Dr. Christopher Graham works as a member of Division Director Dr. Greg Kennedy's lab.Dr. Christopher Graham works as a member of Division Director Dr. Greg Kennedy's lab.Through research, this division aims to advance the field of GI surgery by developing novel care delivery models that improve surgical quality and outcomes.

Our clinical research program, which is supported by the Surgical Innovation and Research Core, has an active interest in quality improvement for our surgical patients. Through clinical trials, we work to discover which preoperative, operative and postoperative interventions are most important for improving the outcomes of our patients. We are also interested in understanding the sources of disparity in surgical outcomes among high-risk groups of patients. Our team collaborates broadly to try to understand the impact of surgery on high-risk groups, such as the elderly, and what we can do to make surgery safer for these patients.

Our basic science research program includes robust investigations into areas such as the impact of bariatric surgery on bone health, as well as how environmental exposures interact with the human body to change one’s risk for cancer. Our basic research is funded by the National Institutes of Health, the Society for Surgery of the Alimentary Tract and other sources.

Research Programs

Bariatric Surgery and Metabolism

Led by Jayleen Grams, M.D., Ph.D., this program focuses on glucose and skeletal metabolism through the study of osteocalcin, a bone-derived protein, using an osteocalcin knockout animal model developed here at UAB. Additionally, current efforts are directed toward using an animal model of Roux-en-Y gastric bypass to investigate the impact of bariatric surgery on skeletal biology and health as well as on the central nervous system and microbiome.

Faculty

Chemoprevention of Colorectal Cancer

Led by Dr. Greg Kennedy, these research efforts are focused on chemoprevention of colon and rectal cancer. His funded laboratory uses genetic models to better understand how chemicals prevent tumor formation and what genetic pathways are responsible for their effects. The ultimate goal is to identify targeted agents that are better tolerated by patients in hopes of preventing colon and rectal cancer.

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ERAS and Surgical Disparities

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.

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Gastrointestinal Surgery

Health Disparities

Disparities in health outcomes occur due to patient, provider and healthcare system factors. In surgery, these disparities include higher mortality, longer length-of-stays (LOS), increased complications, and more readmissions for minority and disadvantaged populations. The mechanism for these disparities remains very unclear and certain surgical populations, such as patients with inflammatory bowel disease, have particularly worse outcomes. We are interested in identifying health disparities at the national, regional and local level and understanding why they occur in certain populations. Our approach uses both quantitative (i.e, big data analysis) and qualitative (i.e, patient-level interactions such as interviews and focus groups) methods to identify, understand and reduce disparities.

Specific efforts include studying the effect of Enhanced Recovery After Surgery (ERAS) programs on reducing disparities, profiling the gastrointestinal microbiome of minority surgical patients and establishing the role of social determinants of health on surgical outcomes.

Faculty

  • Chu, Daniel, I, M.D.

Prevention and Treatment of Endocrine Diseases

This program has numerous clinical studies involving patients with parathyroid, thyroid, and adrenal disease. Our clinical area of expertise is the role of minimally invasive endocrine surgery techniques in the management of patient with hyperparathyroidism, thyroid nodules, and adrenal lesions. We have significant experience with minimally invasive radioguided parathyroidectomy (MIRP) and multiple ongoing, multi-disciplinary, prospective clinical trials for endocrine cancers and other endocrine diseases.

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VA Readmission

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.

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