American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Precision medicine helps surgeons make better calls in the clinic

OCTOBER 24, 2017
Clinical Congress Daily Highlights, Tuesday First Edition

Surgeons and their patients could significantly benefit from a military initiative that uses precision medicine to support clinical decisions.

Despite tremendous advances in military medicine, surgical complication rates remain high at 15 to 20 percent, U.S. Navy Captain Eric Elster, MD, FACS, Uniformed Services University, Bethesda, MD, said Tuesday. Because the military treats as many as 75,000 military personnel a year, efforts to address this critical gap in care could have a significant impact both on medical outcomes and costs, he said.

The management of battle injured, trauma and surgical patients remains largely dependent upon traditional, visually guided clinical decision-making, Dr. Elster said. But outcomes often depend not just on physical injuries that can be seen, but also on bodily responses that cannot be seen, such as inflammation. As a result, clinical decisions are correct only up to 85 percent of the time, leading to higher costs.

The military’s Surgical Critical Care Initiative is focused on providing individualized treatment based on underlying biology, dramatically improving patient outcomes while reducing costs, and developing Clinical Decision Support Tools (CDSTs) that predict outcome and guide therapy. Ultimately, these tools would improve patient outcome and quality of life; significantly reduce health care costs and increase the efficiency of care delivery; and accelerate return to function.

The initiative is aggregating an extensive set of clinical and biomarker data, including data from genomic sequencing of patient tissue, to develop predictive algorithms.

These tools are already well along for invasive fungal infection and massive transfusion protocol, Dr. Elster said. Tools are also in development for acute kidney injury, hospital-acquired infections, open abdomen, wound closure, physiological monitoring, pneumonia, venous thromboembolism, and severe traumatic brain injury. 

If all of the tools are developed, adopted and work effectively, each year more than 5,600 military patients would benefit from them and the military would save $111 million in medical costs. If they were disseminated among all civilian hospitals in the U.S., more than 467,000 patients could benefit annually and the overall cost of health care could be cut by $10 billion.

“This is the future of precision medicine in surgical critical care,” Dr. Elster said.

This future is not decades away, he added, but as soon as 2020.

Additional Information:
The Named Lecture, Excelsior Surgical Society/Edward D. Churchill Lecture, was held October 24, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at

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