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Surgical Outcomes Research Center (SORCE)

 

The Effects of Indocyanine Green Angiography on Deep Inferior Epigastric Perforator Flap Design and Post-Operative Fat Necrosis
Project Description: The aim of this study is to prospectively evaluate the effect of intra-operative Indocyanine Green Angiography (IGA) on both flap design and rate of post-operative fat necrosis in patients undergoing autologous breast reconstruction utilizing the Deep Inferior Epigastric Artery Perforator (DIEP) flap. For this study group, the influence of SPY® technology on flap design will be determined by identifying how perforator selection based on pre-operative CTA is modified intra-operatively based on SPY® perfusion visualization. We believe that perforator selection in DIEP breast reconstructions, a process traditionally dictated at our institution by pre-operative CTA, may be heavily influenced by intra-operative IGA. We further hypothesize that use of intra-operative IGA in DIEP breast reconstructions may reduce the incidence of post-operative fat necrosis. In order to determine the effect of IGA on the rate of post-operative fat necrosis, the rate of fat necrosis observed in our study population will be compared to a published rate of fat necrosis seen in patients undergoing DIEP-based breast reconstruction without use of SIGA technology.

Investigative Team:
David Mathes, Plastic and Reconstructive Surgery
Alexander Gougoutas, Plastic and Reconstructive Surgery
Habib Rahbar, Radiology

Beyond Hospital Doors: Developing Best Practice Benchmarks for Skilled Nursing Facilities
Funder: University of Washington Department of Surgery
Project Description: An increasing number of patients are being discharged to skilled nursing facilities (SNFs) for post-acute care (PAC) and rehabilitation following hospitalization. Population and hospital-based cohort studies have consistently demonstrated worse survival for intensive care unit, surgical, and trauma patients discharged to SNFs compared to those discharged home or to rehabilitation facilities. Despite the growing body of evidence, PAC is poorly understood in terms of facility-related risk factors for mortality, readmission, rehabilitation, and transition to home. Funding from the University of Washington Department of Surgery will be used to 1) characterize variability in patient-centered outcomes for individuals discharged to SNFs and 2) help develop a collaborative prospective pilot trial aimed at establishing best practice guidelines to decrease length of stay, avoid readmissions, and optimize utilization of post-discharge services.

Investigative Team:
Giana Davidson, General Surgery
David R. Flum, General Surgery
Saman Arbabi, General Surgery
Wayne McCormick, Gerontology & Geriatric Medicine

Surgical Care and Outcomes Assessment Program (SCOAP) (www.scoap.org)
SCOAP Surgical Checklist Initiative (www.scoap.org/checklist)
Funders: Life Sciences Discovery Fund, SCOAP Member Hospitals, Industry
Project Description: SCOAP is a physician-led collaborative that tracks variance in surgical care across almost all Washington State hospitals and aims to reduce inappropriate care, variation in care, adverse outcomes while promoting greater cost-effectiveness. SORCE serves as the academic home for SCOAP research and development.

Investigative Team:
David R. Flum, General Surgery
E. Patchen Dellinger, General Surgery
Adam Goldin, Pediatric Surgery
John Gore, Urology
Mark Meissner, Vascular Surgery
Mike Porter, Urology
Benjamin Starnes, Vascular Surgery
Sean Sullivan, Pharmacy and Health Services
Tom Varghese, Cardiothoracic Surgery
Hunter Wessells, Urology

National Surgical Quality Improvement Program (NSQIP)
Project Description: NSQIP is a risk-adjusted data collection mechanism that collects and analyzes surgical clinical outcomes data.

Faculty Team:
E. Patchen Dellinger, General Surgery
David R. Flum, General Surgery

Longitudinal Assessment of Baratric Surgery (LABS)
Funder: National Institute of Diabetes and Digestive and Kidney Diseases
Project Description: As part of the NIH-funded LABS consortium, this project aims to evaluate short- and long-term outcomes of bariatric surgery through a series of studies following patients before and after bariatric surgery. Overall goals of this study are to analyse the risks and benefits of bariatric surgery, its impact on the health of patients with extreme obesity, and to identify types of patients who are most likely to benefit from bariatric surgery.

Investigative Team:
David R. Flum, General Surgery
E. Patchen Dellinger, General Surgery
Saurabh Khandelwal, General Surgery
Brant Oelschlager, General Surgery
Richard Thirlby, Virginia Mason Medical Center
Andrew Wright, General Surgery 

Feasibility, Efficacy, and Mechanisms of Surgical vs Medical Diabetes Treatment
Funder: National Institute of Diabetes and Digestive and Kidney Diseases
Project Description: This study aims to execute a randomized clinical trial comparing the outcomes and effects of gastric bypass surgery versus an optimal medical/lifestyle intervention to treat type 2 diabetes mellitus in patients with a BMI of 30-40 kg/m2.

Investigative Team:
David E. Cummings, Metabolism, Endocrinology, and Nutrition
David R. Flum, General Surgery
David Arterburn, Group Health Research Institute
Karen Foster-Schubert, Metabolism, Endocrinology, and Nutrition
Mario Kratz, Public Health Sciences
Jerry Palmer, Metabolism, Endocrinology, and Nutrition

Mechanisms of Glycemic Improvement after Gastrointestinal Surgery (RYGB Mechanisms)
Funder: National Institute of Diabetes and Digestive and Kidney Diseases
Project Description: This study examines the mechanisms mediating the weight-independent anti-diabetes impact of Roux-en-Y gastric bypass (RYGB) surgery and identifies modifiable components of surgical operation that impact glucose homeostasis.

Investigative Team:
David R. Flum, General Surgery
David E. Cummings, Metabolism, Endocrinology, and Nutrition
Karen Foster-Schubert, Metabolism, Endocrinology, and Nutrition
Andrew Wright, General Surgery

Comparative Effectiveness Research Translation Network (CERTAIN)
Funders: Agency for Healthcare Research and Quality, Life Sciences Discovery Fund
Project Description: CERTAIN is Washington State’s learning healthcare system, a network of over 40 diverse healthcare provider organizations participating in continuous evaluation of healthcare delivery, generation of evidence through research, and learning to improve patient care. CERTAIN is a suite of projects and programs that track quality, benchmark best practices, drive improvement, and allow all healthcare stakeholders to have their input heard as to what is needed to improve the system.

CERTAIN Projects Include:
1. Breast Cancer Patient-Reported Outcomes Adapted Tool
Funder: University of Washington Department of Surgery
Project Description: Most breast cancer patient-reported outcomes (PROs) tools were developed for research use as opposed to routine clinical practice, so little is known about how to apply PROs to measure performance of healthcare delivery. In addition, existing breast cancer PRO measurement tools used in isolation do not adequately reflect all issues representative of high quality care to the patient. This project aims to create an adapted PROs tool to guide breast cancer quality improvement activities, through a collaborative effort amongst breast cancer patients and surgeons to select metrics from existing validated PROs tools that reflect the health-related quality of life (HRQOL) and treatment satisfaction issues most relevant to patients having recently undergone oncologic breast surgery and/or reconstruction. The adapted PROs tool developed through patient and physician feedback will be implemented and evaluated for feasibility and acceptance among patients and surgeons within the Surgical Care and Outcomes Assessment Program (SCOAP) network.

2. CERTAIN Chronic Low Back Pain (CLBP) Pilot Study
Project Description: What Developed within CERTAIN, this study aims to characterize the population of adult patients with chronic low back pain within the University of Washington Neighborhood Clinics system and describe the healthcare utilization and costs associated with CLBP treatment. Data collection will consist of a combination of medical record review, Microsoft® Amalga data pulls and patient-reported outcomes (PROs). The results of this study will help contribute to the overall understanding of the various treatments received for CLBP in a real-world primary care setting and make potential recommendations for the most appropriate, cost-effective care.

3. Collaborative to Improve Native Cancer Outcomes (CINCO)
Surgical Disparities in Lung, Prostate, Breast, and Colorectal Cancer in American Indian/Alaska Natives
Funder: National Cancer Institute
For more information, visit the CINCO webpage on the CERTAIN website.

4. Collaborative for Healthcare research in behaviOral economIcs and deCision sciEnceS (CERTAIN CHOICES)
Funder: University of Washington Department of Surgery
For more information, visit the Decision Sciences webpage on the CERTAIN website.

5. mPOWEr
Funders: University of Washington Institute of Translational Health Sciences, University of Washington Department of Surgery, University of Washington Center for Commercialization
For more information, visit the mPOWEr webpage on the CERTAIN website.

6. Safe and Sound
For more information, visit the Safe and Sound webpage on the CERTAIN website.

7. The CERTAIN Hub: A Platform for Improved Patient Data Collection and Stakeholder Engagement
Funder: Agency for Healthcare Research & Quality
Project Description: This project expands the CERTAIN infrastructure with a CERTAIN Hub that interfaces with patients in nonclinical and outpatient settings to assess Patient Reported Outcomes (PRO) and other patient perspectives of care; as well as expand the CERTAIN network through engagement of the stakeholder community, advanced prioritization techniques and by the developing end-user oriented tools and products.

SORCE investigators have several population-based studies underway evaluating trends in surgical care and nationwide population-based outcomes using secondary analyses of clinical and administrative databases, including SEER, SEER-Medicare, Medicare, and CHARS:

Evaluating the Use and Outcomes of Axillary Lymph Node Surgery in the Treatment of Breast Cancer in Elderly Patients
Funder: National Cancer Institute
Investigative Team:
Sara Javid, General Surgery
Josh Carlson, Pharmacy

A Population-Based Evaluation of the Use and Outcomes of Neoadjuvant Chemotherapy
Funder: Marsha Rivkin Center for Ovarian Cancer Research
Investigative Team:
Sara Javid, General Surgery
Josh Carlson, Pharmacy

Quality and Outcomes of Esophageal Cancer Care
Funder: National Cancer Institute
Investigator:
Tom Varghese, Cardiothoracic Surgery

Variation and Care in Urological Procedures
Funder: Private Foundation
Investigative Team:
Hunter Wessels, Urology
Mike Porter, Urology

 

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Modified March 2014 - MDH

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