CANDIDATE- Dr. Thomas Robinson, MD is an Associate Professor of Surgery at the University of Colorado at Denver (UCD). Dr. Robinson has a strong background in both aging related research (studying post-operative delirium) and education (teaching surgeons geriatric specialty knowledge). Dr. Robinson's immediate career goals are to learn the skills necessary to perform exceptional aging-related translational research in the field of surgery. Dr. Robinson's long term career goals are to become an independent translational researcher with a focus on studying post-operative delirium in elderly patients, and to become a national champion of geriatrics research and education within the field of surgery. RESEARCH PROJECT- Post-operative delirium is a common, deleterious complication in elderly patients. This double-blinded, placebo controlled trial (including subjects 60 years and older following a major operation requiring surgical ICU admission) will randomize patients to receive L-tryptophan supplementation or placebo with the primary outcome measure being the incidence and/or duration of excitatory (both hyperactive and mixed) post-operative delirium. Delirium will be assessed twice daily post-operatively. Biomarkers (tryptophan, serotonin and melatonin) will be measured pre- and post-operatively. We hypothesize that the incidence and/or duration of excitatory (both hyperactive and mixed) post-operative delirium will be reduced in the group receiving L-tryptophan supplementation compared to placebo. CAREER DEVELOPMENT- The three main areas of Dr. Robinson's career development plan includes clinical research knowledge, geriatric specialty care knowledge and neuropsychology knowledge. At the end of the career development training, Dr. Robinson will be a surgeon who has acquired the skills of a translational research, and who understands fundamentals in geriatrics and the neurosciences. ENVIRONMENT- The environment at UCD is ideal for allowing an enthusiastic young surgeon to acquire expertise and to perform surgical aging-related translational research. The Department of Surgery resolutely supports Dr. Robinson's research and career development efforts. Dr. Robinson has established close and productive mentor-mentee relationships over the past two years with his primary co-mentors. The Denver VA supports enrollment of geriatric surgical patients for the proposed study.

Public Health Relevance

In the United States, 55% of all operations performed are in patients older than 65 years and delirium is the most common post-operative complication in elderly patients. The goal of this research endeavor is to reduce post-operative delirium in elderly individuals who undergo major operations. If successful, this study could have profound implications for the care of millions of elderly patients undergoing operations annually.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZAG1-ZIJ-4 (A1))
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Wagster, Molly V
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University of Colorado Denver
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United States
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Gajdos, Csaba; Kile, Deidre; Hawn, Mary T et al. (2015) The significance of preoperative impaired sensorium on surgical outcomes in nonemergent general surgical operations. JAMA Surg 150:30-6
Robinson, Thomas N; Dunn, Christina L; Adams, Jill C et al. (2014) Tryptophan supplementation and postoperative delirium--a randomized controlled trial. J Am Geriatr Soc 62:1764-71
Gajdos, Csaba; Kile, Deidre; Hawn, Mary T et al. (2013) Advancing age and 30-day adverse outcomes after nonemergent general surgeries. J Am Geriatr Soc 61:1608-14
Jones, Teresa S; Dunn, Christina L; Wu, Daniel S et al. (2013) Relationship between asking an older adult about falls and surgical outcomes. JAMA Surg 148:1132-8
Robinson, Thomas N; Wu, Daniel S; Pointer, Lauren et al. (2013) Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 206:544-50
Robinson, Thomas N; Wu, Daniel S; Sauaia, Angela et al. (2013) Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties. Ann Surg 258:582-8; discussion 588-90
Robinson, Thomas N; Wu, Daniel S; Pointer, Lauren F et al. (2012) Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. J Am Coll Surg 215:12-7; discussion 17-8
Robinson, Thomas N; Wallace, Jeffrey I; Wu, Daniel S et al. (2011) Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg 213:37-42; discussion 42-4
Robinson, Thomas N; Raeburn, Christopher D; Tran, Zung V et al. (2011) Motor subtypes of postoperative delirium in older adults. Arch Surg 146:295-300
Robinson, Thomas N; Wu, Daniel S; Stiegmann, Gregory V et al. (2011) Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am J Surg 202:511-4