Through the study of breast cancer outcomes data, we seek to inform treatment practices and improve patient care for breast cancer. We are currently investigating national as well as institutional level data to 1) characterize practice patterns for patients with ductal carcinoma in situ (DCIS) across the U.S.; 2) understand the implications of new consensus guidelines on margin status for early stage breast cancers from the Society of Surgical Oncology and American Society for Radiation Oncology on reexcision lumpectomy rates for breast conserving surgery, 3) explore the role of racial disparities among breast cancer screening and treatment programs.

A variety of research studies to reduce length of stay, decrease complications and mortality, decrease readmissions and improve overall outcomes of endocrine surgery patients are underway. Studies include comparative effectiveness, patterns of care, physician-patient communications, as well as disparities.

Visit the UAB Neuroendocrine Surgery Lab or learn more about the UAB Endocrine Surgery Clinical Research Program.

Dr. James Kirklin is the principal investigator of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), a national registry that tracks patients who are receiving mechanical circulatory support device therapy to treat advanced heart failure. The registry is a joint effort of the National Heart Lung and Blood Institute, Centers for Medicare and Medicaid Services, the Food and Drug Administration, clinicians, scientists and industry representatives.

Division of Cardiothoracic Surgery's Benjamin Wei, M.D., and James Donahue, M.D., work collaboratively to analyze institutional and national databases to improve oncologic outcomes, reduce morbidity and cost, and decrease length of stay. Additional efforts are aimed at implementing patient reported outcomes into our practice patterns and better understanding the effects of limited health literacy on these outcomes.

The Vascular Surgery group is committed to analyzing and improving outcomes for patients with complex vascular disease. Reducing readmissions, defining predictors of poor outcomes, and reducing health disparities are a primary focus.

Evaluations of large-scale surgical quality databases can help with discovery of trends in care and risk factors for adverse surgical events. Current and prior work in our division by faculty and trainees has explored a range of medical, surgical, and device factors that contribute to variation in outcomes utilizing the Society for Vascular Surgery Vascular Quality Initiative (VQI) database; details of these Outcomes Research projects by clinical focus and investigator can be found on our division’s Vascular Surgery Research Page.

We are excited to additionally extend of the reach of these surgical quality databases, both through evaluation of registry data linked to Medicare claims data in selected projects through the VISION Coordinated Registry Network, and through collaboration in the International Consortium of Vascular Registries (ICVR).

Apart from research in surgical quality databases, we have also utilized review of our electronic medical record from our tertiary medical center to evaluate unique populations in vascular surgery, evaluate our local care practices, and create care protocols in vascular surgery.

Enhanced Recovery Programs (ERPs) link multimodal perioperative processes (e.g., patient education, early mobilization, non-opioid pain regimes, etc.) into a fully integrated package to reduce LOS, POCs and readmissions for patients after major surgery. ERP is also a model through which we may better understand mechanisms of disparities at the patient, provider and healthcare system levels. UAB ERPs currently span nine surgical service lines with further projected growth. Over 4,000 UAB patients have undergone ERP and we have one of the nation's largest databases for outcomes research.

• Bariatric Surgery Enhanced Recovery Protocol
• Colorectal Enhanced Recovery Protocol
• Pancreatic Surgery Enhanced Recovery Protocol
• Vascular Lower Extremity Bypass Enhanced Recovery Protocol
• Ventral Hernia Enhanced Recovery Protocol

Perioperative communication between surgeons and family members is a critical time, especially the time immediately following the procedure. The experience is susceptible to communication breakdowns, and uncertainty heightens emotions and anxiety for the patient’s family, creating barriers to communicating critical information. While previous studies have focused on decreasing anxiety during wait times, no interventions focus on optimizing the communication following surgery. This postoperative conversation is critical to building trust between caregivers and surgeons, addressing caregiver needs, and equipping caregivers with knowledge needed to provide post-surgical care at home. Improving this process could impact the patient’s susceptibility to infections or other complications, length of hospital stay, and potential unplanned hospital readmissions.

Hospital readmissions have recently been targeted as a hospital quality measure. Readmissions can increase both costs and resource utilization and are associated with poorer patient outcomes. While much research on readmissions has been done in the medical patient population, there has been little study of reasons for readmission in the surgical patient population. In contrast to medical admissions, index surgical admissions are usually planned, and post-hospital care coordination often begins before the patient is admitted to the hospital. It will be important to identify which patients have high risk for readmission after surgery and to understand whether a readmission is potentially preventable, represents a quality of care issue or indicates failure of the care transition plan. By incorporating the contributions of patient comorbidity, self-efficacy, caregiver status, procedure complexity and system factors on readmissions, we can develop a risk prediction tool to identify those patients at highest risk.

More than 150,000 Americans 65 years and older will have major gastrointestinal surgery annually, and these patients frequently experience functional and cognitive decline, leading to reduced quality of life and diminished survival. Clinical outcomes in older patients are significantly improved when hospitals utilize an Acute Care for Elders (ACE) treatment model in which older patients are placed in specialized units where a multidisciplinary team follows evidence-based geriatric care practices. Due to a shortage of geriatric-trained physicians, dissemination of the ACE model for surgical patients has been limited, and most hospitals lack the financial resources to create dedicated ACE units. Geriatricians and surgeons at UAB have implemented a modified version of the ACE model (Virtual ACE) to address these problems with dissemination of the ACE model. Virtual ACE is a novel combination of information technology and engagement with nursing staff to deliver ACE quality care without requiring specialized geriatric units.

Health disparities in surgery (i.e., surgical disparities) exist. Many surgical populations suffer from disproportionately worse access, care and outcomes in surgery. Racial/ethnic disparities, which represent one type of disparity, have been demonstrated across many surgical disciplines including colorectal surgery. African-American patients have particularly worse outcomes with higher mortality, longer length-of-stays (LOS) and more readmissions. The factors that would reduce these inequities are unknown, which exposes a major gap in our understanding of surgical disparities and our ability to reduce them. Our team uses both quantitative (big data, clinical registries, etc.) and qualitative (focus groups, interviews, etc.) methods to help address these questions. We also apply important concepts such as health literacy to better frame our approaches. Ultimately, these research findings will be used to improve the care for all surgical patients.

The Transplant Epidemiology & Analytics in Medicine (T.E.A.M.), an interdisciplinary health services research group within the UAB Comprehensive Transplant Institute, supports a broad range of health services research projects aimed at improving outcomes for kidney transplant recipients and living donors and overcoming health disparities in access to and outcomes of transplantation. Research focuses on development of novel risk prediction tools to accurately identify pre-donation risk factors associated with the development of post-donation comorbidities. Administrative data linkages with national registries allow for comprehensive outcome ascertainment for both recipients and donors. Current randomized clinical trials include educational strategies to assist patients in identifying living donors and integration of HIV positive kidneys into transplantation. Cost effectiveness analysis is used to optimize strategies for organ allocation and treatment. Quantitative investigation is complemented by a wide range of qualitative and mixed methods to improve our understanding of the needs of our patients and donors.

• Jayme Locke, MD MPH FACS FAST

• Douglas Anderson, MD MS

• Michael Hanaway, MD

• Paul MacLennan, PhD

• Rhiannon Reed, MPH, DrPH

• Saulat Sheikh, MBBS

• Carlton Young, MD

• Haiyan Qu, PhD

• Robert Cannon, MD, FACS

The Transplant Epidemiology & Analytics in Medicine (T.E.A.M.), an interdisciplinary health services research group within the UAB Comprehensive Transplant Institute, supports a broad range of health services research projects aimed at improving outcomes for liver transplant recipients and overcoming health disparities in access to and outcomes of transplantation. This program is focused primarily on liver transplant candidate evaluation, management, and outcomes for adults, ensuring that culturally and ethnically appropriate assessment strategies are used to eliminate age and racial health disparities. National registry data allows for examination of regional variation in organ use, allocation, listing practices, and sex-based disparities. Current randomized clinical trials include integration of HIV-positive livers into transplantation.

• Jayme Locke, MD MPH FACS FAST

• Robert Cannon, MD, FACS

• Saulat Sheikh, MBBS

• Paul MacLennan, PhD

• Rhiannon Reed, DrPH

• Haiyan Qu, PhD