KFJ award 2011 goes to bold and world-renowned researcher

“It is rare that the highest quality of research is implemented in a paradigm shift for a whole world of treatment.” Meet the winner of the KFJ award 2011, Professor Henrik Kehlet, Consultant, MD.

He has researched closely with patients for more than 40 years and is world-renowned for his evidence-based research into post-op recovery and for developing the concept ‘fast-tract surgery’ or ‘accelerated recovery’, which in many contexts has turned the world of the conventional ‘latin’ doctor on its head, and in practice has revolutionised work methods and working procedures at hospitals world-wide.

His success is international and is practised within a number of specialist areas, such as breast surgery, orthopaedic surgery, abdominal surgery, lung surgery, vascular surgery and urology. Patients have less pain, leave the hospital bed faster with consequent fewer complications, and can be discharged after shorter admissions. For a number of elective operations, admission time has been more than halved in the past decade. Benefits go to the patients as well as the health service.

A cheeky boy and a flat tyre
Yet Professor Kehlet, Consultant, MD, still plays the role as the cheeky boy of the class and stubbornly continues to pursue the basic question: Why is it still dangerous to be admitted to hospital for surgery?

“The basic problem is that when people are traumatised, we react differently than when we have a flat tyre on our bicycle and replace the the old tube with a new. You can ride your bike again, but the patient who has undergone surgery is still “flat” and not ready to go home. Patients are in unnecessary pain, suffer from fatigue, nausea and vomit and have many discomforts. They do not drink or eat, and therefore they do not leave the hospital bed, which is the most ‘dangerous’ place a patient who has undergone recent surgery can be,” said Professor Kehlet.

Concepts and nausea in the system
According to Professor Kehlet, many employees in the health sector “feel sick” when they hear about accelerated recovery, which unfortunately is because many employees have misunderstood this concept. Basically, it is about reducing the patient’s risk of complications and other unwanted consequences during admission and surgery.

“A common misconception is that the primary goal of the concept for accelerated patient courses and fast-track surgery is to reduce admission time from, for example, four to two days or less. Actually, it is rather simple. Patients must be made well quicker. Moreover, the discharge criteria are the same, no matter how long the patient is admitted,” said the internationally acclaimed clinical researcher, who admits to being persistent and impatient on behalf of the patient, when it comes to implementation and the speed at which it happens.

Success and ongoing challenges
“It is true that in practice the concepts of fast-track surgery and accelerated patient courses have been able to document epoch-making results world-wide. And it is also true that instead of being long-term and painful in the aftermath, a number of operations are now being carried out in a much shorter time than previously, and with far less discomfort for the patients; both in Denmark and abroad. So far so good. But we are still facing a number of basic challenges, and for me there is no doubt that we can become much better, when it comes to actual product control. We often lack own data, and we have to become much better at ensuring that we act on data in practice. This means on the basis of product control,” said Professor Kehlet.

However, there is still a need for intensive research into the mechanisms for why a patient undergoing surgery has a risk of developing chronic pain, blood clots, amnesia, rehabilitation needs, etc. The list of complications is long. One of the basic mechanisms is the surgical stress response with a combination of stress-hormone release and inflammation, which together affects organs inappropriately. The future will focus on minimal invasive surgery and pharmaceutics to provide ‘pain-free, stress-free and risk free surgery’.

“We have to keep asking patients and staff alike the same basic and simple question: Why are you in hospital? And based on the many answers, intervene and prevent pain, fatigue, organ impact and thereby complications and long-term convalescence. In brief, we must continue to research into post-op recovery, but we must also use the knowledge we already have within surgical pathophysiology and convert this into to practice. In this context, we probably also need to look into whether there is a need for more updated professional management together with increased own product control,” said Professor Kehlet.

About the KFJ award 2011
Kirsten and Freddy Johansen’s medical award, the KFJ award, which is presented by the Faculty of Health Sciences; University of Copenhagen, is one of Denmark’s largest and most prestigious awards. With the award comes DKK 1.5 million.
In 2011, the award has been presented to a clinical researcher as well as a pre-clinical researcher for the first time.

Professor Henrik Kehlet, Consultant, MD, is the first recipient of this clinical KJF award. The award was presented to him for his work on improving surgical courses for patients. The assessment committee of the KFJ award wrote in its nomination “It is rare that the highest quality of research is implemented in a paradigm shift for a whole world of treatment.”

The award ceremony took place on 21 June 2011 at the University of Copenhagen, where the pre-clinical research award was also presented to Professor Henrik Clausen for his work on decoding the third language of life; glycoconjugates.