OPRI has become part of Department of Orthopaedics

Since 2016, University of Chicago’s Operative Performance Research Institute (OPRI) has become part of Department of Orthopaedics. OPRI is dedicated to improving all aspects of surgical care by focusing on quality, patient safety, communication, technology/innovation, cost, and outcome.

Survey-based studies have been an important methodology within OPRI. Many projects have contributed to the improvements in shared decision-making practices and overall quality of surgical care. We have developed questionnaires which has led to publications in Journal of Bone and Joints Surgery on patients’ perceptions of the practice of overlapping surgeries, in Journal of Surgical Education on trainee participation in surgery, and in American Journal of Surgery, on perceived quality of communication between members of the surgical, anesthesia, and nursing teams. These findings suggested deficiencies in the current ways that surgical care is delivered, and potential methods to improve communication within the care team, and with patients. The last publication is now evolving into a second stage where a digital system can be developed to decrease the barrier to communication between the surgical teams. Other projects that have focused on patient perceptions of industry-surgeon relationships, and expectations of surgeon involvement in pre- and post-operative care.

Much of the outcome research are conducted through “large data,” with available insurance claims databases including PearlDiver, which is an online repository which contains millions of de-identified, HIPAA compliant records from Humana and Medicare patients, spanning from 2007 through 2017. The database contains information on laboratory results, prescription information, diagnoses and procedural codes, and physician specialty information. With this, we are able to assess frequency of re-operation and associated complications following initial admission and track treatments received leading up to the date of surgery. With this database, we have performed research on relationship between lumbar spine fusion and dislocation of total hip replacement, ACDF nonunion rates, diabetes’ effect on outcome of rotator cuff repair, and many others.

Given the considerable costs that are associated with surgical procedures, the operating room remains a primary target for improvements in efficiency. To this end, one of main OPRI mission is to decrease cost of surgical care in the operating room. One recent project has been to standardize the preparation of routine orthopaedic procedures, including knee and shoulder arthroscopy. Prior to intervention, multiple surgical packs and up to 22 pill-packed items had to be picked before the start of surgery; after intervention, multiple surgeon’s preferences were considered, and a common list of supplies have been consolidated into one pack, thus reducing cost (through discount and reducing waste), and increasing efficiency and team satisfaction.

OPRI has served a significant educational mission within the hospital, and we have mentored over 25 medical students and 10 orthopaedic residents in the last 2 years. Trainees have learned about health services research, and many have had publications. Several students have been given school-wide and conference-specific awards based on their research. OPRI also maintain collaborative relationships, including with all perioperative services, hospital supply chain, Bucksbaum Institute for Clinical Excellence, Booth School of Business, and many others. We hope to expand these numerous connections and relationships to continue our missions to deliver better surgical care.