare - Postdoctoral Researcher 
• Mårten Renberg - PhD Candidate 
• Ellen Leigard - PhD Candidate 
• Arman Valadkhani - PhD Candidate 
• Matteo Bottai - Affiliated Statistician 
• Fredrik Granath - Affiliated Statistician