Research in the Division of General Surgery is currently focused on several areas in general surgery, trauma and surgical critical care. The surgeons in this division are specialized to care for a wide range of patients and may include the following: patients with common general surgical conditions such as hernias and biliary colic; patients with severe injuries, whether they require surgery or not; patients requiring evaluation for emergent surgery for a number of different conditions such as gallbladder disease, appendicitis, small bowel obstruction or diverticulitis; and surgical patients requiring care in an intensive care unit.
The Injury and Acute Care Surgery Research Program is committed to inter-disciplinary, collaborative, broadly based clinical research to advance the care of patients with injury. Research is an integral part of our mission as a Trauma Center and an Acute Care Surgery program. Our approach has been to engage in research activities driven by the needs of our patient population. Given this focus, we endeavor to discover and generate knowledge that can be translated into clinical solutions for our patients and our communities. We strive to produce empirical evidence to support trauma and acute care surgery practice. Research may involve patients directly, or the use of data from the MUSC Trauma Registry. In addition, we engage in large multi-center trials at a national level and pursue projects involving the analysis of large datasets from many sources.
The injury research efforts are headed by Samir M. Fakhry, MD, FACS, an experienced researcher with numerous ongoing research projects grants, and publications. An Injury and Acute Care Surgery Researcher, Pamela Ferguson, PhD, provides expertise in epidemiology, with prior clinical experience as an emergency department nurse. All of the Divisional faculty are involved in research, and medical students and residents rotate through the clinical laboratory to gain research experience. Our research focus has been almost exclusively on original research with some participation in clinical trials designed and funded by industry. Examples of our recent and current areas of interest and some funding sources are shown below:
1) The Virtual TeleConsult Clinic: Leveraging Cost–Effective Technology to Improve Access to Quality Tertiary Health Care. This is a Duke Endowment funded project to evaluate a telemedicine platform that allows primary care physicians to access specialist consultation at MUSC. It allows patients in rural areas to reduce driving time by hours, costs for parking and gas, and time off from work by not having to travel to MUSC.
2) Blunt Hollow Viscous Injury. This injury is unusual and difficult to diagnose. Dr. Fakhry originated a multi-institutional study of this injury and served as the coordinating center for 95 Trauma Centers from around the US. As the largest such project to date, the study generated several publications that will likely be definitive references on the subjects of blunt small bowel, colon, duodenal and stomach injury. Follow-up investigations of the impact of this work on outcomes are ongoing.
3) Chest Trauma. This common injury stretches form a rib fracture with relatively minimal consequences to severe chest injury with many rib fractures and an unstable flail chest that can result in prolonged hospitalization and death. Recent advances into chest wall stabilization suggest that such therapies have the potential to ameliorate severe chest trauma. We engaged in one of the early national trials of this therapy.
4) Traumatic Brain Injury (TBI). Our researchers have conducted studies of evidence based protocols for the care of TBI patients, factors associated with the development of post-traumatic epilepsy, disparities in the care of patients with TBI, the prevalence of TBI in inmates in SC, and other TBI-related subjects. We have an ongoing project funded by MUSC to investigate how TBI outcome is affected by access to Level I trauma centers in SC.
5) Integration of Mental and Physical Health. We have a clinical psychologist from the MUSC National Crime Victims Research and Treatment Center working with us through an MUSC Interdepartmental Fellowship award. Projects have focused on post-traumatic stress disorder following trauma, which has been shown to result in poorer outcomes, and have included assessment of cortisol levels and the follow-up of trauma patients via electronic media.
6) The Impact of Insurance Status on Conversion Rates of Laparoscopic Cholecystectomy. Using a representative national dataset, we are evaluating whether the lack of healthcare insurance coverage is associated with presentation at a more advanced or complicated stage of gallbladder disease resulting in operations that may be too difficult to perform safely using laparoscopic techniques. This disparity would result in higher costs, longer hospital stays and more patient pain and complications.
7) The Finding of a “Transition Point” on Abdominal CT Scan in Patients Suspected of Having Small Bowel Obstruction (SBO). The finding on CT scan of a transition point is interpreted by many clinicians as a marker of SBO requiring surgical intervention. There is no compelling data in support of this dogma. We are conducting a multi-year, single institution retrospective study to determine whether the finding of a “transition point” is associated with the need for surgical intervention for SBO.