Our Super Specialty: Outcomes Research at the Global Center
The Global Center Outcomes Research Group (GCORG) is a world leader in Outcomes Research. The surgeons and gastroenterologists in the Center have led studies that have advanced the management of colorectal and inflammatory bowel disease. These studies have improved our understanding of how best to treat simple, complex, common and rare colorectal disease conditions using medical therapy, endoscopic procedures and surgical techniques.
When endoscopic or surgical procedures are needed, researchers within the center have vast experience in evaluating outcomes of both novel and established techniques to identify the best procedure for a particular condition that allows high-quality results with best possibility of cure or control of the disease or disorder that minimally impinges on the patient thus maximizing quality of life alongside. Feedback from such experience with evaluating our outcomes after procedures and operations has helped us progressively improve results and allows us to offer and individualized approach as to the best treatment, procedure or operation for a particular patient.
Our team has collectively published more than 1000 peer-reviewed manuscripts in medical and surgical journals. Most of these publications are in journals with the highest impact factor worldwide and several have transformed medical, interventional, endoscopic and surgical management of colorectal, inflammatory bowel disease and pouch disorders.
Three of our surgeons feature in the top 10 in the world rankings as the most accomplished in research in their areas of expertise (Scholar GPS).
- Ravi P. Kiran, MD | Scholar Profiles and Rankings | ScholarGPS
- Bo Shen, MD | Scholar Profiles and Rankings | ScholarGPS
- James M. Church, MD | Scholar Profiles and Rankings | ScholarGPS
About Outcomes Research
What is outcomes research?
Outcomes research in medicine refers to the systematic investigation of the results or consequences of healthcare practices and interventions. It aims to assess the effectiveness, safety, quality, and impact of medical treatments, procedures, and healthcare policies on patient health outcomes and overall well-being. This research delves beyond traditional clinical endpoints like mortality rates to encompass a wide range of measures, including patient-reported outcomes, quality of life assessments, healthcare utilization, and cost-effectiveness analyses.
Why is outcomes research important?
Outcomes research in medicine is crucial because it helps doctors and healthcare providers understand the real impact of their treatments and interventions on patients. By studying outcomes like effectiveness, safety, and quality of life, researchers can identify what works best for different medical conditions and populations. This knowledge allows healthcare professionals to make informed decisions about treatment options, tailor care to individual patient needs, and continuously improve healthcare practices. Ultimately, outcomes research helps ensure that patients receive the most effective and appropriate care possible, leading to better health outcomes and quality of life for everyone.
How are we conducting outcomes research and what is unique about GCORG?
Our center's mission is multifaceted. Firstly, we strive to streamline data acquisition and management while conducting rigorous research on surgical outcomes and quality. This involves not only traditional clinical endpoints like mortality and complications but also delves into patient preferences, quality of life, and cost-effectiveness, providing a comprehensive understanding of the impact of surgery and interventional endoscopy in managing benign and malignant colorectal disorders and IBD.
Furthermore, the Columbia Global Center serves as a hub for developing and implementing quality improvement programs based on our research findings. By identifying areas for enhancement in clinical practices, we aim to continually elevate the standards of care in colorectal surgery and interventional endoscopy for IBD patients, ultimately leading to improved outcomes and quality of life.
Lastly, our center is committed to conducting policy analysis on the development, introduction, and utilization of medical technology within colorectal surgery and IBD interventional endoscopy. By collaborating with experts in economics, health policy, epidemiology, computer programming, statistics, and decision analysis, we aim to inform and shape the future of colorectal surgical practices and interventional endoscopy techniques for IBD management.
This all is part of our dedication to driving innovation, improving patient care, and shaping the future of colorectal surgery and interventional endoscopy for IBD intervention.
Topics of outcome research in GCORG:
These are examples of outcome research topics conducted in the Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy.
- Evaluation of minimally invasive surgical approaches (laparoscopic, robotic) versus traditional open surgery for colorectal procedures.
- Assessment of complications and morbidity rates associated with different surgical interventions in colorectal surgery.
- Patient-reported outcomes and functional outcomes following colorectal surgery, including bowel function and urinary function.
- Analysis of risk factors for surgical site infections and strategies for prevention in colorectal surgery.
- Comparative effectiveness of different surgical techniques for colorectal cancer resection.
- Evaluation of enhanced recovery after surgery (ERAS) protocols in colorectal surgery and their impact on postoperative recovery and length of hospital stay.
- Assessment of long-term outcomes and recurrence rates following surgical treatment for inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn's disease.
- Comparative analysis of different surgical techniques for managing colorectal polyps, including endoscopic resection versus surgical resection.
- Evaluation of surgical innovations and emerging technologies in colorectal endoscopy and surgery, such as
- Assessment of quality of life outcomes and functional outcomes in patients undergoing stoma creation and reversal surgeries.
Practice changing studies from researchers in GCORG
This a list of studies from our group that have changed practice worldwide
Practice changing studies in Perioperative care
Combined Bowel Prep and Antibiotics Lower Complications in Colorectal Surgery
The study aimed to determine if bowel preparation before colorectal surgery affects outcomes like infections and leaks. It reviewed data from 8,442 patients and compared three groups: those who had no bowel prep, those who had just mechanical bowel prep, and those who had both mechanical bowel prep and antibiotics. The results showed that using either form of bowel prep helped reduce the risk of complications such as infections and bowel obstructions. Specifically, using both mechanical prep and antibiotics was the most effective, cutting down complications like surgical site infections and leaks by about half compared to no preparation at all.
Safe Same-Day Discharge for Colorectal Surgery Patients
The study explored whether some patients who have colorectal surgery can safely go home the same day instead of staying in the hospital. They found that with careful selection and preparation, about one-third of patients could be discharged within 24 hours after surgery, without compromising their safety. These patients experienced similar outcomes—such as rates of complications and readmissions—as those who stayed in the hospital longer. This approach could improve patient experience, reduce hospital stays, and potentially lower healthcare costs.
High Blood Sugar After Surgery Increases Risk of Complications even in Patients without Diabetes
The study examined the impact of high blood sugar levels in patients without diabetes who underwent elective colorectal surgery. They found that many of these patients experienced high blood sugar after surgery, which was linked to a higher risk of complications and death. The more elevated the blood sugar levels, the greater the risk of problems. This suggests that even in patients without a history of diabetes, monitoring and managing blood sugar levels after surgery is important to reduce risks and improve outcomes.
Other Practice Changing Studies
Long-Term Success of IPAA in Crohn's Disease
The study looked at how well ileal pouch-anal anastomosis (IPAA) works for people with Crohn's disease, a condition where this surgery is less commonly performed compared to ulcerative colitis. They followed 204 patients who had the surgery and found that 71% still had their pouch after 10 years. Those who had their Crohn's disease diagnosed either before or soon after the surgery had better outcomes, with most reporting good continence and high satisfaction. However, patients diagnosed later had worse results, though about half still kept their pouch after 10 years. Overall, IPAA can be effective for Crohn's patients, especially when the disease is diagnosed early.
Novel Advancement Flap Technique
The study looked at the long-term results of using a modified rectal advancement flap surgery to treat complex anal fistulas. The success is based on the use of small incisions, small flaps both proximal and distal, and good patients selection. The study followed 98 patients, including those with Crohn's disease and anovaginal fistulas, for an average of 7 years. Overall, the surgery was successful, with a 93% healing rate. Most patients who initially had normal bowel control maintained it after surgery, while those with Crohn's disease had slightly lower healing rates. The findings suggest that rectal advancement flap is an effective treatment for complex anal fistulas, providing good long-term outcomes.
Advancement flap repair: a good option for complex anorectal fistulas - PubMed (nih.gov)
Novel Endoscopic Classification for Diverticulitis
The study introduced a new endoscopic system to assess the severity of diverticular disease and predict patient outcomes. By examining factors like the number and size of diverticula and the condition of the sigmoid colon, the system was able to forecast the likelihood of needing surgery and how soon. In their analysis of 762 patients, they found that those with more severe diverticulosis were more likely to need surgery sooner. With an average follow-up of 11 years, the study suggests that using this grading system could help doctors make better decisions about managing diverticular disease.
Novel International Classification System for Desmoid Tumors
The study evaluated a staging system for desmoid tumors in patients with familial adenomatous polyposis to see if it helps in categorizing the severity and predicting outcomes. They applied this system to 101 patients and found that the tumors were divided into four stages based on size, symptoms, and complications. The results showed that patients with earlier-stage tumors generally needed less treatment and had better outcomes, with few deaths reported in the early stages. In contrast, patients with later-stage tumors were more likely to require surgery, chemotherapy, and had higher mortality rates. The study suggests that this staging system effectively predicts the severity of desmoid tumors and could be useful for guiding treatment and future research.
Practice guiding studies
Management of pouch neoplasia: consensus guidelines from the International Ileal Pouch Consortium.
Kiran RP, Kochhar GS, Kariv R, Rex DK, Sugita A, Rubin DT, Navaneethan U, Hull TL, Ko HM, Liu X, Kachnic LA, Strong S, Iacucci M, Bemelman W, Fleshner P, Safyan RA, Kotze PG, D'Hoore A, Faiz O, Lo S, Ashburn JH, Spinelli A, Bernstein CN, Kane SV, Cross RK, Schairer J, McCormick JT, Farraye FA, Chang S, Scherl EJ, Schwartz DA, Bruining DH, Philpott J, Bentley-Hibbert S, Tarabar D, El-Hachem S, Sandborn WJ, Silverberg MS, Pardi DS, Church JM, Shen B.
Lancet Gastroenterol Hepatol. 2022 Sep;7(9):871-893. doi: 10.1016/S2468-1253(22)00039-5. Epub 2022 Jul 5.
Shen B, Kochhar GS, Rubin DT, Kane SV, Navaneethan U, Bernstein CN, Cross RK, Sugita A, Schairer J, Kiran RP, Fleshner P, McCormick JT, D'Hoore A, Shah SA, Farraye FA, Kariv R, Liu X, Rosh J, Chang S, Scherl E, Schwartz DA, Kotze PG, Bruining DH, Philpott J, Abraham B, Segal J, Sedano R, Kayal M, Bentley-Hibbert S, Tarabar D, El-Hachem S, Sehgal P, Picoraro JA, Vermeire S, Sandborn WJ, Silverberg MS, Pardi DS.
Lancet Gastroenterol Hepatol. 2022 Jan;7(1):69-95. doi: 10.1016/S2468-1253(21)00214-4. Epub 2021 Nov 10.
Shen B, Kochhar GS, Kariv R, Liu X, Navaneethan U, Rubin DT, Cross RK, Sugita A, D'Hoore A, Schairer J, Farraye FA, Kiran RP, Fleshner P, Rosh J, Shah SA, Chang S, Scherl E, Pardi DS, Schwartz DA, Kotze PG, Bruining DH, Kane SV, Philpott J, Abraham B, Segal J, Sedano R, Kayal M, Bentley-Hibbert S, Tarabar D, El-Hachem S, Sehgal P, McCormick JT, Picoraro JA, Silverberg MS, Bernstein CN, Sandborn WJ, Vermeire S.
Lancet Gastroenterol Hepatol. 2021 Oct;6(10):826-849. doi: 10.1016/S2468-1253(21)00101-1. Epub 2021 Aug 18.
Shen B, Kochhar GS, Navaneethan U, Cross RK, Farraye FA, Iacucci M, Schwartz DA, Gonzalez-Lama Y, Schairer J, Kiran RP, Kotze PG, Kobayashi T, Bortlik M, Liu X, Levy AN, González Suárez B, Tang SJ, Coelho-Prabhu N, Lukas M, Bruining DH, El-Hachem S, Charles RJ, Chen Y, Sood A, Mao R, Loras C, Dulai PS, Picoraro JA, Chiorean M, Lukas M, Shergill A, Silverberg MS, Sandborn WJ, Bernstein CN.
Lancet Gastroenterol Hepatol. 2021 Jun;6(6):482-497. doi: 10.1016/S2468-1253(20)30394-0. Epub 2021 Apr 17.
Shen B, Kochhar G, Navaneethan U, Farraye FA, Schwartz DA, Iacucci M, Bernstein CN, Dryden G, Cross R, Bruining DH, Kobayashi T, Lukas M, Shergill A, Bortlik M, Lan N, Lukas M, Tang SJ, Kotze PG, Kiran RP, Dulai PS, El-Hachem S, Coelho-Prabhu N, Thakkar S, Mao R, Chen G, Zhang S, Suárez BG, Lama YG, Silverberg MS, Sandborn WJ.
Lancet Gastroenterol Hepatol. 2020 Apr;5(4):393-405. doi: 10.1016/S2468-1253(19)30366-8. Epub 2020 Jan 16.
Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline.
PelvEx Collaborative.
Br J Surg. 2022 Nov 22;109(12):1251-1263. doi: 10.1093/bjs/znac317.
Empty pelvis syndrome: PelvEx Collaborative guideline proposal.
PelvEx Collaborative.
Br J Surg. 2023 Nov 9;110(12):1730-1731. doi: 10.1093/bjs/znad301.
Bagshaw PF, Tuck AS, Aramowicz JM, Cox B, Frizelle FA, Church JM.
Dis Colon Rectum. 2024 Jan 1;67(1):160-167. doi: 10.1097/DCR.0000000000002947. Epub 2023 Sep 14.
Bagshaw P, Cox B, Frizelle FA, Church JM.
Gut. 2021 Feb;70(2):441-442. doi: 10.1136/gutjnl-2020-321655. Epub 2020 Jun 2.
Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW; American College of Gastroenterology.
Am J Gastroenterol. 2015 Feb;110(2):223-62; quiz 263. doi: 10.1038/ajg.2014.435. Epub 2015 Feb 3.
Giardiello FM, Allen JI, Axilbund JE, Boland CR, Burke CA, Burt RW, Church JM, Dominitz JA, Johnson DA, Kaltenbach T, Levin TR, Lieberman DA, Robertson DJ, Syngal S, Rex DK; American Society for Gastrointestinal Endoscopy.
Am J Gastroenterol. 2014 Aug;109(8):1159-79. doi: 10.1038/ajg.2014.186. Epub 2014 Jul 22.
Giardiello FM, Allen JI, Axilbund JE, Boland CR, Burke CA, Burt RW, Church JM, Dominitz JA, Johnson DA, Kaltenbach T, Levin TR, Lieberman DA, Robertson DJ, Syngal S, Rex DK; American Society for Gastrointestinal Endoscopy.
Gastroenterology. 2014 Aug;147(2):502-26. doi: 10.1053/j.gastro.2014.04.001.
Giardiello FM, Allen JI, Axilbund JE, Boland CR, Burke CA, Burt RW, Church JM, Dominitz JA, Johnson DA, Kaltenbach T, Levin TR, Lieberman DA, Robertson DJ, Syngal S, Rex DK; American Society for Gastrointestinal Endoscopy.
Gastrointest Endosc. 2014 Aug;80(2):197-220. doi: 10.1016/j.gie.2014.06.006.
Giardiello FM, Allen JI, Axilbund JE, Boland CR, Burke CA, Burt RW, Church JM, Dominitz JA, Johnson DA, Kaltenbach T, Levin TR, Lieberman DA, Robertson DJ, Syngal S, Rex DK.
Dis Colon Rectum. 2014 Aug;57(8):1025-48. doi: 10.1097/DCR.000000000000000.
Weissman SM, Burt R, Church J, Erdman S, Hampel H, Holter S, Jasperson K, Kalady MF, Haidle JL, Lynch HT, Palaniappan S, Wise PE, Senter L.
J Genet Couns. 2012 Aug;21(4):484-93. doi: 10.1007/s10897-011-9465-7. Epub 2011 Dec 14.
Book on Management of Colorectal Disease from the Global Center
Recently, Dr. Bo Shen and Dr. Ravi Kiran, two faculty members of the Global Center, edited a new book titled "Corrective Endoscopy and Surgery in Inflammatory Bowel and Colorectal Disease.” The book provides a comprehensive guide to the advanced endoscopic and surgical techniques used to manage and correct complications arising from inflammatory bowel disease (IBD) and other colorectal conditions. The book covers a range of topics, including the latest innovations in minimally invasive procedures, strategies for handling surgical complications, and the integration of endoscopy with surgical interventions to optimize patient outcomes. All chapters were developed with significant involvement and contributions from the members of the Global Center. It serves as a valuable resource for clinicians seeking to enhance their skills in managing complex cases and improving the quality of care for patients with challenging bowel and colorectal diseases.
List of Publications per Member of the Global Center:
Kiran RP - Search Results - PubMed (nih.gov)
Church J - Search Results - PubMed (nih.gov)
Shen B - Search Results - PubMed (nih.gov)
Su LC - Search Results - PubMed (nih.gov)
Bertucci Zoccali M - Search Results - PubMed (nih.gov)
Ahmed Ali U - Search Results - PubMed (nih.gov)
Contact Us
If you would like to learn more about our research at the Global Center, please contact us at (212) 342-1155 and choose option 1.