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.
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.
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 are in the process of creating a prospective registry from which to answer important research questions about patient-centered care and best practices for patients with rectal prolapse, fecal incontinence, obstructed defecation, and pelvic organ prolapse. Ongoing research questions include: the rate of mesh complications and functional outcomes after robotic ventral rectopexy and predictors of success after injection of botox into the levators ani muscles for obstructed defecation and levator ani syndrome.
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 on molecular profiling, technology development, and liquid biopsy, including investigations of circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and targeted extracellular vesicles (EVs/exosomes) from patient samples and patient-derived models of breast and metastatic colorectal cancer. She was co-chair of the 2018 Gordon Research Conference on Liquid Biopsy for Cancer and a thought leader of the themed collection 'Personalised Medicine: Liquid Biopsy' for the Royal Society of Chemistry journal, Lab on a Chip .
Dr. Jeffrey was a founding member of the Stanford-Norway team that pioneered the molecular classification of breast tumors into distinct subtypes, including luminal and basal-like/triple-negative breast cancers, using transcriptional profiling. Her lab has developed or optimized CTC capture and analysis technologies and was among the first to perform high-dimensional single-cell transcriptional profiling of CTCs from patient blood samples. The Jeffrey Lab’s current research focuses on technology development and generation of patient-derived models for measuring drug response in single cells, clustered cells, and metastases.
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.
James N. Lau, MD, MPH
While Dr. James N. Lau’s clinical focus is on minimally invasive and bariatric surgery, his research focus has almost uniformly been focused on medical education in all its breadth and depth. His educational portfolio is focused on issues and curricular program evaluation in undergraduate and graduate medical education as well as the development of an interprofessional and interdisciplinary community of medical educators at Stanford. As a mentor to any and interested in medical education, his interest is in the development of his mentees’ individual career research foci. This has led to his investigations into physician wellness, emotional intelligence, residency attrition, skills assessment, mentorship, and the flipped classroom.
His individual specific passions have resulted in investigations and works of scholarship in the educational environment (specifically medical student mistreatment) and in the power of culture change with interprofessional team training. His master’s in health professions thesis in medical student mistreatment was featured in Academic Medicine and was awarded the MHPE Program’s award for best thesis that year. He continues to investigate and define mistreatment through qualitative means. His passion in teamwork and communication has become manifest In the use of interprofessional in-situ simulation in the operating room to change the culture to value everyone’s opinion. He is actively involved in studying this team training initiative through a mixed methods review including patient outcomes, focus groups and interviews, and direct observations.
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.
View a complete list of the group's scholarly contributions.
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
Dr. Staudenmayer is a health services researcher focusing on systems of care, particularly as they relate to care delivery for vulnerable patient populations such as the elderly. Her work in systems of care has focused on ensuring that trauma systems are functioning at their optimal levels and are financially viable. She also has explored how the older adult population has distinct needs from the younger adult population. With regards to this population, she has combined the development of new care processes and research to define optimal care. For example, one clinical study currently underway evaluates standardized goals of care discussions for older adults with head injuries. Other work in this space has been accomplished using national-level datasets and employing various epidemiologic and econometric techniques. In addition to her own research, she is also involved in a large national project funded through the Coalition for National Trauma Research to establish trauma research priorities, and another to determine systems issues as they relate to pre-hospital trauma deaths.
Given the importance of having quality data to both improve care for patients and to perform deeper-level analyses of these problems, Dr. Staudenmayer is also studying how to improve healthcare information systems. One project involves exploring the quality of information contained within current EMR systems. Starting July, 2019, she is working with the American College of Surgeons to develop digital services aimed at helping surgeons improve care delivery and to streamline data collection.
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
Our 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. I am interested in barriers to access and provision of surgical care, the quality of surgical services, and outcomes research.
My current projects focus on the quality of surgical care and strategies for improving the safety and reliability of surgical delivery in resource poor settings. We are working with hospitals in Ethiopia and Cambodia on a surgical infection prevention and control program in conjunction with Lifebox, a nonprofit focused on improving surgical safety worldwide. I have been involved in surgical program assessment projects in Cambodia, India, the UK, and the United States. From 2006-2009 I was part of the World Health Organization’s Safe Surgery Saves Lives program where we quantified the global volume of surgery and created, implemented, evaluated, and promoted the WHO Surgical Safety Checklist.
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.