Derek Roberts

Background

Derek Roberts is a fourth-year General Surgery Resident and the Efficiency, Quality, Innovation, and Safety (EQuIS) Research Fellow at the University of Calgary in Calgary, Alberta. EQuIS is a multidisciplinary group of clinicians and researchers interested in improving the quality and efficiency of surgical care provided in Calgary, Canada, and internationally.

Derek completed a Bachelor of Science in Pharmacy (and practiced as a pharmacist for three-years) and an MD with Distinction at Dalhousie University in Halifax, Nova Scotia in 2005 and 2009, respectively. After then pursuing two-years of general surgery residency training at the University of Calgary, he completed a Residency in the Clinician Investigator and Surgeon Scientist Programs, a PhD in Epidemiology, and a KT Canada Strategic Training in Health Research (STIHR) Graduate Training Program/Fellowship at the same institution in 2015. Trainees awarded a KT Canada STIHR Fellowship receive formal graduate training in the science and practice of KT. KT is an evolving clinical science that attempts to bridge the gap between “what we know” and “what we do” in medicine and surgery by ensuring that clinicians are aware of and effectively use research evidence to inform their healthcare decision making.

After completing his general surgery residency in June of 2018, Derek hopes to pursue fellowship training in vascular and endovascular surgery and a career as a KT-focused surgeon-scientist.

Research Summary

As opposed to single-stage or definitive surgery, “damage control surgery” is a potentially life-saving surgical approach that allows the initial trauma surgical operation to be abbreviated after control of bleeding and gross contamination from gastrointestinal tract or pancreaticobiliary injuries using one or more “damage control interventions.” This allows surgeons to restore the pre-injury status or physiology of the patient in the Intensive Care Unit before returning to the operating room for additional surgery.

Although damage control surgery may improve survival in select, severely injured patients, its use is associated with a number of complications, and therefore should only be used when appropriately indicated. The overall objective of Derek’s PhD thesis was therefore to identify and evaluate candidate indications for use of damage control surgery and damage control interventions in civilian trauma patients. As a key predictor of the success of a research program aimed at developing indications in trauma patients may be the coproduction of knowledge with knowledge users, we purposively built relationships with and among surgical practice leaders in the United States, Canada, Australia, New Zealand, Europe, and South Africa. Using this integrated KT intervention, these leaders were involved in the research from the setting of questions through to the interpretation of the resultant data.

To summarize the research described in Derek’s PhD thesis abstract (available at: http://theses.ucalgary.ca/handle/11023/2206): To identify the circumstances in which damage control surgery may be appropriately used, we conducted a scoping review. Of 27,732 citations identified by the search, we included 270 articles that reported 1,107 indications for DC surgery and 424 indications for 16 different thoracic, abdominal, pelvic, or vascular DC interventions (Roberts et al. Indications for use of damage control surgery and damage control interventions in civilian trauma patients: a scoping review. J Trauma Acute Care Surg 2015;78(6):1187-96). We conducted a content analysis to synthesize these indications into 123 codes representing unique indications for damage control surgery (Roberts et al. Indications for use of damage control surgery in civilian trauma patients: a content analysis and expert appropriateness rating study. Ann Surg 2016;263(5):1018-27) and 101 codes representing unique indications for 16 different DC interventions (Roberts et al. Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in civilian trauma patients: a content analysis and expert appropriateness rating study. J Trauma Acute Care Surg 2015;79(4):568-79). An international panel of trauma surgery experts subsequently assessed 101 (82.1%) of the coded indications for damage control surgery and 78 (77.2%) of the coded indications for damage control interventions to be appropriate for use in modern civilian trauma care. We conducted a systematic review to identify studies reporting data on the reliability or validity of indications and, among 31,014 indications identified, we included 36 studies that evaluated 79 unique indications. Of these, only nine had evidence supporting that they were associated with improved survival (manuscript in the peer-review process).

Finally, we conducted a cross-sectional survey of trauma centers and surgeons located in the United States, Canada, Australia, and New Zealand (Roberts et al. Opinions of practicing surgeons on the appropriateness of published indications for use of damage control surgery in trauma patients: an international cross-sectional survey. J Am Coll Surg 2016;223(3):515-29). In total, 232 (64.8%) trauma centers responded. These centers nominated 366 surgeons to survey about indications for damage control surgery, of whom 201 (56.0%) responded. Respondents assessed 15 (78.9%) preoperative and 23 (95.8%) intraoperative indications to be appropriate. These indications provide a practical foundation to guide practice while studies are conducted to evaluate their impact on patient outcomes.