A Mission to Ensure Quality Surgery For Cancer Patients

Posted in GUMC Stories

MAY 29, 2015-Waddah B. Al-Refaie, MD, FACS , came to Washington in 2013 to do the bold research he knows will matter to the thousands of patients who receive surgery to remove their cancer each year.

What attracted Al-Refaie was a prestigious university and medical school (Georgetown University Medical Center and its School of Medicine) partnered with a strong network of research-minded hospitals (MedStar Health) that together are capable of national leadership in the field of surgical oncology.

Al-Refaie also saw a powerful and singular quality in Georgetown that can guide truly meaningful advances in surgical care for those who are most in need — the underserved and the vulnerable elderly. “The institution has a wonderful legacy of compassionate care and for research that furthers that mission,” he said shortly after his arrival.

Now, in less than two years, he has established — and is already leading — what is arguably one of the strongest research relationships between Georgetown University and MedStar Health — the MedStar-Georgetown Surgical Outcomes Research Center (MG-SORC).

MG-SORC is a coalition of surgeons, other clinicians, statisticians, epidemiologists, economists and other scientists committed to advancing the efficient and effective delivery of surgical care in the United States, Al-Refaie said.

VIDEO: Meet Dr. Al-Refaie

Putting researchers, grants, studies in place

That isn’t hyperbole. To date, 15 physicians and researchers at Georgetown University Medical Center (GUMC), MedStar Health and the RAND Corporation are collaborating with MG-SORC — many more are expected to join the effort. Seven other scientists have joined the organization’s internal advisory board. (A complete list of collaborators and organizations is below.)

Eight studies and abstracts have already been submitted for publication or for presentation at international scientific meetings, and multiple other studies are underway.

Grants have already been awarded for multiple projects, including two highly competitive MedStar-Georgetown Partnership Research grants.

All this while Al-Refaie performs his duties as chief of surgical oncology at MedStar Georgetown University Hospital (MedStar GUH) and surgeon-in-chief at Georgetown Lombardi Comprehensive Cancer Center. He holds clinic once a week, and performs surgery on patients with GI cancers, soft tissue sarcoma or malignant melanoma two or three times a week.

And on May 11, Al-Refaie was installed as the John S. Dillon Chair in Surgical Oncology — a distinguished position that honors John Dillon, MD, a prominent Georgetown surgeon. During the ceremony, Al-Refaie emphasized the need for a robust surgical outcomes program.  

“In the U.S., there are over 2 million cancer patients, and up to 40 percent will need surgery. We need to help surgeons help their patients do a better job in terms of access, quality and outcomes,” Al-Refaie said.

“We’re positioning ourselves to be leaders, not followers.”

Investigating risky readmissions

Al-Refaie understands the need for surgical outcomes research. While at the University of Minnesota, his research into surgical cancer care disparities for vulnerable populations was recognized nationally and internationally.

He believes surgeons need to establish “value and outcomes-based” practices. One reason is that federal health agencies and insurers are starting to ask for outcomes evidence, but the bigger goal is that outcomes “help both patients and their surgeons in terms of access and quality.”

“There are cancer patients at risk for worse outcomes — older individuals, ethnic or racial minorities, patients with subpar insurance or who have multiple disorders. They are vulnerable and tend not to do well in terms of access to quality care,” he said.

Vulnerable patients are often under-treated, but they can also be over-treated, Al-Refaie said.

MG-SORC has launched two pilot projects with MedStar Health Research Institute and MedStar Washington Hospital Center that Al-Refaie believes will morph into major studies, supported by federal grants.

One examines hospital surgical readmissions, “which can be costly and destructive to patients and hospitals,” he said. MG-SORC has already examined patterns of readmissions within the MedStar health system and found that older patients are not at risk for a high readmission rate because they stay longer in the hospital to begin with, compared to national averages.

Investigators are now looking at the pattern of readmissions in minority-serving hospitals using a nationally representative database. Preliminary results suggest these hospitals do have high rates of readmission, Al-Refaie said.

He and his team are also developing a unique readmission “score” for surgical oncology at MedStar GUH and the MedStar Washington Hospital Center. Patients are put at a low, intermediate or high risk for readmission based on individual and surgical criteria. “This will set the stage for possible intervention and care coordination — simple things, like calling a patient at home or bringing them in for clinic visits, could help control readmission,” Al-Refaie said.

Patients teach the surgeons

He and Roxanne Jensen, PhD , of Georgetown Lombardi, are leading a team that, in essence, will investigate outcomes by asking patients about their surgical recovery — their outcomes as they experience it. “Surgeons cannot answer some of the most common questions patients ask, such as ‘when will I return to my norm? When can I go back to work?’ We have a surgical perspective, of course, but we don’t know how to answer those questions in a way that is relevant to each individual.”

Because outcomes depend on mental, social, physical variables, age, general health and, sometimes, race, Al-Refaie and Jensen want MedStar patients to answer surveys tailored to a specific cancer surgery. They will be questioned before their surgery, after surgery and before they leave the hospital, then during follow-up clinic visits.

“Surgical patients will be educating surgeons,” Al-Refaie said. “What better way is there to learn about outcomes?”

These studies are examples of the kind of “contributions to science on disparities in surgical oncology care that will help establish a foundation for which a nationally recognized surgical outcomes research center can be built,” he said.

By Renee Twombly
GUMC Communications