Outcomes and Health Services Research (HSR) is conducted in every division in the Department of Surgery, focusing on advancing the knowledge, understanding and implementation of best-evidence care in surgery. Research projects are diverse and include cross-disciplinary work in health disparities, quality improvement, surgical outcomes, disease management and population health. Researchers have significant experience with big data, institutional data linkage and both quantitative and qualitative research methods. Our researchers also have a long history of collaborations with HSR researchers across other departments and institutions beyond UAB.
In tandem with these research efforts, the department is passionate about training the next generation of surgeon-scientists and researchers. Our department has deep experience working with students (high school, undergraduate, graduate, and medical/graduate school), residents and faculty. In addition, weekly conferences are held to discuss works-in-progress, conduct grant/manuscript reviews and to share ideas.
Our department's HSR portfolio is shown below. Please contact us if you would like to participate in these projects or if you have any questions.
Surgical Outcomes
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ACS-NSQIP Projects
UAB has been a long-standing participant in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). In response to recent NSQIP semi-annual reports 2021-2023, our multidisciplinary team is focused is on improving acute renal insufficiency after general and colorectal procedures. Our trained nurse abstractors help facilitate all NSQIP data collection. Researchers routinely reach out to obtain specific NSQIP data pulls to incorporate validated NSQIP data into various research projects including colorectal and other gastrointestinal operations.
Faculty conducting research in this space include: -
Breast Cancer
Our breast cancer outcomes research seeks to inform treatment practices and improve patient care for breast cancer.
We are currently investigating national as well as institutional level data to:
- explore the role of racial disparities among breast cancer screening and treatment programs
- assess the impact of Medicaid expansion on screening and treatment in breast cancer
- understand the implications of consensus guidelines on margin status for early stage breast cancers from the Society of Surgical Oncology and American Society for Radiation Oncology on reexcision lumpectomy rates for breast conserving surgery.
Faculty conducting research in this space include:
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Cardiovascular Surgery
Outcomes research in the area of cardiothoracic surgery focuses on analyzing institutional and national databases to improve peri-operative outcomes in case of lung cancer by reducing morbidity and cost, and decreasing length of stay. Additional research aims to implement patient-reported outcomes into practice patterns and better understand the effects of limited health literacy on postoperative outcomes.
Faculty conducting research in this space include:
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Endocrine Surgery
Our Endocrine Surgery outcomes research focuses on understanding the etiology and improving the outcomes of patients with endocrine diseases such as thyroid
cancer, hyperthyroidism, hyperparathyroidism, Cushing’s Syndrome,
hyperaldosteronism, pheochromocytoma, neuroendocrine disease, multiple endocrine neoplasia, and other associated syndromes. Additionally, our faculty our studying methods to reduce length of stay, decrease complications
and mortality, decrease readmissions and improve overall outcomes of endocrine
surgery patients. Studies include comparative effectiveness, patterns of care,
physician-patient communications, as well as disparities.Faculty conducting research in this space include:
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Enhanced Recovery Programs
Enhanced Recovery Programs (ERPs) link multimodal perioperative processes including patient education, early mobilization, and non-opioid pain regimes into a fully integrated package to reduce hospital length of stay, postoperative complications and readmissions for patients after major surgery. UAB ERPs currently span nine surgical service lines, and over 4,000 UAB patients have undergone ERP after surgery, resulting in a large database with which to study various quality improvements and other outcomes.
Faculty conducting research in this space include: -
Gastrointestinal Cancer
Cancer-related outcomes research is conducted by faculty across the Department of General Surgery. Research focuses on improving the outcomes of patients receiving surgical and non-surgical care for pancreatic cancer, liver and biliary cancer, gastric cancer, esophageal cancer, colon and rectal cancer, and peritoneal surface malignancies. Our faculty study methods to decrease length of stay, decrease complications and mortality, as well as improve the delivery of cancer care overall.
Faculty conducting research in this space include: -
Global Surgery
Global surgery is an integrative field of study that includes research, practice and advocacy to ensure improved and equitable surgical care worldwide. It recognizes the diverse and extreme disparities globally, with a focus on access to surgical care in vulnerable populations globally, with the mission of achieving health equity for all people in need of surgical care, with an emphasis on underserved populations. We value providing outstanding and compassionate medical care for all through innovative research and multidisciplinary collaboration while educating the future generation of leaders in surgery. Our faculty have focused on the impact of breast cancer screening and early detection in low-resource settings, and collaborate on various breast cancer projects and initiatives in Tanzania, Kenya, and Cameroon and with the WHO Global Breast Cancer Initiative.
Faculty conducting research in this space include:
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Inflammatory Bowel Disease
Surgical outcomes and quality improvement research in inflammatory bowel disease focuses on patients with Chron’s disease and Ulcerative colitis, which affect over 3 million people in the United States. Black patients have been shown to experience significantly higher readmission rates and longer lengths of stay after major surgery compared to White patients with inflammatory bowel disease. Faculty conducting research in this field focus on the Identification of high-risk populations in inflammatory bowel disease to better inform the development of interventions to improve post-operative outcomes and decrease readmissions and hospital length of stay.
Faculty conducting research in this space include: -
Rural Surgery
Rural surgery faces several challenges including an older population with more comorbidities, limited healthcare resources, and financial stress faced by rural hospitals. Patients living in rural locations have been shown to have worse overall outcomes. Research studying the barriers faced by rural patients is of vital importance as we aim to improve health equity.
Faculty conducting research in this space include: -
Trauma & Injury Science
The Center for Injury Science, founded in 1999, conducts research to promote injury prevention and to improve trauma care. Our mission is to improve outcomes from injury at all stages of care, from the prehospital setting through to resuscitation, acute care and rehabilitation. Our approach is cross-cutting and multidisciplinary. Clinicians from many specialties – including trauma surgeons, emergency medicine physicians, anesthesiologists, intensivists and rehabilitation specialists – work closely with epidemiologists, basic scientists, biostatisticians, health economists, health psychologists and methodologists. The center is comprised of four units: the Clinical Trials Unit, the Trauma Care Delivery Research Unit, the Basic Science and Translational Research Unit, and the Evidence Synthesis Unit.
Faculty conducting research in this space include:
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Vascular Surgery
Outcomes research in vascular surgery focuses on analyzing and improving outcomes for patients with complex vascular disease. Reducing readmissions, defining predictors of poor outcomes, and reducing health disparities are a primary focus. In addition to research focusing on evaluating our local care practices through review of electronic medical records, current research projects use large databases including the Society for Vascular Surgery Vascular Quality Initiative (VQI), Vascular Implant Surveillance and Interventional Outcomes Network (VISION) Coordinated Registry Network and International Consortium of Vascular Registries (ICVR) databases.
Faculty conducting research in this space include:
Quality Improvement
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Enhanced Recovery Program
Enhanced Recovery Programs (ERPs) link multimodal perioperative processes (e.g., patient education, early mobilization, non-opioid pain regimes, etc.) into a fully integrated package to reduce LOS, POCs and readmissions for patients after major surgery. ERP is also a model through which we may better understand mechanisms of disparities at the patient, provider and healthcare system levels. UAB ERPs currently span nine surgical service lines with further projected growth. Over 4,000 UAB patients have undergone ERP and we have one of the nation's largest databases for outcomes research.
- Bariatric Surgery Enhanced Recovery Protocol
- Colorectal Enhanced Recovery Protocol
- Pancreatic Surgery Enhanced Recovery Protocol
- Vascular Lower Extremity Bypass Enhanced Recovery Protocol
- Ventral Hernia Enhanced Recovery Protocol
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Surgical Communication and Behavior
Perioperative communication between surgeons and family members is a critical time, especially the time immediately following the procedure. The experience is susceptible to communication breakdowns, and uncertainty heightens emotions and anxiety for the patient’s family, creating barriers to communicating critical information. While previous studies have focused on decreasing anxiety during wait times, no interventions focus on optimizing the communication following surgery. This postoperative conversation is critical to building trust between caregivers and surgeons, addressing caregiver needs, and equipping caregivers with knowledge needed to provide post-surgical care at home. Improving this process could impact the patient’s susceptibility to infections or other complications, length of hospital stay, and potential unplanned hospital readmissions.
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VA Readmissions
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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Virtual Acute Care for Elders
More than 150,000 Americans 65 years and older will have major gastrointestinal surgery annually, and these patients frequently experience functional and cognitive decline, leading to reduced quality of life and diminished survival. Clinical outcomes in older patients are significantly improved when hospitals utilize an Acute Care for Elders (ACE) treatment model in which older patients are placed in specialized units where a multidisciplinary team follows evidence-based geriatric care practices. Due to a shortage of geriatric-trained physicians, dissemination of the ACE model for surgical patients has been limited, and most hospitals lack the financial resources to create dedicated ACE units. Geriatricians and surgeons at UAB have implemented a modified version of the ACE model (Virtual ACE) to address these problems with dissemination of the ACE model. Virtual ACE is a novel combination of information technology and engagement with nursing staff to deliver ACE quality care without requiring specialized geriatric units.
Health Disparities
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Cancer Disparities
Cancer-related disparities may be related to differences in cancer incidence, prevalence, screening rates, stage at diagnosis, treatments received, as well as cancer-related morbidity, mortality and survivorship. Over the past several decades, progress in cancer prevention, early detection and treatment has led to overall decrease in cancer death rates. However, all populations have not benefited equally from these advances. These disparities based on race, ethnicity, socioeconomic status, geography, are due to multi-level underlying causes. The multiple underlying factors contributing to disparities have not yet been understood, which is a gap in our understanding of surgical disparities and our ability to reduce them. It is important to identify, understand, and develop interventions to reduce these disparities. We use both quantitative (national databases, clinical registries, etc.) and qualitative (interviews, focus groups, etc.) methods to help address these questions.
Faculty conducting research in this space include:
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Colorectal and Other Gastrointestinal Disease Disparities
Research in this area focuses on improving the outcomes after bariatric surgery, surgery for inflammatory bowel disease, as well as other minimally invasive and abdominal wall operations. Our faculty study methods to improve post-operative outcomes including decreasing morbidity and length of stay.
Enhanced Recovery Programs (ERPs) link multimodal perioperative processes including patient education, early mobilization, and non-opioid pain regimes into a fully integrated package to reduce hospital length of stay, postoperative complications and readmissions for patients after major surgery. UAB ERPs currently span nine surgical service lines, and over 4,000 UAB patients have undergone ERP after surgery, resulting in a large database with which to study various quality improvement and other outcomes.
Faculty conducting research in this space include: -
Surgical Disparities and Health Literacy
Health disparities in surgery (i.e., surgical disparities) exist. Many surgical populations suffer from disproportionately worse access, care and outcomes in surgery. Racial/ethnic disparities, which represent one type of disparity, have been demonstrated across many surgical disciplines including colorectal surgery. 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. Our faculty use both quantitative (national databases, clinical registries etc.) and qualitative (interviews, focus groups etc.) methods to help address these questions.
We also apply important concepts, such as health literacy, to better frame our approaches. Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. Studies have observed that patient education, understanding, and engagement in surgical processes lead to better surgical outcomes and reduced disparities.
These observations suggest a potential role for health literacy, defined as an individual’s capacity to obtain, process and understand health information, in determining surgical outcomes. Our faculty are focused on developing, and implementing, health-literacy based interventions in surgery.
Faculty conducting research in this space include:
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Transplant Disparities
The Transplant Epidemiology & Analytics in Medicine (T.E.A.M.), an interdisciplinary health services research group within the UAB Comprehensive Transplant Institute, supports a broad range of health services research projects aimed at improving outcomes for liver and kidney transplant recipients and living donors and overcoming health disparities in access to and outcomes of transplantation.
Areas of focus for this program include:
- Liver transplant candidate evaluation, management, and outcomes for adults, ensuring that culturally and ethnically appropriate assessment strategies are used to eliminate age and racial health disparities.
- Development of novel risk prediction tools to accurately identify pre-donation risk factors associated with the development of post-donation comorbidities.
- Examination of regional variation in organ use, allocation, listing practices, and sex-based disparities through national registry data.
- Cost-effectiveness analysis to optimize strategies for organ allocation and treatment. Quantitative investigation is complemented by a wide range of qualitative and mixed methods to improve our understanding of the needs of our patients and donors.
Current randomized clinical trials include educational strategies to assist patients in identifying living donors and integration of HIV-positive kidneys and livers into transplantation.
Faculty conducting research in this space include:
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Vascular Disparities
Vascular surgery disparities research focuses on understanding and addressing the unequal access to quality vascular care among different populations. Faculty conducting research in this area are working to identify factors contributing to disparities, and study the impact of disparities on patient outcomes, identify barriers to care, and develop strategies to improve access to vascular surgery care.
Faculty conducting research in this space include: