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Jefferson Surgical Solutions

Over the past five years, the Saligman Family Surgery Pilot Grant Program has supported 21 novel research ideas within the Department of Surgery, sparking innovation for our faculty and trainees alike. These projects explore a range of topics related to improving the quality and safety of surgical care. What follows are highlights of two studies that have demonstrated success and long-term potential for continued research to improve patient care.

Primary Non-Function Following Liver Transplant: How Do We Define High Risk Retransplant Candidates?
Principal Investigator:
Adam S. Bodzin, MD

Although deceased donor liver transplant success rates are excellent, transplant physicians still face the most feared complication: primary non-function (PNF) of liver allografts.

This pilot has been using the Scientific Registry of Transplant Recipients (SRTR) database to evaluate the number of patients who experience PNF following a liver transplant. Dr. Bodzin, along with resident Peter Altshuler, MD, and other members of the team, are identifying the proportion of patients with PNF who undergo retransplantation and analyzing their survival rates. After retransplantation, patients have considerably lower survival rates compared to those for whom the primary transplant is a success.

In the past year, this team has performed extensive analysis of more than 3,000 patients who suffered PNF. They used that analysis to create a Recipient PNF Futility Score, which they presented at the Philadelphia Academy of Surgery, where the paper earned second place out of 68 submissions.

Their analysis also identified an unintended subpopulation of patients with PNF who are relisted for transplant but improve on their own and have long-term survival without retransplant.

“We want to understand which pretransplant characteristics might predict this ability to experience PNF and improve without retransplant,” explains Dr. Bodzin. “This will be another important patient population that we will define by a risk model, ultimately guiding physician management of this dreaded morbidity.”

Evaluating Variations in Lung Cancer Surgical Outcomes Along Referral Pathways
Principal Investigator:
Tyler S. Grenda, MD, MS

Lung cancer screening has gained momentum with healthcare payers, including the Centers for Medicare and Medicaid Services (CMS), based on mortality benefits demonstrated in screening trials. These benefits are predicated on early detection in at-risk populations, as well as subsequent treatment of those diagnosed with lung cancers.

“Surgical resection is the standard of care for early-stage disease,” explains Dr. Grenda. “Yet there is significant variation in mortality across nationally representative cohorts of patients.”

With the help of the Saligman Grant funding, Dr. Grenda and his team purchased individual state inpatient databases from both the Healthcare Cost and Utilization Project (HCUP) and the Pennsylvania Healthcare Cost Containment Council. They are using these databases to further evaluate the relationship between services used and quality of patient care.

“More specifically, we are evaluating the quality and efficiency of care from the initial diagnosis or staging evaluation to postoperative care,” Dr. Grenda says. “We’re working to determine if certain provider ‘networks’ or referral patterns simply provide higher-quality care across the entire continuum for lung cancer.”

This team has already generated preliminary data to motivate future studies and serve as pilot data for additional work aimed at better understanding quality and efficiency in lung cancer care.

“We hope our efforts will help in identifying factors underlying variation in lung cancer outcomes and opportunities for quality improvement across the spectrum of care,” he concludes.

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