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.

Faculty

• Krontiras, Helen, M.D.
• Lancaster, Rachael, B., M.D.
• Parker, Catherine C., M.D.

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.

Faculty

• Chen, Herbert, M.D.
• Fazendin, Jessica M., M.D.

Racial disparities in health outcomes have been demonstrated across many surgical disciplines including colorectal surgery. With post-operative lengths-of-stay (LOS) spanning 8-12 days, post-operative complication (POC) rates approaching 30 percent and 30-day readmission rates of 15 percent, colorectal operations account for nearly 25 percent of all complications in general surgery. African American patients have even 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.

Enhanced Recovery After Surgery (ERAS) pathways link multimodal perioperative processes (e.g., patient education, early mobilization, non-opioid pain regimens, etc.) into a fully integrated package to reduce LOS, POCs and readmissions for patients after colorectal surgery. However, the adoption of ERAS in the United States is inconsistent and its effect on surgical disparities is unclear.

Our research group is interested in identifying, understanding and reducing disparities in surgery. ERAS is a model through which we may better understand mechanisms of disparities at the patient, provider and healthcare system levels. Our team uses both quantitative (big data, clinical registries, etc.) and qualitative (focus groups, interviews, etc.) methods to help address these questions. Ultimately, these research findings will be used to improve the care for all surgical patients.

Faculty

• Chu, Daniel I., M.D.

The microbiome refers to all the microorganisms (bacteria, fungi, archaea) that live within and on the body. Research has found differences between the gut microbiota of individuals with certain colorectal conditions, such as inflammatory bowel disease or colorectal cancer, and healthy controls. Studies have shown that intestinal bacteria may also play a role in healing after surgery. Our research group aims to better understand the mechanisms by which the microbiome may influence healing after colorectal surgery and the role it may play in surgical outcomes, such as anastomotic healing and leaks. This project is a collaboration between the UAB Division of Gastrointestinal Surgery and the UAB Microbiome Core.

Faculty

• Chu, Daniel I., M.D.

The Comprehensive Transplant Institute Outcomes Research Center at UAB supports a broad range of health services research projects aimed at improving outcomes for transplant recipients and living donors. Researches focuses on novel risk prediction tools capable of accurately identifying pre-donation risk factors associated with the development of post-donation comorbidities. Additionally, optimizing long-term health outcomes after living kidney donations particularly among African-Americans and optimizing integration of HIV positive kidneys into transplantation are a primary focus.

Faculty

• Locke, Jayme, M.D.
• Young, Carlton J., M.D.

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.

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.

Faculty

• Morris, Melanie S., M.D.

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.

• Spangler, Emily, M.D., M.S.

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.

Enhancing use of geriatric care principles is especially important for gastrointestinal surgery patients, because surgery causes multiple functional deficits and surgeons frequently fail to adjust post-operative care to the unique needs of older patients. Currently, Virtual ACE has been implemented on four surgical units at UAB, and our preliminary work suggests that Virtual ACE improves some short-term postoperative outcomes. This project will enhance the dissemination and implementation of evidence-based geriatric care for surgical patients.

Faculty

• Morris, Melanie S., M.D.