TopMedTalk

Latest Episodes:

TopMedTalk Classic: Managing Perioperative Risk in Frail Patients Sep 07, 2026

Show notes

This month's TopMedTalk Classic has been digitally remastered for you and we've added the Q&A which wasn't part of the original podcast.

We're featuring a talk first broadcast in 2018, featuring BobbieJean Sweitzer, Systems Director, Preoperative Medicine, Inova Health, Falls Church, Virginia, and Professor of Medical Education, University of Virginia.

BobbieJean discusses whether perioperative risk in frail patients can be managed, emphasizing that current risk tools underweight frailty and functional outcomes. Using cases and data from U.S. nursing home residents, she highlights high postoperative mortality and functional decline after procedures such as colectomy and breast surgery, arguing for multidisciplinary, patient-inclusive decision-making that considers nonoperative and palliative options.

Sweitzer describes Northwestern's implementation of quick frailty and cognitive screening, plus interventions including anemia treatment, nutritional optimization, and elements of prehabilitation, noting evidence that screening can trigger goal clarification and more palliative care consults.

In the Q&A, speakers debate frailty-tool consensus, motivating patient engagement, funding prehab services, interpretation of mortality reductions after screening, and strategies to influence surgeons' decision-making.

Original podcasts:

https://topmedtalk.libsyn.com/periop-medicine-sig18-can-perioperative-risk-in-the-frail-be-managed

TopMedTalk: Periop SIG18 | Perioperative frailty - panel discussion

SMART trial designs, perioperative data ecosystems, and collaboration Sep 03, 2026

Show notes

At the Collaborative Clinical Trials meeting in Prato, Italy, Mike Grocott and co-host Mark Priestley speak with Sachin Kheterpal, University of Michigan Medical School's Associate Dean for Research Information Technology and the Robert B Sweet Professor and Kelley M. Kidwell, Chair of the Department of Anesthesiology and Professor of Biostatistics at the University of Michigan School of Public Health and Senior Associate Dean for Faculty Affairs .

Kidwell explains sequential multiple assignment randomized trials (SMART) as multi-stage designs that randomize at key decision points to evaluate treatment sequences, distinguishing them from adaptive trials and addressing misconceptions about sample size. Kheterpal describes the University of Michigan–led Multi-Center Perioperative Outcomes Group (MPOG), contrasting EHR-based automated extraction and individual provider feedback with manually collected programs like NSQIP, and discussing alignment with AQI/NACOR and inspiration from UK National Audit Projects to improve documentation for future inference. They note emerging use of large language models to extract outcomes from free-text notes, discuss pragmatic trial designs including THRIVE, and emphasize the value of close statistician–clinician collaboration and scientific humility, highlighting a BMJ talk on countering misinformation.

For more information on EBPOM Dingle, go here now: www.ebpom.org

Perioperative Profile: Dan Sessler Aug 31, 2026

Show notes

In this TopMedTalk perioperative profile, host Andy Cumpstey interviews Professor Dan Sessler, Vice President for Clinical and Outcomes Research and Professor of Anesthesiology and Biostatistics at UTHealth Houston (McGovern Medical School), about his career as a perioperative trialist with over 1,000 publications.

Sessler describes his scientific family background, early inspiration from clinical trials through Henry Kaplan's Hodgkin's work, and a shift from planned pediatric oncology to anesthesiology. He recounts building a research career starting with perioperative thermoregulation at UCLA and UCSF, then expanding into broad outcomes research, ultimately founding a large Department of Outcomes Research at the Cleveland Clinic and advocating for large multicenter trials.

He emphasizes mentorship, philanthropy, and his current focus on reducing postoperative mortality through better ward monitoring and prevention beyond "failure to rescue."

The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery.

Go now to http://www.ebpom.org

IARS 2026: Foundation for Anesthesia Education and Research (FAER) Aug 27, 2026

Show notes

At The International Anesthesia Research Society (IARS) and Society of Critical Care Anesthesiologists (SOCCA) meeting in Montreal, TopMedTalk hosts Mike Grocott and former editor-in-chief Desiree Chappell speak with FAER board members Dr. Rebecca A. Aslakson, Chair and Professor with Tenure, Department of Anesthesiology, University of Vermont Health Network and Dr. Michael Gropper, Professor and Chair of the UCSF Department of Anesthesia and Perioperative Care, about the Foundation for Anesthesia Education and Research (FAER).

We describe how FAER's early-career support—especially the Mentored Research Training Grant—helped launch our guest's own research trajectories and facilitates transition to larger funding, with about 60% of MRTG recipients later obtaining NIH funding.

They outline FAER's origins (founded in 1986 in partnership with the ASA), funding mechanisms spanning medical students to early faculty, partnerships with multiple specialty organizations, and career development resources including networking, mock study sections, and a National Academy of Medicine collaboration, emphasizing mentorship and community as central to long-term research success.

Find out more about EBPOM Dingle now: www.ebpom.org

TopMedTalk AI: AI-Augmented Ultrasound for Regional Anaesthesia Aug 24, 2026

Show notes

In Scotland at St Andrews, TopMedTalk AI hosts Andy Cumpstey and James Bowness discuss AI in regional anaesthesia with Bernard Victor Delvaux, staff anesthesiologist at the Centre Hospitalier Privé Claude Galien in Quincy-sous-Sénart, France.

Bowness describes a regional anaesthesia course using AI-augmented ultrasound imaging, augmented reality simulated needling, and cadaveric ultrasound with real needle insertion. Delvaux discusses his research in AI-assisted nerve recognition, explains supervised model development through large-scale ultrasound image annotation for GE Healthcare's C-NERF, and they explore how to evaluate AI beyond pixel-based metrics toward clinically oriented utility and safety, including differences in usefulness for trainees versus experts. They discuss model design across anatomical sites, the need for diverse training and external validation data, risks from poor image acquisition, and barriers such as trust and autonomy. Delvaux outlines priorities for ESRA's AI working group, focusing on AI literacy and faster, reliable evaluation guidance.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

Go now to http://www.ebpom.org

Breaking Trials: ITACS Trial on Preoperative IV Iron for Anaemia Before Cardiac Surgery Aug 20, 2026

Show notes

Recorded at the excellent ANESTHESIOLOGY® 2025 in San Antonio. Hear Andy Cumpstey and Mike Grocott interview Paul Myles, a Professor of Anaesthesiology and Perioperative Medicine at Monash University in Melbourne, Australia.

Here we focus upon his group's approach to large pragmatic, multicenter international trials and the process of selecting and developing study questions within a clinical trials network. Myles presents the ITACS trial (intravenous iron treatment for anaemia before cardiac surgery), designed because anaemia is common (~30%) in elective cardiac surgery and is associated with increased complications, longer hospital stay, mortality, and greater transfusion requirements, while prior randomized evidence supporting routine preoperative IV iron clinics has been weak despite observational associations.

The two-arm randomized controlled trial enrolled about 1,000 patients scheduled for cardiac surgery 1–26 weeks ahead across 33 hospitals in 10 countries; patients with anaemia due to causes unlikely to benefit from iron (e.g., megaloblastic anemia, certain iron storage diseases) were excluded, while non–iron deficiency anaemia was included. Participants received a single 1 g dose of IV iron in the weeks preoperatively, with a primary endpoint of days alive and at home at 90 days to capture patient-centered recovery and the functional impact of complications.

Results included a statistically significant one-day improvement in days alive and at home, modestly higher preoperative haemoglobin, markedly improved iron indices, and a marked reduction in red cell transfusions intraoperatively and through 30 days and 3 months; the team estimated saving 44 units of red cells per 100 patients treated. The one-day benefit was mainly driven by fewer readmission days, and a formal cost-effectiveness analysis (with Australian resource-use data) is underway with planned publication within six months. The discussion highlights why mild anaemia matters in major surgery due to postoperative blood loss and recovery, and notes that while extrapolation to other major surgeries with expected blood loss >500 mL may be considered, the hosts and Myles emphasize ongoing equipoise and the need for additional large randomized trials outside cardiac surgery.

We strongly suggest you investigate our forthcoming EBPOM Ireland conference, being held in the beautiful location of Dingle. World leading experts in perioperative medicine presenting the latest cutting edge research in periperative medicine and enhanced recorvery after surgery.

Find more information at EBPOM.org

EBPOM London 2026: European Postoperative Care Pathways Aug 17, 2026

Show notes

This presentation was recorded at the Evidence Based Perioperative Medicine (EBPOM) 2026 Annual Global Meeting.

It features Nicolai Bang-Foss, Consultant, head of GI and orthopaedic anaesthesia, Hvidovre University Hospital, Denmark

His main research field is the perioperative care of the elderly emergency patient. Specific areas of research have been regional analgesia, transfusion thresholds, outreach programs and perioperative logistics as well as perioperative haemodynamics.

He describes wide European variation in postoperative pathways driven largely by ICU bed capacity, with Scandinavian countries running lean systems that push PACUs toward 24-hour, higher-acuity perioperative units and preoperative optimization for emergency laparotomy and hip fracture care.

He outlines nonstandardized PACU/IMC structures, variable nursing education, and Danish strategies such as bypassing PACU for uncomplicated spinal anesthetic hip/knee replacements to free capacity for high-risk cases.

He also reports research suggesting PACU nurses' clinical judgment outperforms discharge scores and highlights deteriorating surgical ward staffing and post-COVID pressures affecting triage and outcomes.

If you'd like to hear presentations of this standard - before anyone else - we suggest you investigate our forthcoming EBPOM Ireland conference, being held in the beautiful location of Dingle. World leading experts in perioperative medicine presenting the latest cutting edge research in periperative medicine and enhanced recorvery after surgery.

Find more information at EBPOM.org

Breaking Trials: The VITAL trial on TIVA, volatiles and outcome Aug 13, 2026

Show notes

Recorded at the Evidence Based Perioperative Medicine (EBPOM) World Congress in London this episode of TopMedTalk sees Andy Cumpstey speaking with a panel of experts about the VITAL trial: a pragmatic randomised controlled trial about volatile vs total intravenous anaesthesia (TIVA) for major non-cardiac surgery in adult patients. The primary outcome was days alive and out of hospital at 30 days.

Despite finding no significant differences in the primary outcome, the trial reveals that patients receiving TIVA anesthesia experience better recovery, with less postoperative nausea and other side effects. The conversation also touches on the trial mechanics, related ongoing studies, and implications for future research and clinical practice.

Our guests include Professor Joyce Yeung, Director, Perioperative Medicine Clinical Trials Network, Associate Clinical Professor at University of Warwick and Honorary Consultant in critical care; Dr Shaman Jhanji, Consultant in Anaesthetics and Intensive Care Medicine at the Royal Marsden Hospital, London and Professor Bernhard Riedel, Director, Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia

The paper is here: https://jamanetwork.com/journals/jama/fullarticle/2852741

For more about EBPOM check out www.ebpom.org

ANZCA ASM: Emerging Leaders Aug 10, 2026

Show notes

At the ANZCA Annual Scientific Meeting in Auckland, Kate Leslie and Andy Cumpstey discuss ANZCA's Emerging Leaders Conference (ELC), a retreat-style program held immediately before the ASM for clinicians within five years of achieving FANZCA, with allowances for career disruptions.

Their guests, Dr Saana Taylor FANZCA and Dr Vik Singh FANZCA, co-conveners of this year's ELC, describe shaping this year's New Zealand-hosted ELC with an Aotearoa focus, naming it Te Herenga Matua ("the pursuit of consciousness") and emphasizing collaboration, communication, wellbeing, compassion, and equity.

The program included Māori and Pacific health sessions, leadership self-reflection, and an interactive session challenging fixed leadership "styles," alongside strong mentorship and networking with senior college leaders. Highlights included the openness of delegates, relationship-building, and a keynote on leadership "outside the box." Next year's ELC will be in the Adelaide Hills, with applications opening in September.

More here:

https://www.anzca.edu.au/fellowship/information-for-new-fellows/emerging-leaders-conference

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

Go now to http://www.ebpom.org

SOAP 2026: Ron George on community, partnerships, and expanding peripartum anaesthesia Aug 06, 2026

Show notes

From the 58th annual meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP) in Montreal, Mike Grocott and new co-host Joe Larvin speak with SOAP president Ron George about SOAP's growth to over 1,000 attendees and its international, collaborative community.

George outlines his career from Dalhousie to UCSF and back to Canada as director of obstetric anesthesia at Mount Sinai Hospital in Toronto, highlighting its high-risk referral practice and large, internationally diverse fellowship program. He reflects on his presidency's focus on mission alignment and partnerships, including work with the New York State Society of Anesthesia, discussions with the California Society of Anesthesia, and a planned memorandum of understanding with the World Federation of Societies of Anaesthesiologists (WFSA) to support evidence-based global education.

He also discusses formative work in low- and middle-income settings, advocacy, peripartum anesthesiologist roles, and meeting highlights such as trainees, pain during cesarean delivery panels, and the Gerard W. Ostheimer Lecture.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

Go now to http://www.ebpom.org

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