The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit

Welcome

The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit’s mission is: to improve the public’s health by advancing critical care and perioperative medicine through rigorous epidemiological research and education.

In addition to improving clinical care, the unit’s goal is to advance the Division of Critical Care Medicine within Duke Anesthesiology as a leader in research into the outcomes of perioperative medicine and critical illness. It seeks to increase and improve the evidence base by using rigorous methodology, robust cross-talk across disciplines, subject-matter expertise, and in the education of professionals caring for the critically ill and perioperative population.

Message from the Directors

Vijay Krishnamoorthy, MD, PhD & Karthik Raghunathan, MBBS, MPH

Vijay Krishnamoorthy, MD, PhD & Karthik Raghunathan, MBBS, MPH

Welcome to Duke Anesthesiology’s Critical Care and Perioperative Epidemiologic Research (CAPER) Unit! Through a foundation built on the rigorous methodologic principles of epidemiology and health services research, our unit aims to fill the gap between basic science research and clinical trials, by conducting high-quality observational research to advance knowledge in the care of perioperative and critically ill patients. We are comprised of a methods core (methodologists, analysts and data sources), subject-matter experts and a diverse membership who are all dedicated to advancing outcomes research in the fields of critical care and perioperative medicine. Through this, our goal is to improve health outcomes in perioperative and critically ill populations, both locally and globally. Please explore our website and feel free to contact us if you would like to be a part to this diverse and exciting group!

Core Operating Values

The following core operating values influence the culture and public image of the Critical Care and Perioperative Epidemiological Research (CAPER) Unit as an effective organization to improve the public’s health through research, education, and collaboration.

With humility and curiosity, it seeks answers to questions posed by patients, families, clinicians, and others interested in the delivery of high-quality perioperative and critical care. The CAPER Unit will conduct work with the following core values:

  • Caring Attitude
  • Respectfulness
  • Diversity
  • Integrity and Accountability
  • State of the Art Practices
  • Collaboration
  • Education
  • Financial Sustainability

What We Do

The CAPER Unit conducts rigorous observational research in critical care and perioperative medicine, using foundational principles, grounded in epidemiology and health services research. The term “outcomes research” is commonly used as a part of the daily discussions among not only clinicians, but also researchers, administrators, health policymakers, economists, and payors. There are several factors that have contributed to the growth of interest in outcomes research, and critical care and perioperative outcomes research in particular:

  1. The evidence base is lacking for much of daily clinical practice, particularly when data from randomized-controlled clinical trials (RCT) are limited.
  2. Health care costs have skyrocketed, forcing stakeholders to consider the value of medical care. For example, critical care accounts for greater than one percent of the entire gross domestic product of the United States, and is expected to rise further as the population ages.
  3. There has been a dramatic rise in the volume of health care data available, with a concurrent advancement in statistical techniques and computing capabilities. Because it would be costly and impractical to conduct an RCT to answer every clinical question, rigorous observational studies in large and diverse patient cohorts help to fill this gap.
  4. Greater scrutiny into the methodology of clinical studies have revealed that heterogeneity exists with regard to methodologic rigor in critical care outcomes studies, rendering many to bias. This is especially relevant, as millions of dollars in research funding are poured into clinical trials that are based on preliminary observational data.

Because of these reasons, the CAPER Unit is focused on conducting high-quality, observational research in perioperative and critical care medicine.

Why Do We Need?

Why do we need a Critical Care and Perioperative Outcomes Research Unit at Duke Anesthesiology?

The unique nature of critical care and perioperative research requires a specialized group conducting diverse research applying a core set of foundational methods that can help to fill gaps in evidence and advance patient care. Because of the combination of world leaders with subject matter expertise in a variety of critical care and perioperative domains (i.e. coagulation, nutrition, injury, acute brain disorders, etc.) with methodologists that have expertise in outcomes research within Duke Anesthesiology, the CAPER Unit has a unique opportunity to harmonize these areas. Therefore, the unit can organize its strengths in a diverse variety of domains in critical care and perioperative medicine under a common methodologic framework.

CAPER Research Graphic

Research

Initially, the CAPER Unit will focus its research efforts around five major themes:

Current Projects

  1. Examination of the use of capture-recapture methods to optimize ascertainment of exposures and outcomes in perioperative and critical care research
  2. Examination of natural experiment designs (coupled with Roger’s diffusion curve) to reduce residual confounding in observational perioperative research
  3. Improving methods for before-after studies in perioperative research
  4. Review of advanced methods for reducing cofounding in perioperative and critical care research (mediation analysis, natural experiment design, instrumental variable analysis, propensity scores, and interrupted time series)

Current Projects

  1. Mechanisms and clinical impact of myocardial dysfunction following traumatic brain injury
  2. Multi-organ dysfunction following traumatic brain injury
  3. Optimizing early hemodynamic management in adult and pediatric traumatic brain injury
  4. Trends and variation in healthcare utilization following severe acute brain injury
  5. Racial and ethnic disparities in healthcare utilization following severe acute brain injury
  6. Systematic review of incidence of multi-organ dysfunction following moderate-severe traumatic brain injury
  7. Examination of impact of ICU care on outcomes following traumatic brain injury in Tanzania
  8. Clinical epidemiology of moderate traumatic brain injury in low and middle-income countries
  9. Descriptive epidemiology of outcomes (healthcare utilization, readmission, mortality, violence, arrest) following emergency room visit for opioid overdose
  10. Opioids following surgery in the United States and impact of the Veteran’s Affairs Opioid Safety Initiative
  11. Guideline adherence for multimodal analgesia in TKA (VA versus non-VA)

Current Projects

  1. Association of FDA warning (reading hydroxyethyl starch) with bleeding outcomes following musculoskeletal surgery in the United States
  2. Unintended consequences of albumin for perioperative resuscitation
  3. Balanced fluids versus saline on outcomes in critically ill patients: mediating effects of chloride level
  4. Progression of chronic kidney disease following major abdominal surgery: effect modification by baseline renal function
  5. Heart-rate and blood-pressure coupling in perioperative medicine
  6. Effect of oral nutrition supplements on perioperative outcomes
  7. Joint and combined effects of multimodal analgesia in perioperative medicine
  1. Examination of the introduction of Sugammadex on post-op respiratory failure
  2. Perioperative lung-protective ventilation strategies
  3. SCCM Discovery Network SAGE Study
  1. Association between gonadal hormones on ICH pathophysiology and outcome
  2. Affects of blood pressure agent class used after ICH  on hematoma growth and mortality
  3. Use of SSRIs prior to ICH affects long-term outcome
  4. Incidence, mediators, and outcome of ARDS after ICH
  5. Defining associations between serum, CSF, and radiographic biomarkers with acute ICH pathophysiology and long-term outcome

Not only do the CAPER members produce excellent science, but they are dedicated to supporting the early careers of clinician scientists.

Duncan McLean, MB, ChB

Meet the Team

Vijay Krishnamoorthy, MD, PhD
Vijay Krishnamoorthy, MD, PhD
Assistant Professor of Anesthesiology

Karthik Raghunathan, MBBS, MPH
Karthik Raghunathan, MBBS, MPH
Associate Professor of Anesthesiology

Suresh Agarwal, MD, FACS, FCCP
Suresh K. Agarwal, MD, FACS, FCCP
Professor of Surgery

Atilio Barbeito, MD, MPH
Atilio Barbeito, MD, MPH
Associate Professor of Anesthesiology

Raquel R. Bartz, MD, MMCi
Raquel R. Bartz, MD, MMCi
Assistant Professor of Anesthesiology

Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA
Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA
Professor of Anesthesiology

Krista Haines, MA, DO
Krista L. Haines, MA, DO
Assistant Professor of Surgery

Michael L. James, MD, FAHA, FNCS
Michael L. James, MD, FAHA, FNCS
Associate Professor of Anesthesiology

Tetsu Ohnuma, MD, MPH
Tetsu Ohnuma, MD, MPH
Associate in Research

Srinivas Pyati, MD
Srinivas Pyati, MD, MBBS
Assistant Professor of Anesthesiology

Quintin J. Quinones, MD, PhD
Quintin J. Quinones, MD, PhD
Assistant Professor of Anesthesiology

Rebecca Schroeder, MD
Rebecca A. Schroeder, MD
Associate Professor of Anesthesiology

Shreyansh Shah, MBBS
Shreyansh Shah, MBBS
Assistant Professor of Neurology

John Whittle, MBBS, MD, FHEA, FRCA, FFICM
John Whittle, MBBS, MD, FHEA, FRCA, FFICM
Assistant Professor of Anesthesiology

David A. Williams, MD, MPH
David A. Williams, MD, MPH
Assistant Professor of Anesthesiology

Paul E. Wischmeyer, MD, EDIC
Paul E. Wischmeyer, MD, EDIC
Professor of Anesthesiology

Fellows
Duncan MacLean, MB ChB
Mohammad Rasouli, MD

Intern
Yu Shao, MD, PhD

Residents
Julien Colbert, MD
Jordan Komisarow, MD (Dept. of Neuorsurgery)
Sean Moore, MD
Rosalie Yan, MD

Biostatistician
Matthew Fuller

Administrative Support
Katelynne Durrant

Who We Work With

The CAPER Unit will leverage its existing collaborations (for SMEs, data and analytic support) with additional new collaborations at Duke to enhance its ability to conduct the most rigorous outcomes research in perioperative and critical care medicine.

  • Harborview Injury Prevention and Research Center, University of Washington
  • Institute for Healthcare Delivery and Population Science, University of Massachusetts
  • Iceland Perioperative Outcomes Research Center
  • Veteran’s Affairs Health Services Research and Development Center
  • University of North Carolina, Gillings School of Public Health
  • University of Washington School of Public Health
  • SCCM Discovery Network
  • Surgical Center for Outcomes Research
  • Departments in Duke University School of Medicine
    • Medicine (Division of Pulmonary Critical Care Medicine)
    • Surgery (Divisions of Emergency Medicine and Trauma/Acute Care Surgery)
    • Neurology (Division of Neurocritical Care)
  • Department of Population Health Sciences

Updates & Announcements

CPOP Seminar Series
Twice a month
5 – 6 PM | MSRBIII, Room 1125

Contact Us

Critical Care and Perioperative Epidemiologic Research (CAPER) Unit
40 Duke Medicine Circle
DUMC 3094
Durham, NC 27710

Katelynne Durrant
Staff Assistant

Chris KeithCritical Care and Perioperative Epidemiologic Research (CAPER) Unit