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. Data science is a specific area of expertise and experience for the VA Anesthesiology Service Division faculty. Dr. Karthik Raghunathan is especially active in areas related to whole health and complementary integrative health. Contributors to morbidity and mortality in the vulnerable VA population are also an active area of investigation.
A list of current projects is below.
Current Projects
The Relationship Between Leadership, Teamwork, and Team Performance During Simulated Cardiac Arrest
PI: Barbeito
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, rather than as an independent factor.
Prehabilitation of Veterans with Exercise and Nutrition (PREVENT)
PI: Barbeito
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.
Blood Pressure Variability and Perioperative Outcomes
PI: 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. Manuscript accepted.
Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain
PI: 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 the prevention of post-amputation chronic pain.
Spinal Cord Stimulation: A Retrospective Analysis of Clinical Impact on Veterans with Spinal Radicular Pain and Healthcare Utilization
PI: Pyati
Spinal cord stimulation is becoming a more commonly utilized modality for the 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
PI: Raghunathan
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. Funded by Grifols SSNA/ Manuscript published, abstracts presented IARS (2021, 2022).
Do CAN Scores Predict Prolonged Length-of-Stay, Re-Hospitalization, Mortality, and Other Adverse Outcomes in Diverse Surgical Populations?
PI: 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. Manuscript published.
Pilot Study for Tourniquet Ischemia Monitoring in Extremity Surgery
PI: Pyati
The overarching purpose of this research is to improve the safety of tourniquet use. Despite the ubiquitous use of tourniquets across countless surgical procedures on the extremities, there is no effective monitor that allows data driven tourniquet management in the operating room. We seek to investigate Near Infrared Spectroscopy regional oximeters in lower extremity surgery to determine whether this advancing technology can be used to assist in managing tourniquet use. In addition, we will identify changes in micro RNA expression during long duration extremity surgery under tourniquet and correlate these changes with NIRS-collected tissue oxygenation parameters.
Effect of Thoracic Epidural on the Incidence and Severity of Post-Thoracotomy Pain
PI: 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
PI: Van de Ven, Pyati
Complimentary 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.
Identification and Validation of Biomarkers of Acute Kidney Injury Recovery
PI: Schroeder
Post-operative acute kidney injury is recognized as a significant source of morbidity and even mortality. Early recognition of the process is difficult with current capabilities. This study tests the accuracy and feasibility of a novel set of urine and serum biomarkers in early detection of AKI.
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
PI: Raghunathan
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. Ongoing studies examining equity and AUDIT-C in relation to pain and opioid use.
Perioperative Stroke
PI: Raghunathan
The treatment of acute ischemic stroke with the 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. Manuscript published 2022.
Effects of HES-FDA Warning on Hospital
PI: Raghunathan
Hydroxy-ethyl starch solutions were removed from US hospitals in response to an 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. Manuscript published 2020.
DNR Orders in the Perioperative Period
PI: Raghunathan
This study seeks to characterize Code Status (DNR Orders) in relation to three common surgical procedures within the ACS NSQIP database. The study compares the characteristics of patients with versus without DNR Orders. Manuscript published 2020.
Combinations of Multi-Modal Analgesia after Surgery
PI: Raghunathan
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. Several manuscripts were published (2019, 2020, 2021, 2022).
Crystalloid Use in NonCardiac Surgery
PI: Raghunathan
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 crystalloids. Funded by Grifols SSNA. Several abstracts presented IARS (2021, 2022).
Oral Nutritional Supplementation in the Perioperative Period
PI: Raghunathan
Malnutrition is common in surgical populations and increases the risk of poor outcomes. This project attempts to determine if oral supplementation in the perioperative period can decrease this risk. Funded by Abbott. Several manuscripts were published and abstracts were presented at IARS (2021, 2022, ASPEN).