Grant Application

Jennifer Holder-Murray, MD, FACS,  UPMC Hillman Cancer Center

Proposed Innovation

Enhanced Recovery After Surgery (ERAS) protocols have significantly improved perioperative care, improved patient length of stay, and decreased mortality. But ERAS protocols have high variability in medications and treatments to achieve these goals. Identifying which components of the protocols are most effective will reduce overtreatment, improve quality of care, and improve resource utilization.

Through this innovative project, embedded clinical trials will be used to test protocols to determine which ones are most effective for patients undergoing surgery at UPMC.

Improvements in Action

The UPMC Randomized, Embedded Multifactorial Adaptive Platform Trial for Perioperative Medicine (REMAP Periop) is a novel trial to evaluate and ultimately implement the best perioperative care pathways. The goal is to determine the optimal perioperative care for patients admitted for elective surgeries within specialties actively practicing ERAS.

This project is a collaborative effort between the departments of anesthesiology and perioperative medicine, surgical departments, and the Office of Health Care Innovation. The study will begin with abdominal surgical specialties and expand across specialties and hospital sites over time. The focus will be on preoperative and intraoperative care, including anesthesia, pain management, and nausea prevention.

Intended Outcomes

A REMAP study is a randomized trial driven by machine learning software that can test multiple variables simultaneously. This study will allow new variables to be added during the trial, enabling cutting-edge technology to be introduced in real time to keep up with advances.

During the project, investigators will analyze the number of hospital-free days 30 days post-surgery, opioid consumption, and postoperative nausea and vomiting. Identifying which components of perioperative care work best is expected to further reduce overtreatment, improve quality of care, reduce costs, and improve the use of resources.