A coalition of interdisciplinary researchers from four institutions — including Weill Cornell Medical College and Hospital for Special Surgery — has won a prestigious award recognizing the team's success in translation of research discoveries pertaining to perioperative outcomes in orthopedic surgery into clinical practice.
The team, led by Dr. Madhu Mazumdar, professor of biostatistics in public health and chief of the Division of Biostatistics and Epidemiology in the Department of Public Health at Weill Cornell, and Dr. Stavros G. Memtsoudis, a clinical associate professor of anesthesiology and public health at Weill Cornell and associate attending anesthesiologist at Hospital for Special Surgery, garnered the esteemed Team Science Award from the Association for Clinical Research Training, American Federation for Medical Research, Association for Patient Oriented Research and Society for Clinical and Translational Science during their annual Translational Science meeting April 18-20.
Composed of anesthesiologists, an orthopedic surgeon, a spine surgeon, biostatisticians, and epidemiologists from Weill Cornell, Hospital for Special Surgery, University of Massachusetts Medical School and Mathematica Policy Research in Princeton, N.J., the team was recognized for studying various aspects of the perioperative epidemiology including the incidence, risk factors and trends of morbidity and mortality, changes in the population receiving care and — following the concepts of comparative effectiveness research — outcomes associated with different orthopedic surgical approaches and anesthetic techniques. The team was also recognized for spurring national dialogue on these issues. The award carries a $1,000 cash prize.
"This is a big honor for us," Dr. Mazumdar said. "Any of us could get recognized for our individual work, but getting honored for being a team scientist and especially winning an award with this large and diverse group of collaborators is very gratifying."
The team began four years ago with five collaborators. Dr. Memtsoudis was writing an article on the perioperative period in orthopedic surgery with his colleague, Dr. Alejandro Della-Valle, an orthopedic surgeon at Hospital for Special Surgery and reached out to Dr. Mazumdar for some biostatistical help. As the biostatistics core director of the Clinical Translational Science Center grant, Dr. Mazumdar was working on increasing collaboration between its partner institutions and recognized an opportunity in this effort. She enlisted other Center biostatisticians, Dr. Yan Ma from Hospital for Special Surgery and Ya-lin Chiu from Weill Cornell, and thus the team was born.
The team initially engaged in research on the safety of bilateral total knee replacement surgery, which seemed to be linked to increased perioperative morbidity and mortality. Using nationally represented databases, the researchers discovered in the first large-scale national study on this subject that the procedure carries a three-fold adjusted risk for in-hospital mortality, even when performed on younger and healthier patients. Moreover, the researchers found that staggering the procedure across several days produced even greater risk for morbidity and mortality.
As a result, Hospital of Special Surgery revised its institutional guidelines on who is an appropriate candidate for same stage bilateral knee replacement surgery and who would benefit from having two procedures staged months apart, Dr. Memtsoudis said. In addition, the Hospital discontinued the protocol of staging procedures only days apart. The team is now organizing a symposium at the Hospital in September with national health care leaders and experts in an effort to develop national guidelines.
With funding from the Clinical and Translational Science Center, and from an Agency for Healthcare Research and Policy grant to establish a Center for Education and Research on Therapeutics at Weill Cornell, as well as Hospital for Special Surgery's Department of Anesthesiology, the team later began delving into other perioperative studies impacting heavily upon the fields of general orthopedic surgery, anesthesiology and spine surgery. They also developed and disseminated innovative methods and software for performing meta-analysis, wrote tutorial papers for improved use of appropriate statistical methods in these clinical fields and advanced a novel model for obtaining editorial review work from biostatisticians to ensure consistency and quality in reporting of statistical results. The team is currently studying outcomes of patients with metabolic syndrome as well as depression undergoing spine and joint surgery to identify how these factors impact morbidity, mortality, disposition, length of stay and hospitalization cost.
"Our clinical colleagues were asking so many 'right' questions that were both relevant and actionable that we just kept going," Dr. Mazumdar said.
Three years and some 45 scientific papers later, the team now encompasses 14 researchers who have trained nearly two dozen fellows, residents, graduate students and medical students in interdisciplinary research. Team members believe these trainees truly understand the added value of working in a team.
"Without any of these people and the funding sources, this level of outcome and impact wouldn't be possible," said Dr. Mazumdar.
This team's success led to the development of a new model for research collaboration between personnel from the Medical College and any Weill Cornell-affiliated hospital that could be reproduced for many other disease systems and processes.
The Division of Biostatistics and Epidemiology at Weill Cornell has described this model for collaboration on its website. The Division and the collaborating Basic Science and Clinical Departments use their operational, grant funds or clinical revenues to support a team of biostatisticians and epidemiologists charged with enhancing the productivity of research programs in the Basic Science/Clinical Departments at Weill Cornell. Dr. Mazumdar often also arranges a cost-sharing model with grants, from centers including the Clinical and Translational Science Center.
Dr. Mazumdar spoke about this model of team science through enhancement of centralized biostatistical shared resources and encouraged utilization of biostatistical colleagues as connectors in her acceptance speech for the award at the annual meeting. She also called for incorporating participation in team science in promotion and tenure criteria of all institutions. Dr. Francis Collins, the director of the National Institutes of Health, and many Clinical and Translational Science Center biostatistics core directors and members in the audience applauded this team building model and planned for similar development at their institutions, Dr. Mazumdar said.
The outcomes of this joint venture also led to personal successes. Dr. Mazumdar attributes her selection as one of 54 senior women faculty for the 2011-2012 class of fellows by the renowned Hedwig van Ameringen Executive Leadership in Academic Medicine Program for Women at Drexel University College of Medicine — commonly known as ELAM — at least partly due to the success of this research team. Other team members also won awards from the European Hip Society, the American Society of Regional Anesthesia, and American Statistical Association. Many also earned promotions based on the productivity of this team.
"I've achieved more with this team than I ever thought possible," Dr. Memtsoudis said. "I'm incredibly proud of our work."