General Surgery Research Initiatives
Asian Liver Center
The Asian Liver Center at Stanford University is the first non-profit organization in the United States that addresses the disproportionately high rates of chronic hepatitis B infection and liver cancer in Asians and Asian Americans. Founded in 1996, the center addresses the gaps in the fight against hepatitis B through a four-pronged approach of collaboration, advocacy, research, and education & outreach (CARE). The ultimate goal of the Center is to eliminate the transmission and stigma of hepatitis B, and reduce deaths from liver cancer and liver disease caused by chronic hepatitis B.
Dan Azagury, MD
Dr. Azagury’s research interests align with his clinical and teaching endeavors. He has two main areas of interest: medical innovation and novel technologies, and foregut and bariatric procedures and outcomes. His outcomes research focuses on the effects of bariatric surgery on the all aspects of patient’s health as well as long-term outcomes. His other area of interest revolves around innovation: how to develop novel and relevant medical devices, how to evaluate their impact and cost/benefit for patients, and how to implement novel technologies to solve current unmet needs. His research projects often include multidisciplinary collaborations including with gastroenterologists, cardiologists, neurosurgeons, engineers and computer scientists.
Aaron J. Dawes, MD, PhD
Dr. Dawes’s research focuses on understanding and improving care for vulnerable populations with cancer. He is currently studying the role of public insurance programs, including 1) the differential impact of Medicaid managed care on high-risk populations, 2) how the safety-net workforce has responded to capitation, and 3) whether capitation has led to improvements in efficiency or cost containment. His long term goals involve forming partnerships with local and state governments to develop and implement data-driven policy interventions to improve access and quality of care.
Dan Delitto, MD, PhD
Dr. Delitto’s research focuses on novel immunotherapeutic approaches to fibrotic tumors, particularly pancreatic cancer. His goals are to change the pattern of inflammation produced by fibroblasts to create an environment permissible to antitumor immune responses. He is also working in collaboration with investigators at Johns Hopkins on an implantable hydrogel vaccine applied to threatened surgical margins, with encouraging preclinical data suggesting margin sterilization is attainable.
Frederick M. Dirbas, MD
Dr. Dibas's research focuses on accelerated, partial breast irradiation, and within that even more specifically intra-operative radiotherapy for breast cancer (IORT). Currently, he is also collaborating with Michael Clarke, MD, of the Stanford Stem Cell Institute investigating the role of breast cancer stem cells in the radiobiology of breast cancer, specifically: tumor quiescence, resistance to therapy, and late recurrence.
Monica Dua, MD
Dr. Dua participates in the Benign Pancreas Program at Stanford and her outcomes research includes both benign and malignant aspects of GI/HPB surgery with a focus on the management of severe pancreatitis as well as surgical strategies for the treatment of necrotizing pancreatitis. Other research interests include the application of minimally invasive approaches to the surgical management of HPB diseases including laparoscopic techniques in liver surgery and the use of laparoscopic and robotic platforms in pancreatic surgery. She currently has an ongoing clinical trial looking at the myoelectric activity of the stomach following pancreaticoduodenectomy as a function of predicting which patients are at higher risk of developing delayed gastric emptying or postoperative ileus. This study is being performed concurrently with the introduction of the division’s enhanced recovery after surgery perioperative care pathways to facilitate improved patient outcomes in those undergoing pancreatic resections.
Dr. Dua was also awarded funding this year as a Co-PI on a Stanford Cancer Center proposal to implement the collection of patient-reported outcomes for GI Oncology (specifically HPB) patients. The specific aims of this study are to create disease-specific quality of life questionnaires and build them into the electronic medical system; to operationalize their distribution and collection in the outpatient clinics and MyHealth; and to build the capability to run individual and aggregate reports on patient-reported outcomes. This infrastructure for collecting disease-specific patient-reported outcomes will not only help clinicians understand the subjective patient experience but also improve the process of treatment decision-making, ultimately improving the quality of care.
Dan Eisenberg, MD
My primary research interest is in obesity and bariatric surgery in special populations. Specifically, we are studying surgical outcomes in obese Veterans who represent a higher risk cohort of bariatric surgery, being a majority male population that is older and carries a higher burden of disease. In addition, we are currently studying obesity in Veterans with spinal cord injury, with a goal to identify gaps in assessment and management of obesity in this special population.
Joe Forrester, MD
The goal of the SIR-S group, led by Dr. Joe Forrester, is to understand interactions between the microbiological world and the surgical patient. Through our research, we aim to reduce the morbidity and mortality associated with infections in surgical patients. To achieve this goal, a portion of the group’s research focuses on describing the spread of pathogens impacting surgical patients at the local, state, national, and international level. We are particularly intrigued about how this spread is influenced by climate change, population migration, urbanization, and conflict. In order to better inform surveillance recommendations, we have worked to understand existing surveillance systems targeting surgical site infections in low- and high-resource settings. We believe that surgical and public-health communities currently under-utilize predictive models for most pathogens that infect surgical patients. To this end, we are invested in leveraging computer-learning to provide real-time, real-world predictions of outbreak spread and disease emergence. In addition, we are also intensely interested in the clinical treatment of surgical patients infected with emerging and re-emerging pathogens, and how emerging and re-emerging pathogens may influence provision of surgical care.
Our group is open to working and collaborating with undergraduates, medical students, post-graduate students, and fellow faculty interested in improving how we co-exist with microbial pathogens. Please email jdf1@stanford.edu with any questions or interest.
Brooke Gurland, MD, FACS, FASCRS
Pelvic floor dysfunction affects 20% of women and <10 % of men over their lifespan. Treating pelvic floor dysfunction crosses a series of disciplines in urology, gynecology, gastroenterology, and colorectal surgery. These clinical issues — critical to Women’s Health — range from urinary and fecal dysfunction, pelvic organ prolapse, and evacuatory dysfunction to pelvic floor spasm and chronic pain.
At the Multidisciplinary Pelvic Health Center at Stanford, we have a robust prolapse registry that addresses patient profiles, risk factors for prolapse recurrence, pelvic floor imaging, surgical decision making and complications. We have currently received funding to perform a multicenter study that evaluates the cost effectiveness of combined rectal and vaginal surgery.
Mary Hawn, MD, MPH
Dr. Hawn’s area of research is health services researcher focusing on surgical quality measurement and policy. She has a background and training in epidemiology coupled with her leadership roles in surgical quality measurement. Her expertise and extensive experience in evaluation of surgical quality process and outcome linkage has impacted national policy and changed guidelines. She has performed a comprehensive evaluation of the Surgical Care Improvement Project (SCIP) implementation using national VA data. Defining robust metrics of surgical quality that are actionable and can lead to sustained improvement in our field are of utmost importance.
She also has experience with risk prediction modeling for surgical patients. During the Decision Support for Safer Surgery study she and her team developed models of real-time risk prediction for major complications and prospectively validated our models in patients and with expert surgeons. They were able to discern where computational risk prediction has added value and where it falls short. They currently have several ongoing national studies investigating readmissions following major surgical procedures to identify opportunities for improving care and reducing costs as well as de-implementing low value care.
Stefanie S. Jeffrey, MD
Integration of Liquid Biopsy into Clinical Cancer Care
Jan. 2019
Dr. Jeffrey’s research expertise is in genomic and transcriptomic molecular profiling of cancer, technology development, and liquid biopsy, including investigations of circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and targeted extracellular vesicles (EVs/exosomes). She led an interdisciplinary team that invented a CTC-capture technology and transcriptionally profiled CTCs at the single-cell level. Her lab has generated patient-derived xenograft models of breast and metastatic colorectal cancer to investigate CTC shedding, metastases, and drug response.
Dr. Jeffrey has close collaborations with colleagues at the School of Engineering and elsewhere on the development and application of new technology platforms. These include different types of microfluidic systems, surface-enhanced Raman spectroscopy for culture-free identification of bacterial pathogens in sepsis, advanced optical methods for drug testing in cancer, and nanophotonics for rapid genomic and proteomic analyses in viral diseases and malignancy.
Mardi Karin, MD
Dr. Mardi R. Karin’s primary interest is in optimizing clinical outcomes for nipple sparing mastectomy and breast reconstruction. Given the recent advances in breast MRI imaging, that now allows for 3D MRI image reconstruction and detailed viewing of the blood supply to the nipple area, this additional information can be used as a guide to the blood flow patterns to the nipple. Dr. Karin uses 3D Breast MRI images to identify blood flow patterns to the nipple, to develop surgical techniques to preserve blood flow to the nipple for optimal results with nipple sparing mastectomy. By prospectively tracking clinical outcomes, it appears that this improved ability to preserve blood flow to the nipple results in lower rates of nipple necrosis and mastectomy skin necrosis that can occur as a result of poor perfusion, and thus improved clinical outcomes. Clinical outcomes are evaluated and tracked by Dr. Karin in collaboration with the Plastic and Reconstructive surgeon, Dr. Arash Momeni and others. It is hoped that this will translate into shorter healing time for patients, and also ultimately more optimal cosmetic outcome with nipple-sparing mastectomy and breast reconstruction.
Electron Kebebew, MD
Dr. Kebebew’s clinical and translational research is focused on three main scientific goals: 1) to develop effective therapies for fatal, rare and neglected endocrine cancers by identifying driver genomic/genetic events that govern cancer initiation/progression; 2) to identify new methods, strategies and technologies for improving the diagnosis of endocrine neoplasms and the prognostication of endocrine cancers; and 3) to develop methods for precision treatment of endocrine tumors utilizing genomic/genetic information and advanced imaging modalities.
Cindy Kin, MD
Dr. Cindy Kin is a colorectal surgeon whose research interests include treatments and outcomes of inflammatory bowel disease, medical decision-making in surgical patients, and implementation and outcomes of enhanced recovery pathways. She uses both quantitative and qualitative research methods to address these questions. Current projects include: biologic use and surgical complications among patients with inflammatory bowel disease, the use of opioids among patients undergoing surgical procedures and prescribing practices of surgeons, the effect of a multimodal prehabilitation program on patient experience and outcomes, and medical decision-making among patients with inflammatory bowel disease.
Lisa Knowlton, MD, MPH
Dr. Knowlton is a trauma and critical care surgeon and health services researcher who is currently an Assistant Professor within the Department of Trauma Surgery and Surgical Critical Care at Stanford University Medical Center. Using mixed methodologies and advanced geospatial mapping techniques, she has conducted evaluations of access to safe surgery in numerous low- and middle-income countries. This research has resulted in collaborations with the World Health Organization, non-profits, government officials and Ministries of Health. In addition to her global health expertise, she has most recently focused on better understanding the complex interplay between local access to healthcare and patient outcomes. This is particularly relevant to trauma patients, where significant disparities exist based upon socioeconomic and insurance status, and the financial burden of injury can be devastating for underinsured trauma patients and the hospitals in which they are treated. She has been awarded the 17th C. James Carrico Faculty Research Fellowship by the American College of Surgeons to better understand the link between socioeconomic status, insurance coverage and quality of patient outcomes for trauma patients receiving care within U.S hospitals.
Future goals of her research curriculum include developing novel reimbursement initiatives for quality trauma care, providing economically sustainable strategies for ensuring best outcomes among trauma patients and long-term viability of our essential trauma systems.
James R. Korndorffer, Jr. MD, MHPE, FACS
Dr Korndorffer’s research interest and focus is on education and assessment of medical learners—including undergraduate medical education learners, graduate medical education learners and the practicing physician lifelong learners. He has been involved in developing and evaluating novel teaching strategies, as well as unique assessment and evaluation methods.
A large body of his research focuses on the use of simulation for learning and assessment. He was an early adopter of the use of simulation for surgical training and has been actively involved in this research since 2003. He performed some of the early work using proficiency-based training instead of time base training for skill acquisition. This has now become the norm—whether called proficiency-based training or mastery learning.
He has continued this programmatic research with additional emphasis on simulation for assessment. It is this focus on assessment that has been recognized nationally. His additional area of interest is in patient safety and quality improvement through teamwork in the hospital environment. Combining these two areas he is investigating the role simulation education has in patient care quality and healthcare system safety.
Dana T. Lin, MD
Dr. Lin’s primary research focus is in surgical education, specifically around curriculum design, and cognitive and technical skills acquisition and assessment. Her projects leverage technological innovation such as gamification, mobile applications, and video-based learning to enhance surgical training. Another area of particular interest is physician well-being, which includes identifying factors that mitigate distress and burnout, exploring its impact on clinical performance and patient-reported outcomes, and assessing programs designed to optimize surgeon wellness.
Arden M. Morris, MD, MPH
Implementation of the Synoptic Operative Report for Rectal Cancer
May 2018
Arden M. Morris, MD, MPH is Professor of Surgery and Vice Chair for Clinical Research in the Department of Surgery. She recently served on the National Quality Forum Consensus Standards and Approval Committee and was a Visiting Scholar at the Russell Sage Foundation. As a practicing surgeon and health services researcher, she uses quantitative and qualitative methods to focus on quality, patient centered care, and disparities in care. Dr. Morris is completing analyses for a collaborative multicenter mixed methods study to understand patient and provider influences on decision making and the quality of colorectal cancer care. Her results have provided critical information on the importance of doctor-patient communication, patient values, and socioeconomic considerations in shaping treatment decisions. She next intends to study the implementation of patient-centered policies in ways that support patient-provider relationships, facilitate coordination of care, and explicitly engage patients in their care.
Dr. Morris was recently recruited by Stanford University to develop and lead the Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center. With goals to improve the value of healthcare through research that informs policy and implementation, to develop innovative mixed methodologies, and to create a community of surgical health services researchers at Stanford, S-SPIRE Center has already assembled an interdisciplinary team that includes clinical and research faculty with expertise in implementation science, health economics, bioinformatics, and quantitative, qualitative, and mixed methodologies.
Aussama Nassar, MD, MSc, FACS, FRCSC, CHSE
Dr. Nassar, is a clinician and simulation educator with a Master’s degree in Health Sciences Education. His educational research focuses on creating educational assessment tools, the use of simulation based medical education in team training, inter-professional team education and collaboration for trauma and the operating room. Dr. Nassar is currently spearheading a team of researchers in developing a conceptual framework for inpatient focused communication skills curriculum for surgical residents. Furthermore, he is leading a study looking at the utility of in-situ virtual reality simulation for trauma team inter-professional team education and debriefing.
In addition to his educational focus, Dr. Nassar has special research expertise in physician wellness and particularly burnout among academic clinicians.
Jeff Norton, MD
Dunphy's Puzzle Revisited: Is it time to consider antitumor immunity in cancer research.
Sept. 2018
Gene Directed Surgery
Dec. 2017
Tumors are composed of tumor cells and stroma. My research, in collaboration with Dr. Longaker in the Division of Plastic & Reconstructive Surgery, is investigating the tumor stroma to determine if it can be used to affect tumor growth and recurrence. Our initial work has focused on fibroblasts because they are the most common cellular component of the tumor stroma, but in the future, we will also investigate the immune cellular component and signaling molecules like cytokines and growth factors. My prior research focused on the role of cytokines and growth factors in wounds and tumors so I intend to further investigate these factors in our current models with the eventual goal of affecting tumor growth, progression and metastases.
Carla Pugh, MD, PhD
George Poultsides, MD
The main focus of Dr. Poultsides’ research team lies on clinical outcomes analysis following multidisciplinary treatment of hepatic, pancreatic and gastrointestinal malignancies. He has led several nationwide, multi-institutional clinical research collaborations across several academic medical centers in the US on liver, pancreatic, adrenal and gastric cancer. Within Stanford, Dr. Poultsides has developed a novel interdisciplinary research program assessing the completeness of surgical resection for pancreatic cancer. He has served as the principal investigator in two, first in human, prospective clinical trials evaluating the role of mass spectrometric and intraoperative fluorescent imaging during surgery for pancreatic cancer. These research efforts were funded through the 2012 Stanford Hospital Cancer Innovation Fund award and the 2016 Stanford Cancer Institute translational research award.
S-SPIRE Center
S-SPIRE is a community of surgeon-scientists dedicated to improving the value of healthcare through research that informs policy and implementation; promoting a surgical health services research community through mentorship and collaboration; and developing innovative mixed methodologies.
Our interdisciplinary team includes clinical and research faculty with expertise in implementation science, health economics, bioinformatics, and quantitative, qualitative, and mixed methodologies. For more information about opportunities for research collaboration, educational programs, and a summer healthcare career pipeline program for teens from low-income high schools, please visit our website.
Alex Sox-Harris, PhD
Dr. Sox-Harris is a health services researcher, applied statistician, and implementation scientist with several programs of research: quality measurement, predictive modeling, and de-implementation of low value treatments and practices. His quality measurement research across diverse clinical areas has informed measurement science methodology and measure selection by federal agencies and healthcare systems. His current focus is on the development and validation of quality measures for hand surgery, as well as testing strategies to use quality data to drive target behaviors, without causing unintended consequences. His predictive modeling research has focused on musculoskeletal disorders for which surgery is a major treatment option. He recently completed a 4-year VA-funded study that developed the best-in-class prediction models for short-term complications and 1-year improvements in pain and functioning for patients receiving elective total knee and hip replacement.
Dr. Sox-Harris is currently leads a VA-funded study to describe, understand, and reduce low value preoperative testing for patients undergoing low risk surgeries. Future plans include examining a more comprehensive group of low value surgical practices, and developing and testing organizational interventions to improve practice and clinical outcomes. Dr. Sox-Harris also mentors early career surgeon-scientists in the art and craft of building health services research careers.
David A. Spain, MD
Dr. Spain is an active investigator in the field of Acute Care Surgery (Trauma, Emergency and Critical Care Surgery). Along with Eve Carlson, PhD, he is the PI on an R-01 grant from the National Institute on Minority Health and Health Disparities (NIMHHD) on the “Development of a Risk Factor Screen for Mental Health Problems after Sudden Illness or Injury.” Stanford is the coordinating center on this multi-institutional study aimed at developing a practical and accurate screen for PTSD, as well as identify any disparities that may exist. This study will run through 2022.
Dr. Spain is also the site PI on a large multi-institutional trial funded by the DOD - Defense Medical Research and Development Program on “The Pathogenesis of Post-Traumatic Pulmonary Embolism: A Prospective Multi-Center Investigation by the CLOTT Study Group.”
Kristan Staudenmayer, MD, MS
Dr. Staudenmayer’s research has focused using secondary data to generate knowledge around trauma and emergency general surgery systems of care. She has been an active PI funded by the NIH (NIA K08) and the Clinical and Translational Science Award Program. Her research focus has historically been on vulnerable populations, especially those who are financially disadvantaged as well as older adults. These populations are particularly affected by emergent surgical conditions such as trauma or emergency general surgery diagnoses. She has also worked to improve systems of care for these populations. Her body of work on trauma systems aims to evaluate the economically viability of trauma systems, which is necessary to ensure high-quality trauma care can be delivered in the U.S. She also has experience in informatics.
Her most recent work is exploring the development of systems for management of health-related data in electronic health records and mechanisms to automate data utilization for downstream purposes such as point-of-care tools funded through Stanford and the American College of Surgeons. Dr. Staudenmayer has recently submitted a grant to the NIH in conjunction with the ACS with the goal of automating electronic registry creation to facilitate research and quality efforts.
Furthermore, Dr. Staudenmayer holds leadership roles in national academic societies including the American College of Surgeons and the American Association for the Surgery of Trauma. This allows her to shape health services research topics in national trauma and emergency general surgery systems at a national level.
Technology Enabled Clinical Improvement Center
The Technology Enabled Clinical Improvement (T.E.C.I.) Center is a multidisciplinary team of researchers dedicated to the design and implementation of advanced engineering technologies that facilitate data acquisition relating to clinical performance.
The T.E.C.I. team has had great success in quantifying physicians’ clinical experiences using sensor, video, and motion tracking technologies. This work has resulted in an information rich database that enables empirical evaluation of clinical excellence and medical decision making.
By leveraging highly specific and objective clinical performance metrics, the T.E.C.I. Center is harnessing the unique opportunity to support peer to peer data sharing and clinical collaborations that can transform the clinical workflow and ultimately benefit healthcare providers.
The T.E.C.I. Center aims to transform human health and welfare through advances in data science and personalized, technology-based performance metrics for healthcare providers.
Todd Wagner, PhD
Dr. Todd Wagner studies health information, efficiency and value, and health care access. He is particularly interested in developing learning health care systems that provide high value care. He has worked for 20 years in a health care delivery system where economics and clinical care intersect with high-cost or intensive services, such as surgery or critical care.
Dr. Wagner’s work typically includes the analysis of large administrative datasets within the Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center. He has a joint appointment with the Palo Alto VA where he directs of the Health Economics Resource Center and is the Associate Director for the Center for Innovation to Implementation. He also co-directs the Big Data Fellowship, which is supported by VA and NCI.
Dr. Wagner is finishing a study on specialty care access and the role of telemedicine in the VA. Current projects include a study estimating the causal effect of going to 12-step programs for drug abuse and the long-term follow-up from two cardiac surgery clinical trials.
Irene Wapnir, MD
For the past 25 years, Dr. Wapnir has focused on developing and conducting investigator-initiated clinical studies as well as basic and translational research in the field of breast surgical oncology. She is the institutional principal investigator for the NSABP/NRG Oncology Cooperative Group and chair of the chemotherapy for isolated locoregional recurrence of breast cancer (CALOR) trial, which has resulted in new guidelines for patients with estrogen receptor-negative failures.
Additionally, Dr. Wapnir is involved in multiple studies to improve outcomes for nipple sparing mastectomies and safeguard against ischemic complications. This study will complement her previous work in the field and will add to the understanding of skin perfusion. Another one of her initiatives is to simplify the marking of biopsied axillary lymph nodes with tattoo ink. For women with inoperable locally recurrent disease, Dr. Wapnir and her colleague Dr. Telli are using immune-stimulating local treatments to activate a systemic immune response. Lastly, Dr. Wapnir is leading a study to determine the need for radiation therapy in ductal carcinoma in situ or Stage 0 breast cancer.
Thomas G. Weiser, MD, MPH
Lifebox Global
His research is focused on evaluating the role surgical care plays in the delivery of health services in resource poor settings, in particular low and middle income countries. He is interested in barriers to access and provision of surgical care, the quality of surgical services, and outcomes research as well as the science of implementation, how improvements can be made, and how to strengthen compliance with best practices and change behaviors for the better. He also has an interest in domestic policy as it relates to trauma outcomes, trauma systems, insurance coverage and costs of care, and firearm violence.
His current projects focus on the quality of surgical care and strategies for improving the safety and reliability of surgical delivery in resource poor settings. He is the Consulting Medical Officer for Lifebox, a nonprofit focused on improving surgical and anesthetic safety worldwide. Lifebox delivers programs throughout the world in combination with local partners including individual professionals, professional societies, hospitals, other NGOs, and ministries of health. Lifebox works with hospitals in Ethiopia, Liberia, Madagasgar, India, Honduras, and Nicaragua, amongst others, to improve care and evaluate the impact of our work. A few programs of particular impact are the distribution of low cost devices to improve the safety of care (including pulse oximeters for the routine monitoring of patients undergoing anesthesia and a new surgical headlight program) and Clean Cut, a surgical infection prevention and control program now being introduced in several countries.
Dr. Weiser has been involved in surgical program assessment projects in numerous countries. From 2006-2009, he was part of the World Health Organization’s Safe Surgery Saves Lives program where he quantified the global volume of surgery and created, implemented, evaluated, and promoted the WHO Surgical Safety Checklist. He has worked with the WHO and the World Bank and is currently the recipient of a Gates Grand Challenge grant to improve the safety of cesarean section in Ethiopia.
Sherry M Wren MD, FACS, FCS(ECSA)
Dr. Wren’s research program has international and domestic components. Internationally she is investigating access or barriers to care in humanitarian conflict zones and low and middle income countries. In the humanitarian context, she is actively engaged in work to redesign the delivery of surgical care in the humanitarian response to modern conflicts. This work includes surgical disease epidemiology, logistic and response design, international humanitarian law, and policy implications of humanitarian responses. In the non - humanitarian context in low and middle income countries Dr. Wren is using a gender lens to examine barriers to women obtain surgical care and identifying opportunities to address the disparities and under-representation of women as surgical patients in hospitals. Within the US Dr. Wren is interested in outcomes based research, primarily within the VA system to examine cancer, robotics, and risk assessment in surgical patients. Current projects include secondary cancers post radiotherapy and the influence of CHF on surgical outcomes and risk.