With her specific skills in Medical Informatics, Dr. Becky Schroeder leads the departmental efforts related to the Anesthesiology Datamart Project and Research Compliance. Within our group, Schroeder heads our research endeavors, overseeing more than 20 research projects. The VA also has a robust data infrastructure that we leverage towards projects that advance care in the areas of perioperative care, critical care and pain management.
The Relationship Between Leadership, Teamwork, and Team Performance During Simulated Cardiac Arrest
While working with in-hospital cardiac arrest teams, we noticed variability in team performance and wondered whether this related to the skills of the leader, the team, or both. The objective of this project is to quantitatively assess the effects of leadership and teamwork on the quality of resuscitation provided by cardiac arrest teams. We are analyzing recorded in situ cardiac arrest simulations to test our central hypothesis that teamwork is associated with CPR quality and that effective leadership results in improved quality of resuscitation through its effect on teamwork, and rather than as an independent factor.
A Risk Adjusted Transfusion Dashboard for Cardiac Surgery
Are we transfusing too much, or not enough? While we collect lots of transfusion-related data daily, we have no good way of monitoring our blood product utilization in a risk-adjusted manner routinely. The objective of this project is to create a Quality Improvement Transfusion Dashboard that will allow continuous, risk-adjusted monitoring and improvement of transfusion practices for patients undergoing cardiac surgery at the Durham VA Healthcare System.
Prehabilitation of Veterans with Exercise and Nutrition (PREVENT)
Low fitness and poor functional status are among the strongest predictors of postsurgical complications. Prehabilitation takes advantage of the weeks leading up to surgery in order to improve fitness, mobility and nutrition in preparation for the upcoming surgical stress. A prehabilitation program that is delivered using telehealth would be ideal, because it combines accessibility with supervision, encouraging compliance and ensuring adequate training intensity, but such programs do not currently exist within the VA. In this prospective study, we will test the feasibility, acceptability and safety of a 3-4 week multimodal prehabilitation intervention that is supervised and individualized, yet is delivered at home using telehealth technology.
Postoperative Atrial Fibrillation: Predictive Value of Global Longitudinal Strain Obtained by Intraoperative TEE
PIs: Barbeito, JohnBull, Maxwell
Post-operative atrial fibrillation (POAF) following coronary bypass grafting (CABG) is common and is associated with increased mortality. It is known that impaired left ventricular ejection fraction is a predictor of atrial fibrillation (AF) in these patients. Subtle changes in global longitudinal strain (GLS – the change in length of myocardial fibers measured by ultrasound using a technology called speckle tracking) may be a more sensitive marker of LV dysfunction, but its relationship to POAF in patients undergoing cardiac surgery is unknown. We hypothesize that the percentage change in GLS (%∆GLS) intraoperatively may predict the risk of developing POAF.
Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain
PIs: Buchheit, Van de Ven
Strategies for preventing the development of chronic pain syndromes in amputation patients have limited success. This is a prospective, randomized, placebo-controlled trial of regional anesthesia and perioperative oral valproate treatment as a combined prophylactic treatment for prevention of post-amputation chronic pain.
Spinal Cord Stimulation: A Retrospective Analysis of Clinical Impact on Veterans with Spinal Radicular Pain and Healthcare Utilization
Spinal cord stimulation is becoming a more commonly utilized modality for treatment of chronic low back pain, although its effectiveness has not been definitely demonstrated. This retrospective review of patients with spinal cord stimulators placed for treatment of spinal radicular pain at the Durham VA HCS focuses on clinical outcomes and indicators of health care utilization.
Comparative Effectiveness of Perioperative Isotonic Saline vs. Balanced Fluids
The optimal fluid for perioperative volume replacement has been hotly debated for many years. This project uses the Premier database to examine differences in outcomes between patients who received isotonic saline and those who received balanced salt solutions using an epidemiologic approach.
Do CAN Scores Predict Prolonged Length-of-Stay, Re-Hospitalization, Mortality, and Other Adverse Outcomes in Diverse Surgical Populations?
PIs: Schroeder, Raghunathan
The CAN (Care Assessment of Needs) Score, calculated weekly for all veterans cared for by the VA Health Care System, includes data related to demography, specific comorbidities, recent health system utilization, and socioeconomic status. While it is used by primary care clinics to allocate resources, it is unknown if it can be used for perioperative risk stratification. This project studies the ability of the CAN score to predict hospital length of stay and mortality in a large, diverse, surgical population.
Effect of Thoracic Epidural on the Incidence and Severity of Post-Thoracotomy Pain
PIs: Van de Ven, Pyati
Significant chronic pain affects approximately 50% of patients who have undergone a pulmonary resection, whether by thoracotomy or VATS. This study hopes to determine if this rate is reduced in patients who have received a perioperative thoracic epidural.
High Dose, Extended-Duration DHA/EPA Therapy to Prevent Chronic Post-Thoracotomy Pain: A Pragmatic, Comparative Effectiveness Randomized Trial
PIs: Van de Ven, Pyati
Complementary health strategies tend to be low risk but effective. This prospective, randomized, placebo-controlled trial tests the effectiveness of DHA/EPA (high quality fish oil) in preventing chronic pain following thoracotomy.
Single Nucleus Expression Profiling of Human Sciatic Nerve after Traumatic Amputation: Predicting Pain and Functional Outcomes
PI: Van de Ven
Significant chronic pain affects approximately 50% of patients who have undergone a pulmonary resection, whether by thoracotomy or VATS. This study hopes to determine if this rate is reduced in patients who have received a perioperative thoracic epidural at the appropriate spinal level.
Blood Pressure Variability and Perioperative Outcomes
PIs: Schroeder, Raghunathan
Exactly how hemodynamic variability is associated with clinical outcomes is not clear. This large data science project explores the concept of ‘mutual information,’ a non-linear combination of blood pressure and heart rate, and its ability to predict adverse outcomes following surgery.
Establishing a Patient Safety Center of Inquiry at the Durham VA Dedicated to Reducing Opioid-Related AEs and Reducing Prolonged Use of Opioids After Surgery
It has been recognized that a significant number of patients continue to use opioids months or even years after elective surgery, contributing to their risk of opioid-related adverse events. A Patient Safety Center of Inquiry was established, funded by the VA National Center for Patient Safety, to study means of reducing this long-term use of opioids in surgical patients.
The treatment of acute ischemic stroke with use of mechanical thrombectomy has increased since landmark trials showed efficacy in 2015. This study examines how mechanical thrombectomy utilization has changed in recent years among patients with perioperative acute ischemic strokes.
Effects of HES-FDA Warning on Hospital
Hydroxy-ethyl starch solutions were removed from US hospitals in response to a FDA warning in 2013. The effects of this change in clinical practice are the subject of this project, using data from Premier hospitals across the US.
DNR Orders in the Perioperative Period
This study seeks to characterize Code Status (DNR Orders) in relation to three common surgical procedures within the ACS NSQIP database. The study compares characteristics of patients with versus without DNR Orders.
Combinations of Multi-Modal Analgesia after Surgery
This study seeks to examine safety outcomes in patients exposed to different combinations of non-opioid analgesics. The proposal uses charge codes from a large database (Multihospital Premier Alliance) to identify both analgesic exposures and postoperative pulmonary complications.
Crystalloid Use in NonCardiac Surgery
This study seeks to compare Albumin with Crystalloids in patients undergoing major noncardiac surgery. The recent FDA warning on Starch solutions led to changes in intravenous fluid choice and this proposal leverages these changes to determine whether outcomes differed in hospitals that switched to albumin versus to crystalloids.
Oral Nutritional Supplementation in the Perioperative Period
Malnutrition is common in surgical populations and increases risk of poor outcomes. This project attempts to determine if oral supplementation in the perioperative period can decrease this risk.
View the department’s competitive and non-competitive research grant awards by calendar year.