Julie Thacker

Positions:

Associate Professor of Surgery

Surgical Oncology
School of Medicine

Chief of the Section of Colorectal Surgery

Surgical Oncology
School of Medicine

Associate Professor in Medicine

Medicine, Gastroenterology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1998

Indiana University at Indianapolis

Grants:

Technique to Standard Closure Techniques Plus Sylys Surgical Sealant

Awarded By
Cohera Medical
Role
Principal Investigator
Start Date
End Date

Data Architecture for Duke Surgery Bio-repository

Awarded By
MedBlue Incubator, Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.

Animal models suggest postoperative cognitive dysfunction may be caused by brain monocyte influx. To study this in humans, we developed a flow cytometry panel to profile cerebrospinal fluid (CSF) samples collected before and after major noncardiac surgery in 5 patients ≥60 years of age who developed postoperative cognitive dysfunction and 5 matched controls who did not. We detected 12,654 ± 4895 cells/10 mL of CSF sample (mean ± SD). Patients who developed postoperative cognitive dysfunction showed an increased CSF monocyte/lymphocyte ratio and monocyte chemoattractant protein 1 receptor downregulation on CSF monocytes 24 hours after surgery. These pilot data demonstrate that CSF flow cytometry can be used to study mechanisms of postoperative neurocognitive dysfunction.
Authors
Berger, M; Murdoch, DM; Staats, JS; Chan, C; Thomas, JP; Garrigues, GE; Browndyke, JN; Cooter, M; Quinones, QJ; Mathew, JP; Weinhold, KJ; MADCO-PC Study Team,
MLA Citation
Berger, Miles, et al. “Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.Anesth Analg, vol. 129, no. 5, Nov. 2019, pp. e150–54. Pubmed, doi:10.1213/ANE.0000000000004179.
URI
https://scholars.duke.edu/individual/pub1385799
PMID
31085945
Source
pubmed
Published In
Anesth Analg
Volume
129
Published Date
Start Page
e150
End Page
e154
DOI
10.1213/ANE.0000000000004179

Impact of an enhanced recovery pathway on length of stay and complications in elective radical cystectomy: a before and after cohort study.

BACKGROUND: Enhanced recovery after surgery (ERAS) pathways aim to standardize and integrate perioperative care, incorporating the best available evidence-based practice throughout the perioperative period targeted at attenuating the surgical stress response while optimizing physiologic function, with the goal of facilitating recovery. Radical cystectomy is associated with significant postoperative morbidity, but comprehensive ERAS pathways have not been well studied in this population. METHODS: This is a before and after cohort study of an ERAS pathway for radical cystectomy at a large academic medical center. Following introduction of the ERAS pathway and a wash in period, we prospectively collected data from the next 100 consecutive subjects undergoing radical cystectomy with the ERAS pathway. This cohort was compared to a retrospective cohort of 100 consecutive patients undergoing radical cystectomy with traditional care. The primary outcome was hospital length of stay. Secondary outcomes included perioperative management, time to recovery milestones, complications, and costs. RESULTS: Implementation of an ERAS pathway for radical cystectomy was associated with reduced hospital length of stay (median LOS 10 days (IQR = 8-18) vs 7 days (IQR = 6-11); p < 0.0001), reduced time to key recovery milestones, including days to first stool (5.83 vs 3.99; p < 0.001) and days to first solid food (9.68 vs 3.2; p < 0.001), reductions in some complications, and a 26.6% reduction in overall costs (p < 0.001). CONCLUSIONS: Our data support the use of an ERAS pathway for radical cystectomy and add to the increasing body of literature supporting enhanced recovery over a wide variety of procedures. TRIAL REGISTRATION: Not applicable.
Authors
Dunkman, WJ; Manning, MW; Whittle, J; Hunting, J; Rampersaud, EN; Inman, BA; Thacker, JK; Miller, TE
MLA Citation
Dunkman, W. Jonathan, et al. “Impact of an enhanced recovery pathway on length of stay and complications in elective radical cystectomy: a before and after cohort study.Perioper Med (Lond), vol. 8, 2019, p. 9. Pubmed, doi:10.1186/s13741-019-0120-4.
URI
https://scholars.duke.edu/individual/pub1405183
PMID
31440369
Source
pubmed
Published In
Perioperative Medicine (London, England)
Volume
8
Published Date
Start Page
9
DOI
10.1186/s13741-019-0120-4

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naïve Patients.

Surgical care episodes place opioid-naïve patients at risk for transitioning to new persistent postoperative opioid use. With one of the central principles being the application of multimodal pain interventions to reduce the reliance on opioid-based medications, enhanced recovery pathways provide a framework that decreases perioperative opioid use. The fourth Perioperative Quality Initiative brought together a group of international experts representing anesthesiology, surgery, and nursing with the objective of providing consensus recommendations on this important topic. Fourth Perioperative Quality Initiative was a consensus-building conference designed around a modified Delphi process in which the group alternately convened for plenary discussion sessions in between small group discussions. The process included several iterative steps including a literature review of the topics, building consensus around the important questions related to the topic, and sequential steps of content building and refinement until agreement was achieved and a consensus document was produced. During the fourth Perioperative Quality Initiative conference and thereafter as a writing group, reference applicability to the topic was discussed in any area where there was disagreement. For this manuscript, the questions answered included (1) What are the potential strategies for preventing persistent postoperative opioid use? (2) Is opioid-free anesthesia and analgesia feasible and appropriate for routine operations? and (3) Is opioid-free (intraoperative) anesthesia associated with equivalent or superior outcomes compared to an opioid minimization in the perioperative period? We will discuss the relevant literature for each questions, emphasize what we do not know, and prioritize the areas for future research.
Authors
Wu, CL; King, AB; Geiger, TM; Grant, MC; Grocott, MPW; Gupta, R; Hah, JM; Miller, TE; Shaw, AD; Gan, TJ; Thacker, JKM; Mythen, MG; McEvoy, MD; Fourth Perioperative Quality Initiative Workgroup,
MLA Citation
Wu, Christopher L., et al. “American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naïve Patients.Anesth Analg, vol. 129, no. 2, Aug. 2019, pp. 567–77. Pubmed, doi:10.1213/ANE.0000000000004194.
URI
https://scholars.duke.edu/individual/pub1385822
PMID
31082966
Source
pubmed
Published In
Anesth Analg
Volume
129
Published Date
Start Page
567
End Page
577
DOI
10.1213/ANE.0000000000004194

Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery.

BACKGROUND: Postoperative hypotension and hypertension are frequent events associated with increased risk of adverse outcomes. However, proper assessment and management is often poorly understood. As a part of the PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed a consensus document addressing this topic. The target population includes adult, non-cardiac surgical patients in the postoperative phase outside of the ICU. METHODS: A modified Delphi technique was used, evaluating papers published in MEDLINE examining postoperative blood pressure monitoring, management, and outcomes. Practice recommendations were developed in line with National Institute for Health and Care Excellence guidelines. RESULTS: Consensus recommendations were that (i) there is evidence of harm associated with postoperative systolic arterial pressure <90 mm Hg; (ii) for patients with preoperative hypertension, the threshold at which harm occurs may be higher than a systolic arterial pressure of 90 mm Hg; (iii) there is insufficient evidence to precisely define the level of postoperative hypertension above which harm will occur; (iv) a greater frequency of postoperative blood pressure measurement is likely to identify risk of harm and clinical deterioration earlier; and (v) there is evidence of harm from withholding beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors in the postoperative period. CONCLUSIONS: Despite evidence of associations with postoperative hypotension or hypertension with worse postoperative outcome, further research is needed to define the optimal levels at which intervention is beneficial, to identify the best methods and timing of postoperative blood pressure measurement, and to refine the management of long-term antihypertensive treatment in the postoperative phase.
Authors
McEvoy, MD; Gupta, R; Koepke, EJ; Feldheiser, A; Michard, F; Levett, D; Thacker, JKM; Hamilton, M; Grocott, MPW; Mythen, MG; Miller, TE; Edwards, MR; POQI-3 workgroup,; POQI chairs,; Grocott, MP; Physiology group,; Preoperative blood pressure group,; Intraoperative blood pressure group,; Postoperative blood pressure group,
MLA Citation
McEvoy, Matthew D., et al. “Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery.Br J Anaesth, vol. 122, no. 5, May 2019, pp. 575–86. Pubmed, doi:10.1016/j.bja.2019.01.019.
URI
https://scholars.duke.edu/individual/pub1373117
PMID
30916008
Source
pubmed
Published In
Bja: British Journal of Anaesthesia
Volume
122
Published Date
Start Page
575
End Page
586
DOI
10.1016/j.bja.2019.01.019

Uptake of enhanced recovery practices by SAGES members: a survey.

BACKGROUND: The SAGES Surgical Multimodal Accelerated Recovery Trajectory (SMART) Enhanced Recovery Task Force aims to increase awareness and provide tools for members to successfully implement enhanced recovery pathways (ERPs) to improve clinical outcomes and patient satisfaction. An initial step was to survey SAGES member on their knowledge, use, and impediments to enhanced recovery. METHODS: An online survey designed by SMART committee members to define SAGES member's awareness and use of enhanced recovery principles and practice was emailed to all SAGES members. Reminders were sent 2 and 3 weeks later, encouraging completion of the survey. The web-based survey included 48 questions and took an estimated 20 min to complete. RESULTS: A total of 229 members completed the survey. Respondents were primarily general/MIS surgeons (82.6%) working in an urban location (85.5%), with a bell-shaped age distribution (median 35-44). Almost half regularly used some elements of ERPs (48.7%), but 30% were unfamiliar with the concept. Wide variety in the specific ERP elements used and discharge criteria were reported. The majority had to create and implement their own plan (70.4%). Roadblocks to implementation were inconsistencies with partners/covering physicians (56.3%), nursing education (46.6%), and resources (34.7%). When implemented, members saw improvements in length of stay (88%), patient satisfaction (54.7%), postoperative pain (53.3%), time to return of bowel function (52.7%), and readmissions (16.7%). A need for education and standardization was especially seen in preoperative care, with 74.4% fasting patients from midnight the night before surgery. Wide variations were also reported in pain management practices. An overwhelming majority (89%) reported that having a protocol endorsed by a national organization, such as SAGES, would help with implementation. CONCLUSIONS: From this survey of SAGES members, there is a need for education, tools, and standardized protocols to increase awareness, support implementation, and encourage wider utilization of ERP. The overwhelming majority stated having a protocol endorsed by a national organization, such as SAGES, would facilitate implementation.
Authors
Keller, DS; Delaney, CP; Senagore, AJ; Feldman, LS; SAGES SMART Task Force,
MLA Citation
Keller, Deborah S., et al. “Uptake of enhanced recovery practices by SAGES members: a survey.Surg Endosc, vol. 31, no. 9, Sept. 2017, pp. 3519–26. Pubmed, doi:10.1007/s00464-016-5378-8.
URI
https://scholars.duke.edu/individual/pub1351675
PMID
28008470
Source
pubmed
Published In
Surgical Endoscopy
Volume
31
Published Date
Start Page
3519
End Page
3526
DOI
10.1007/s00464-016-5378-8