This is an application for a K08 award for Dr. Frank I. Scott, who will be an Instructor at the University of Pennsylvania starting July 1, 2011. This K08 will provide the candidate with the necessary support to launch a successful career in epidemiologic research in post-operative adhesion-related complications. To achieve his goals, Dr. Scott has proposed a comprehensive career development plan: (1) to implement advanced epidemiologic and biostatistical methods to conduct observational research~ (2) to develop a new research tool for the study of complications of abdominal surgery and post-surgical small bowel obstruction (SBO)~ (3) to conduct research on host-related risk factors and modifiers of adhesion-related SBO~ and (4) to develop an independent research career in epidemiologic and clinical research. Dr. Scott has assembled a mentoring team to assist him in achieving these goals. Dr. James D. Lewis, MD, MSCE, Professor of Medicine and Epidemiology in the Division of Gastroenterology at the University of Pennsylvania, will serve as the candidate's primary mentor. Dr. Lewis is a world-renowned expert in pharmacoepidemiology and gastrointestinal disease epidemiology. Dr. Gary D. Wu, MD, Professor of Medicine and Associate Chief of Research in the Gastroenterology Division will serve as an advisor. Dr. Najjia N. Mahmoud, MD, Associate Professor of Surgery, who has collaborated with Dr. Scott and Dr. Lewis on prior adhesion-related research, will continue to provide invaluable input as an advisor. Dr. Wensheng Guo, PhD, in the department of Biostatistics and Epidemiology, will share his expertise in longitudinal analyses. Post-operative adhesions are responsible for a significant amount of morbidity and mortality, and are the leading cause of SBO in adults. Little is currently known about which host-related factors may impact the risk of post-operative SBO, although hypoxia appears to play a role in animal models. Dr. Scott's research will examine the impact of co-morbid medical conditions associated with microvascular disease on the incidence of post-operative SBO utilizing data from The Health Improvement Network (THIN). Prior research efforts have been limited by the lack of valid medical data from a large population undergoing abdominal surgery. The proposed research will validate diagnostic codes for abdominal surgery and SBO within THIN, thereby generating a novel dataset for such research (AIM 1). The candidate will then conduct a case-control study to assess the association between several common medical conditions, such as hypertension, hyperlipidemia, and diabetes, with the risk of SBO after an intra-abdominal surgery using THIN (AIM 2). Finally, he will assess the effects of statins and ACE-inhibitors, which have known pleiotropic anti-fibrotic effects, on the incidence of post-operative SBO (AIM 3). This research will serve as the foundation for future prospective evaluation of the effect of risk factor modification and medication use to prevent adhesion-related SBO.

Public Health Relevance

Adhesion-related small bowel obstruction is responsible for a significant amount of morbidity and mortality. Because hypoxia is believed to contribute to adhesion formation, we will examine whether conditions associated with microvascular disease are risk factors for post-operative small bowel obstruction. Furthermore, we will study several medications commonly used to treat these conditions, statins and ACE- inhibitors that have anti-fibrotic properties that may reduce the risk of SBO after surgery.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Clinical Investigator Award (CIA) (K08)
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Study Section
Digestive Diseases and Nutrition C Subcommittee (DDK-C)
Program Officer
Saslowsky, David E
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University of Colorado Denver
Internal Medicine/Medicine
Schools of Medicine
United States
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Vajravelu, Ravy K; Mamtani, Ronac; Scott, Frank I et al. (2018) Incidence, Risk Factors, and Clinical Effects of Recurrent Diverticular Hemorrhage: A Large Cohort Study. Gastroenterology 155:1416-1427
Vajravelu, Ravy K; Scott, Frank I; Mamtani, Ronac et al. (2018) Medication class enrichment analysis: a novel algorithm to analyze multiple pharmacologic exposures simultaneously using electronic health record data. J Am Med Inform Assoc 25:780-789
Osterman, Chelsea K; Alanzi, Jaber; Lewis, James D et al. (2018) Association Between Symptomatic Versus Asymptomatic Recurrence and Survival in Bladder Cancer. Clin Genitourin Cancer 16:235-239
Vajravelu, Ravy K; Osterman, Mark T; Aberra, Faten N et al. (2017) Indeterminate QuantiFERON-TB Gold Increases Likelihood of Inflammatory Bowel Disease Treatment Delay and Hospitalization. Inflamm Bowel Dis 24:217-226
Mamtani, Ronac; Clark, Amy S; Scott, Frank I et al. (2016) Association Between Breast Cancer Recurrence and Immunosuppression in Rheumatoid Arthritis and Inflammatory Bowel Disease: A Cohort Study. Arthritis Rheumatol 68:2403-11
Scott, Frank I; Mamtani, Ronac; Haynes, Kevin et al. (2016) Validation of a coding algorithm for intra-abdominal surgeries and adhesion-related complications in an electronic medical records database. Pharmacoepidemiol Drug Saf 25:405-12
Zhang, Frank; Mamtani, Ronac; Scott, Frank I et al. (2016) Increasing use of prescription drugs in the United Kingdom. Pharmacoepidemiol Drug Saf 25:628-36
Scott, Frank I; Horton, Daniel B; Mamtani, Ronac et al. (2016) Administration of Antibiotics to Children Before Age 2 Years Increases Risk for Childhood Obesity. Gastroenterology 151:120-129.e5
Horton, Daniel B; Scott, Frank I; Haynes, Kevin et al. (2016) Antibiotic Exposure, Infection, and the Development of Pediatric Psoriasis: A Nested Case-Control Study. JAMA Dermatol 152:191-9
Shelton, Edward; Laharie, David; Scott, Frank I et al. (2016) Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis. Gastroenterology 151:97-109.e4

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