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Contact Details

Phone
+64 3 474 0999 extn 58830
Email
john.woodfield@otago.ac.nz

University Links

Position
Senior Lecturer
Department
Department of Surgical Sciences (Dunedin)
Qualifications
MBChB(Otago) DTM&H(Liverpool) PhD(Otago) FRACS
Research summary
Measuring and preventing complications, improving fitness before surgery, colorectal surgery, clinical audit, medical care in resource poor settings
Teaching
  • Convenor of ALM6 rotation in surgery
  • Clinical teaching of ALM4 students
  • ELM2 Integrated Cases tutor
Memberships
  • Member, Royal Australasian College of Surgeons
  • Member, Colorectal Surgical Society of Australia and New Zealand
Clinical
General and colorectal surgery including colorectal cancer and IBD surgery, laparoscopic surgery, and colonoscopy

Research

My research interests include:

  1. High Intensity Interval Training (HIIT) to optimise fitness before major abdominal surgery: We have completed a RCT showing significant improvement in fitness and clinically relevant improvement in clinical outcomes. Current projects include optimising HIIT protocols in patients with medical comorbidities and a RCT comparing prehabilitation with HIIT in the hospital, home and the community.
  2. Low anterior resection syndrome (LARS) after anterior resection: We have completed a database of LARS after anterior resection for cancer at Dunedin Hospital. We are currently performing a cross over study assessing the importance of bile acid malabsorption, and have prospective studies planned assessing bacterial overgrown and the role of pelvic floor biofeedback physiotherapy with the ‘Contrain’ device.
  3. Complications after surgery. We are using a validated patient-centred questionnaire developed in our department to identify postoperative problems. Recent published work looks at complications that develop up to six weeks after surgery, and on the impact of incisional surgical site infections on patients. Previous work has examined the accuracy of clinical prediction of complications (and if this can be improved) and the role of prophylactic antibiotics.
  4. Audit and surgical outcomes: I am a co-director of the Otago Clinical Audit. OCA has documented all surgical procedures and complications at Dunedin for over 30 years. We are updating the program, and also use the data to support research and quality control initiatives within the Department of Surgery.
  5. Using ehealth to support patients on their surgical journey: We have partnered with SHI Global, a NZ based ehealth company to develop surgical care packs on an internet based software platform called Go Well Health. This supports patients through the process of diagnosis, prehabilitation, surgical care and convalescence in the community. Current work includes collaborating with the Kōhatu, Centre for Hauora Māori at the University of Otago to codesign the platform and to develop a total colorectal cancer pathway on-line. A series of pilot studies followed by a study to assess the impact of GWH on clinical outcomes are planned.
  6. Bowel preparation in elective colorectal surgery: We have completed a network meta-analysis on different methods of bowel preparation before elective colorectal surgery which was recently published in JAMA surgery. Future work will assess the impact of oral and intravenous antibiotics and mechanical bowel preparation on the microbiome.
  7. Improving outcomes associated with loop ileostomy: We are currently working with ‘The Insides Company’ in a RCT using a novel refeeding device to feed patients down the distal limb of their loop ileostomy before closure. Other recent studies have compared methods of loop ileostomy closure, and the impact of delay in closure on complications and length of stay.
  8. Working with collaborative research network: Including with STRATA assessing appendicitis in rural and urban patients and with the DISCO (surgical prehabilitation) and LARS international collaborative groups.
  9. Medical care in resource poor settings: Having worked in rural Africa as a surgeon for seven years I am interested in medical care in resource poor settings and have been involved in studies looking at trauma, tuberculosis (including the role of lymph node biopsy in diagnosing tuberculosis) and infertility

Other colorectal and general surgical projects that are ongoing or have recently been completed include:

  • Preventing ileus in elective colorectal surgery: A RCT assessing the role of prucalopride has recently been completed
  • ERAS in colorectal surgery
  • VRAM flap after abdominoperineal excision
  • Should surveillance colonoscopy be continued after the age of 75 in patients who have previously been treated for colorectal cancer?
  • The role of aspirin in treating colorectal cancer – the ASCOLT study
  • Case studies in surgery illustrating clinically relevant issues
  • Models assessing bowel damage during colonoscopy

Publications

Elliott, B. M., Bissett, I. P., Harmston, C., and STRATA Collaborative, including Hobson, A., Barnes, T., Tietjens, J., Stringer, M. D., Beasley, S. W., Woodfield, J., Murray, M., & Amer, M. (2023). The impact of delay and prehospital factors on acute appendicitis severity in New Zealand children: A national prospective cohort study. ANZ Journal of Surgery, 93, 1978-1986. doi: 10.1111/ans.18615 Journal - Research Article

Jiang, W., Koh, C., Solomon, M., Karunaratne, S., Beckenkamp, P. R., Clifford, K., Woodfield, J., & Steffens, D. (2023). Time to prioritise quality over quantity in prehabilitation trials: A literature review. Eurasian Journal of Medicine & Oncology, 7(3), 287-303. doi: 10.14744/ejmo.2023.14880 Journal - Research Other

Antoniou, S. A., Huo, B., Tzanis, A. A., Koutsiouroumpa, O., Mavridis, D., Balla, A., … Woodfield, J. C., … Morales-Conde, S. (2023). EAES, SAGES, and ESCP rapid guideline: Bowel preparation for minimally invasive colorectal resection. Surgical Endoscopy. Advance online publication. doi: 10.1007/s00464-023-10477-0 Journal - Research Other

Clifford, K., Woodfield, J. C., Tait, W., Campbell, H. A., & Baldi, J. C. (2023). Association of preoperative high-intensity interval training with cardiorespiratory fitness and postoperative outcomes among adults undergoing major surgery: A systematic review and meta-analysis. JAMA Network Open, 6(6), e2320527. doi: 10.1001/jamanetworkopen.2023.20527 Journal - Research Article

Clifford, K. A., Baldi, J. C., & Woodfield, J. C. (2023). Improving surgical outcomes with prehabilitation: Results from a comprehensive research program. In T. Milne, M. Anwar, L. Burga, H. Harcombe, M. Garelja, A. Middleton, D. C. Ribeiro, N. Fleming, K. Ogbuehi & A. Bahn (Eds.), Proceedings of the 266th Otago Medical School Research Society (OMSRS) Meeting: Research Staff Speaker Awards. Dunedin, New Zealand: OMSRS. Retrieved from https://ourarchive.otago.ac.nz/handle/10523/12839 Conference Contribution - Published proceedings: Abstract

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