Julie Thacker

Positions:

Associate Professor of Surgery

Surgical Oncology
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

Administered By
Surgical Oncology
Role
Principal Investigator
Start Date
End Date

Data Architecture for Duke Surgery Bio-repository

Administered By
Surgical Oncology
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

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

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 Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery.

The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period.
Authors
Hedrick, TL; McEvoy, MD; Mythen, MMG; Bergamaschi, R; Gupta, R; Holubar, SD; Senagore, AJ; Gan, TJ; Shaw, AD; Thacker, JKM; Miller, TE; Wischmeyer, PE; Carli, F; Evans, DC; Guilbert, S; Kozar, R; Pryor, A; Thiele, RH; Everett, S; Grocott, M; Abola, RE; Bennett-Guerrero, E; Kent, ML; Feldman, LS; Fiore, JF; Perioperative Quality Initiative (POQI) 2 Workgroup,
MLA Citation
URI
https://scholars.duke.edu/individual/pub1294786
PMID
29293183
Source
pubmed
Published In
Anesth Analg
Volume
126
Published Date
Start Page
1896
End Page
1907
DOI
10.1213/ANE.0000000000002742

Perioperative Fluid Utilization Variability and Association With Outcomes: Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations.

OBJECTIVES: To study current perioperative fluid administration and associated outcomes in common surgical cohorts in the United States. BACKGROUND: An element of enhanced recovery care protocols, optimized perioperative fluid administration may be associated with improved outcomes; however, there is currently no consensus in the United States on fluid use or the effects on outcomes of this use. METHODS: The study included all inpatients receiving colon, rectal, or primary hip or knee surgery, 18 years of age or older, who were discharged from a hospital between January 1, 2008 and June, 30 2012 in the Premier Research Database. Patient outcomes and intravenous fluid utilization on the day of surgery were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low day-of-surgery fluids with the likelihood of increased hospital length of stay (LOS), total costs, or postoperative ileus. RESULTS: The study showed significant associations between high fluid volume given on the day of surgery with both increased LOS (odds ratio 1.10-1.40) and increased total costs (odds ratio 1.10-1.50). High fluid utilization was associated with increased presence of postoperative ileus for both rectal and colon surgery patients. Low fluid utilization was also associated with worse outcomes. CONCLUSIONS: According to results from this review of current practice in US hospitals, fluid optimization would likely lead to decreased variability and improved outcomes.
Authors
Thacker, JKM; Mountford, WK; Ernst, FR; Krukas, MR; Mythen, MMG
MLA Citation
Thacker, Julie K. M., et al. “Perioperative Fluid Utilization Variability and Association With Outcomes: Considerations for Enhanced Recovery Efforts in Sample US Surgical Populations.Ann Surg, vol. 263, no. 3, Mar. 2016, pp. 502–10. Pubmed, doi:10.1097/SLA.0000000000001402.
URI
https://scholars.duke.edu/individual/pub1119198
PMID
26565138
Source
pubmed
Published In
Ann Surg
Volume
263
Published Date
Start Page
502
End Page
510
DOI
10.1097/SLA.0000000000001402