The stats behind care

Image of Shaun and Dr. Landercasper meeting at a table.

UWL senior Shaun Fleishhacker meets with Dr. Jeffrey Landercasper, of Gundersen Health System, as part of a collaborative research project.

UWL statistical research project answers important healthcare questions

The U.S. is predicted to have a shortage of as many as 90,000 physicians by 2025. One of the greatest areas of demand will be surgeons, according to a March 2015 report from medical schools and teaching hospitals.

A projected national shortage of surgeons means having residents in training in the operating room is critical for preparing the next generation of workers.

Yet veteran surgeons like Dr. Jeffrey Landercasper, of Gundersen Health System, want to make sure that training new surgeons is completely safe for patients.

Through a partnership with UW-La Crosse student researchers, Gundersen was able to get the answer to this question, as well as another critical question related to use of chemotherapy before surgery instead of the more traditional approach of giving it after.

Landercasper was particularly interested in breast cancer surgery because he has performed operations and taught surgical residents in training how to do this type of surgery for three decades. He had already dug into the safety of training question using Gundersen’s database of more than 1,000 breast cancer patients and determined that, in their health system, patient outcomes for safety and cancer cure rates were the same regardless of whether a resident in training was present or absent during surgery. These findings were recently published. Although breast cancer surgical training at Gundersen was safe for patients, there was limited information to know if this was true elsewhere.

Enter three UWL students doing an independent study through UWL’s Statistical Consulting Center who analyzed a national database of breast cancer surgery outcomes in collaboration with Gundersen. Students Jonathan Forsythe, Courtney Mumm and Shaun Fleischhacker worked on the project with Barb Bennie, director of UWL’s off-campus Statistical Consulting Center.

After completion, UWL students presented the results to the Gundersen Health System Department of Surgery and other physicians in March. The results of the study demonstrated that trainees had no harmful influence on surgery outcomes.

Shaun in front of Gundersen Health System.

Shaun Fleischhacker is a double major in economics and statistics.

Fleischhacker, a May graduate, calls that presentation “nerve wracking,” but also important practice for his future as an actuary — someone who analyzes the financial consequence of risk. In the work setting he anticipates having to communicate statistical results — sometimes in high-pressure settings.

Fleischhacker is getting plenty of communication experience after presenting these findings. He also presented them at the National Conference on Undergraduate Research at the University of North Carolina Asheville and UWL’s Celebration of Undergraduate Research and Creativity, both in April.

It was a challenge to communicate complex statistics in a succinct, yet meaningful way, notes Fleischhacker. Yet it was gratifying to see that these results could be useful to surgeons, he adds.

“This information is actionable and important because you would guess that every patient who is undergoing surgery may have some anxiety about that (a resident in training being present),” says Landercasper. “We can now provide them reassurance.”

Students met with Landercasper a couple times a week to discuss their progress on the project during the fall semester. Landercasper would always bring up new and challenging questions that invited more work, says Fleischhacker.

“Without him, we would have been done a lot sooner, but we wouldn’t have had viable results,” he says.

Students Shaun Fleischhacker and Courtney Mumm.

Students Shaun Fleischhacker and Courtney Mumm.

This type of collaboration between clinicians and academic statisticians is critical for advancing patient care, notes Landercasper. He also chairs the American Society of Breast Surgeons Quality Committee, a national committee that finds gaps in care and ways to improve care related to breast cancer.

If the students’ research results successfully undergo peer review and are published, they will be applicable to breast cancer surgeons-and their patients- nationwide, says Landercasper.

A second study, regarding the influence of chemotherapy given before surgery on post-operative complications, using the same national surgical database, was also performed. This study has already been submitted for publication. The plan is to submit a manuscript for peer review and publication of the surgeon in training findings as well.

This research collaboration is part of a Biomedical Research Partnership between UWL and Gundersen Health System that was first piloted in fall 2015. The goal of the partnership is to engage UWL students in health-related research programs as they collaborate with Gundersen personnel in their respective medical research projects.

The partnership is one of four research networks established by the UWL’s Office of Undergraduate Research and Creativity that allows UWL students to apply what they learn in class to solve problems for community clients including businesses, non-profit organizations and civic leaders.

Barb Bennie

Barb Bennie

The breast cancer surgery outcome collaborative project was initiated by Landercasper; Dr. Mallory Bray, a surgical resident in training; and Bennie.

Interaction with professionals and presenting to professionals are hallmarks of the Biomedical partnership, notes Bennie.

“What students were able to learn from that interaction — we can’t replicate in the classroom,” she says. “This turned out to be an incredible experience for the students.”

Chemotherapy study

Student researchers also collaborated with Gundersen to answer a question related to the influence of chemotherapy when given before surgery compared to after surgery. The question is important because a growing number of patients who need chemotherapy are getting it before surgery to minimize tumor sizes before operation, yet it is not clear what effect chemotherapy has on surgical complications such as an infection or readmission to the hospital. Researching this area is of particular importance in breast cancer surgery cases because some women who need a mastectomy could potentially avoid it with a chemotherapy-first approach. Gundersen will be sharing the findings of this research. Results have been submitted for publication.