Perioperative Medicine

About

Vital statistics projections are that by early this current century, the elderly population will increase sharply due to aging of the baby boomers. By 2030, estimates are that one out of five Americans will be 65 years of age or older, while one out of four elderly individuals will be ≥ 85 years of age. The other adult population will have an increased likelihood of requiring surgery. Statistics show that approximately 12% of adults will require surgery each year as compared with 21% of the elderly who will require some form of anesthesia and surgery.

With the continued aging of the population and more older patients needing surgery, improvement of the perioperative care delivery and outcome of the older subjects is critically important. Our group focuses on outcomes research in older surgical patients, with the overall goal to identify methods to improve perioperative care delivery and outcomes of older surgical patients.

Research

The Perioperative Medicine Research Group headed by Dr. Leung focuses on outcomes research involving older surgical patients. Compared to their younger counterparts, older patients tend to have more severe illnesses and poorer clinical outcome after surgery. Of the adverse outcomes, postoperative delirium and cognitive decline are particularly common among the older patients. In our previous work, we found that the occurrence of postoperative delirium has significant implications for health care resource utilization. In a cohort study conducted since 2001, we found patients with postoperative delirium were three times more likely to be discharged to either a skilled nursing facility, another hospital, or nursing home than those without delirium. Furthermore, the duration of in-hospital stay was significantly longer in those with postoperative delirium compared to those without. Therefore, an effective strategy in reducing or preventing postoperative delirium will likely lead to a shorter hospital stay and reduce resource utilization. Despite the prevalence and clinical importance of postoperative delirium and cognitive decline, no specific causative factor has yet been identified for these two conditions, and no preventive therapy is currently available. As a result, our current research focuses on identification of the causes for postoperative delirium and cognitive decline, in order to develop effective strategies to decrease the incidence and severity of these adverse neurological outcomes in older patients undergoing major surgery.

Current projects:
1. The role of genomics in postoperative delirium and sedation

Cohort study in patients aged ≥ 65 years undergoing major noncardiac surgery to identify the role of predisposing patient risk factors, precipitating events and the interaction of these on the occurrence of postoperative delirium. This study is funded by the NIH, National Institute of Nursing Research.
5R01NR017622-02

2. Feasibility and Validity of the TabCAT for Use in Cognitive Assessment of Adult Surgery Patients

Cohort study in patients aged ≥18 years undergoing surgery to understand the similarities and differences of cognitive performance between traditional paper-pen cognitive assessment versus iPad based, using the Tablet Based Cognitive Assessment Tool (TabCAT) software.

3. The Impact of Surgery End Time and Duration on Postoperative Sleep

This study examines if intraoperative factors, specifically surgery end time and duration, impact how older patients sleep after surgery.

 

Recently Completed Projects:
1. The relationship between preoperative sleep disruption and postoperative delirium. This study was funded by the NIH.  5R21AG053715-02

2. The effects of light vs deep anesthesia on postoperative cognitive outcomes. This study was funded by the NIH  5R21AG048456-02 and registered under clinicaltrials.gov (NCT01983384).

3. Clinical trial of gabapentin to decrease postoperative delirium and pain. This study was funded by the NIH/National Institute of Aging  1R01AG031795-01A2 and registered under clinicaltrials.gov (NCT00221338).

4. Aging and perioperative outcomes. This study was funded by the NIH/National Institute of Aging. 5K24AG000948-02

FAQs for Potential Research Participants

Q&A

1. What is postoperative delirium?

It’s a transient state of confusion that can last hours to days. A state of delirium means the temporary and fluctuating inability to think clearly, pay attention, and/or have awareness of their environment. It is common in hospitalized older adults but is thought to be a reversible condition. If you have concern about this, you should speak with your anesthesiologist and surgeon before the planned surgery.

 

2. What is dementia?

While delirium is an acute state of confusion and inattention, dementia comes on gradually and is permanent. Those who have dementia have an increased risk of developing delirium. If you have a concern about baseline memory impairment and affecting their postoperative cognitive changes, again you should speak with your anesthesiologist and surgeon before the planned surgery.

 

3. What can I expect if I volunteer for a research study with the perioperative medicine group?

We conduct thinking and memory questions pre and post-surgery. These questions are done over the phone prior to surgery and in person for the first 3 days during your hospital stay by trained research assistants. If you wish to participate in any of our ongoing studies, please email  [email protected] .

For more information about delirium, visit the American Delirium Society

People

 Jacqueline M Leung, MD, MPH

 Principal investigator, Professor of Anesthesia & Perioperative Care

 UCSF Profile

 

 

 Christopher Tang, BS

 Assistant Clinical Research Coordinator

 UCSF Profile

 

 

 Devon Pleasants, BS, BA

 Assistant Clinical Research Coordinator

 UCSF Profile

 

 

 Sanam Tabatabai, BS

 Assistant Clinical Research Coordinator

 UCSF Profile

 

 

 Danielle Tran, BS

 Assistant Clinical Research Coordinator

 UCSF Profile

 

 

Available Positions

We currently have four staff research associates, and can take on 1-2 students (pre-med or medical) from time to time. We also have non-paid positions for individuals who would like to learn about research and serve as volunteer researchers. We sometimes will take on postdoctoral fellows who have self-funding.

Interested individuals should send their CV to [email protected]

Contact Us

Email: [email protected]
Phone: 415-476-0711
Fax: 415-476-9510

Mailing Address:
UCSF Department of Anesthesia & Perioperative Care
500 Parnassus Avenue, Room MUE-415
San Francisco, CA 94143-0648, USA

Location:
Research Office: Clinical Sciences Building 4th Floor
 

Contribute

We thank you for considering a gift to the Leung's Lab for Perioperative Medicine which helps funding future experiments.

1. Make a Gift Online

To make a donation through a secure online donation form, please click https://makeagift.ucsf.edu

Step 1) Click the "Direct your gift to a specific area" button

Step 2) Select Other, type "Leung's Lab" then click Continue

Step 3) Choose your donation amount, provide the request personal information and payment information. 

Or 2. Mail in Your Gift

Please make your check payable to UCSF Foundation* and mail it to:

UCSF Foundation
Box 45339
San Francisco, CA 94145
Please note on your check "Leung's Lab".


Thank you for your choice to support research for the UCSF Leung's Lab!

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