BULLETIN

Page 20 | Bulletin 92 | July 2015
snap1@rcoa.ac.uk
www.niaa-hsrc.org.uk/SNAPs
The first manuscript (the study
protocol) was published by the
journal, Perioperative Medicine in
April, and all collaborators were listed
in an appendix; the collaborators’
names will be added to Pubmed,
although this may take a little time
owing to the number of contributors.
Ellie is working hard on the main
manuscripts, and an initial results
paper will hopefully be submitted to
journals for peer review in July; our
hope is that some results manuscripts
will be published before the end of
2015, but we will have to wait and
see how the reviewers respond! Our
preliminary look at the results (shared
with some QuARCs at their annual
meeting in March) demonstrates
the value of these data: we now have
important (and sometimes surprising)
information about the prevalence of
different types of anaesthesia-related
discomfort in different types of
surgery, which will generate important
benchmarking targets, and contribute
to the literature which we provide to
patients about what to expect in the
perioperative period.
SNAP-2: EPIdemiology of Critical
Care after Surgery (EPICCS)
So, now to start planning for SNAP-2.
This study is again being supported by
the NIAA, RCoA and specifically by the
AAGBI through a project grant awarded
in December 2014. EPICCS will
focus on decision-making regarding
postoperative critical care admission.
We already know from a number of
high-profile epidemiological studies
that many patients who die soon after
surgery do not receive critical care
support during their surgical episode.
However, the reasons for this are
unclear: is it lack of resources, lack
of appropriate risk-stratification by
clinicians, or the fact that there may
still be equipoise over the benefit of
immediate postoperative critical care
admission in some settings? Despite
this possible equipoise, there may also
be uncertainty over the ethics and
feasibility of undertaking a randomised
controlled trial of postoperative critical
care admission as a treatment strategy;
therefore, a major part of EPICCS will
also be an attempt to determine the
benefit (or otherwise) of postoperative
critical care admission, by using two
relatively novel statistical methods
which can be applied to cohort studies:
Instrumental Variable Analysis and
Propensity Score Matching. This will
be an exciting study and one which we
hope will substantially contribute to
the debate over perioperative resource
utilisation and how we can provide best
care for our high-risk patients. We are
currently seeking a trainee-lead for this
study and they should be appointed by
the time this article is published. We
look forward to working with them and
with the wider anaesthetic community
on delivering another SNAP.
SNAP-3 and beyond…?
On some levels, SNAP-1 may already
be viewed as a success in terms of
supporting research endeavours in
a large number of hospitals (many
of which do not consider themselves
to be ‘academic’) and in terms of
professional engagement and patient
recruitment. The hard work of getting
manuscripts published is far from over,
and successful publication in a good
quality journal remains an important
goal. However, our aspiration is that
the SNAPs should continue, and will
hopefully become a ‘brand’ which
is as recognisable as the ‘NAPs’.
Importantly, we hope that SNAP-
3 and beyond will open up further
opportunities for the profession:
for example, through enabling open
invitations to suggest future topics,
and through supporting new chief
investigators and new trainee-leads
for every successive SNAP. We hope
that professional engagement will be
maintained and grow further, and
above all, we thank you very much for
your support so far.