Medical Student Research Fellowship for Summer 2010
Mentor: Philip E. Greilich, MD
Department: Anesthesiology, Division of Cardiothoracic Anesthesia
Room number: HQ3.320B
Mail Code: 8894
Phone number: 58018
Project title: Impact of Preoperative Anemia on Perioperative Blood Transfusion: Retrospective Analysis and Quality Improvement Initiative
Human subjects IRB approved project number (where applicable): None required for the retrospective analysis since this a quality improvement exercise. IRB submission for the prospective arm of this study will not occur until the Fall of 2010.
Animal subjects IRB approved project number (where applicable): N/A
Project Type: Patient-based research
Brief Description of Project:
Nationally, approximately 30-50% of patients undergoing major cardiac, thoracic and orthopedic procedures are anemic (defined by the World Health organization as 12.5gm/dL for females and 13.5gm/dL for males). UT Southwestern University Hospitals spends over $20, 000,000.00 a year for the procurement, management, administration and treatment of complications associated with blood transfusion. A growing literature suggests red blood cell (RBC) transfusions increase morbidity, mortality and resource utilization in surgical patients. Given these facts, a quality and safety initiative is being undertaken to promote the recognition and resolution of preoperative anemia.
The objectives of this project are to: (1) determine the incidence of preoperative anemia and its association with resource utilization in patients undergoing cardiac, thoracic, major joint and spine surgery at UT Southwestern University Hospitals; (2) identify the primary and secondary "benchmarks" that should be used to monitor future interventions in our blood management practice and; (3) design potential interventions for reducing the incidence of preoperative anemia in surgical patients undergoing procedures requiring 1-3 units of RBC transfusion.
The primary measurements for the retrospective analysis will include: 1) percent
of patients undergoing cardiac, thoracic, major joint and spinal surgery that
present with preoperative anemia; 2) comparison of the incidence of perioperative
RBC transfusion with and without preoperative anemia; 3) incidence of postoperative
complications and extended length of stay in patients with and without preoperative
anemia and; 4) incidence of postoperative complications and extended length
of stay in patients with and without perioperative RBC transfusion.
Role of the Student:
This project is in the preliminary stages of development. The role of the student will be to first assist in a retrospective analysis of the prevalence of preoperative anemia and incidence of transfusion in patients that have undergone surgery at University Hospital. In the second phase of this project, the student will perform a literature review and participate in the design of an interventional trial in which preoperative anemia is actively managed. It is estimated that the retrospective analysis will represent 35% of the project, literature review 25% and protocol design approximately 40%.
The student will be involved with data management, statistical analysis (SPSS) and preparation of an abstract reporting the findings of the retrospective analysis. In Phase II, the student will perform an extensive literature search of interventions and protocols for managing perioperative anemia. Literature will be stored using an electronic reference manager. Participation in the study design will include discussions with a biostatistician and creation of the database for the prospective project. Training in SPSS and use of a reference manager will be provided, if needed.
Students will work hard and will have an opportunity to be exposed to the cardiac surgery team. I will assign authorship based on the quality and quantity of work done contributed to the project.
This project will be funded, in part, by the UT Southwestern Office of Quality
Improvement and Safety.
Previous Research Activities or Publications with Medical Students:
1) Jonathan Boyd, BS (2008-09) - Medical Student at UT Southwestern- Dallas
Jonathan worked as a research assistant in my lab before his 4th year of medical school to gain experience in clinical research with the roles described above.
(Manuscript) John A, Yeh C, Boyd J, Greilich PE, Treatment of Refractory Hypotension with Vasopressin in a Patient Receiving High-Dose Clozapine. Journal of Cardiothoracic and Vascular Anesthesia. Accepted
(Manuscript) Greilich PE, Leonard D, Boyd J, Brilakis E, Jessen ME. Epsilon-aminocaproic acid, but not aprotinin increases cardiac enzyme levels following CABG surgery. In Preparation
(Manuscript) Wyrick CC, Adesanya A, Greilich PE, Boyd J, Sarode R. Body mass index does not influence platelet responsiveness to clopidogrel in patients undergoing percutaneous neurovascular procedures. In Preparation
(Abstract) Wyrick CC, Greilich PE, Boyd J, Adesanya A, Sarode R. Body mass index does not influence platelet responsiveness to clopidogrel in patients undergoing percutaneous neurovascular procedures. In Preparation
(Poster Presentation) Refractory Hypotension with Vasopressin in a Patient Receiving High-Dose Clozapine. Presented at the International Anesthesia Research Society Meeting. March 14th -17th, 2009, San Diego, CA.
(Poster Presentation) High-dose epsilion-aminocaproic acid increases cardiac enzyme levels in patients following CABG surgery. Presented at the 9th UT Southwestern Cardiovascular Research Symposium, October 26-27, 2009, Dallas, TX.
(Poster Presentation) Designing an interventional trial in cardiac surgery patients with excessive bleeding after conventional blood transfusion therapy: A feasibility study. Presented at the 15th Society of Cardiovascular Anesthesiologists Update on Cardiopulmonary Bypass, March 21-26, 2010, Whistler, BC Canada.
2) Neeraj Satyanarayana, BS (2007-08) Medical Student at UT San Antonio
Neeraj worked as a research assistant in my lab for the year prior to starting at UTSA. He worked on a number of projects with the roles described above.
(Manuscript) Greilich PE, Jessen ME, Satyanarayana N, Whitten CW, Nuttall G, Beckham JM, Wall MH. Effect of epsilon-aminocaproic acid and aprotinin on fibrinolysis and blood loss in patients undergoing primary, isolated coronary artery bypasses grafting: A Placebo-controlled non-inferiority trial. Anesthesia and Analgesia 2009;109:15-24.
(Abstract) May T, Douning LK, Satyanarayana N, Sarode R, Gaza J, Davis M, Jenevein E, Buck B, Jessen M, Greilich PE. Cost: benefit analysis of thromboelastography in cardiac surgery. Transfusion 2007;47 (11):A123.
(Abstract) Greilich PE, Taneja R, Satyanarayana N, Whitten CW, Sarode R. Thrombin generation is attenuated with aprotinin, but not with epsilon-aminocaproic acid, in patients undergoing cardiopulmonary bypass surgery. Anesth Analg 2008;106 (SCA suppl):A80.
(Abstract) Greilich PE, Satyanarayana N, Brilakis E, Leonard D, Jessen ME. Epsilon-aminocaproic acid, but not aprotinin increases cardiac enzyme levels following CABG surgery. Anesthesiology 2008;109:A1620.
(Poster Presentation) Cost: Benefit Analysis of Thromboelastography in Cardiac Surgery: A Process Improvement Approach. Presented at the 7th UT Southwestern Cardiovascular Symposium, October 22-23, 2007, Dallas, TX
(Poster Presentation) Epsilon-aminocaproic acid, but not aprotinin increases myocardial ischemic injury in patients undergoing primary coronary artery bypass surgery. Presented at the 13th Annual Society of Cardiovascular Anesthesiologists Update on Cardiopulmonary Bypass, March 9-14, 2008, Whistler, BC, Canada.
(Poster Presentation) Thrombin generation is attenuated with aprotinin, but not with epsilon-aminocaproic acid in patients undergoing cardiopulmonary bypass surgery Presented at the 30th Annual Meeting of the Society of Cardiovascular Anesthesiologists, June 18-20, 2008, Vancouver, BC, Canada.
(Poster Discussion) Epsilon-aminocaproic acid, but not aprotinin increases cardiac enzyme levels following CABG surgery. Presented at American Society of Anesthesiology Meeting, October 18-22, 2008, Orlando, FL.
3) Chad Brouse, MS (2001-2004) Biomedical Engineering student who returned
to his home in Nebraska to attend medical school. Chad worked as a research
assistant in my lab for several years and was involved in a number of projects
with the roles described above.
(Manuscript) Greilich PE, Brouse C, Beckham J, Estrera A, Carr ME: Reductions in platelet contractile force correlates with duration of cardiopulmonary bypass and blood loss in patients undergoing cardiac surgery. Thrombosis Research 2002;105:523-529.
(Manuscript) Nguyen KT, Su1 SH, Sheng1 A, Wawro D, Schwade ND, Brouse CF, Greilich PE, Tang L, Eberhart RC. In vitro hemocompatibility studies of drug-loaded poly (L-lactic acid) fibers. Biomaterials 2003;24:5191-5201.
(Manuscript) Greilich PE, Brouse CF, Whitten CW, Chi L, DiMaio JM, Jessen ME. Antifibrinolytic Therapy During Cardiopulmonary Bypass Reduces Proinflammatory Cytokine Levels: A Randomized, Double-Blind, Placebo-Controlled Study of -Aminocaproic Acid and Aprotinin. Journal Thoracic and Cardiovascular Surgery 2003;1498-1503.
(Manuscript) Greilich PE, Brouse CF, Rinder CS, Smith BR, Jessen ME. Antifibrinolytic therapy during cardiopulmonary bypass reduces leukocyte-platelet adhesion. Anesthesiology 2004;100:225-233.
(Manuscript) Greilich PE, Brouse CF, Rinder HR, Jessen ME, Rinder CS, Eberhart
RC, Whitten CW, Smith BR. Monocyte activation in on-pump versus off-pump coronary
artery bypass surgery. J Cardiothorac Vasc Anesth 2008;22:361-368.