Research
The Montefiore Einstein Department of Anesthesiology’s focus on research and innovation has attracted outstanding physician scientists who are impacting patient care and the future of anesthesiology, surgery, and medicine. We have cultivated a clinically impactful and culturally competent research program dedicated to supporting high-quality investigator-initiated research from inception to completion. Through interprofessional collaborations with our colleagues across Montefiore Einstein and other academic institutions, we leverage our digital health database and analyses to inform decisions in clinical operations, education, and quality improvement to continually elevate patient care.
Montefiore Einstein Anesthesiology Digital Health Laboratory
The Digital Health Laboratory is at the heart of the Department of Anesthesiology’s clinical and observational research. Established in 2021 by Department of Anesthesiology Chair Dr. Matthias Eikermann, the Digital Health Research Lab is comprised of a team of research fellows, a lead data scientist, and clinician scientists. Our researchers use the generation and analysis of highly granular pharmaco-physiological patient data from more than 1 million patients to understand the effects of new medications on patients’ recovery from surgery or critical illness. This powerful information and analyses allows the team to identify rare complications and is the foundation for individualized perioperative treatment. By harnessing Montefiore Einstein’s database of unique patient demographics, we emphasize diversity, equity, and inclusion in our research with a focus on projects that evaluate healthcare disparities.
Professor, Department of Anesthesiology
Clinical and Observational Research
Recent Department Publications
The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs
DOI: 10.1111/anae.16247 Feb 14, 2024
Development and validation of an instrument to predict prolonged length of stay in the postanesthesia care unit following ambulatory surgery
DOI: 10.1007/s12630-023-02604-1 Nov 13, 2023
Association of reintubation and hospital costs and its modification by postoperative surveillance: A multicenter retrospective cohort study
DOI: 10.1016/j.jclinane.2023.111264 Sep 16, 2023
Population Health Research
Led by Dr. Ibraheem Karaye, Chief of Epidemiology and Population Health Research in Anesthesiology, the Digital Health Lab is focused on improving clinical outcomes for Montefiore’s diverse patient population, many of whom face complex socioeconomic barriers. By studying trends in disease burden and health disparities among socially vulnerable populations, our researchers are leveraging digital health to improve population health in the Bronx and beyond.
Dr. Karaye is a physician and epidemiologist who joined the Department of Anesthesiology in 2023, from Hofstra University, where he serves as Associate Professor of Population Health. A nationally recognized scholar and award-winning educator, Dr. Karaye has co-authored more than 100 scientific journal articles. He has published extensively in the peer-reviewed literature on the intersection of social vulnerability and adverse health outcomes, health measurement for estimating disease burden and trends, and disaster and injury epidemiology. A gifted teacher, Dr. Karaye is an integral member of the Digital Health Lab who guides students, trainees, and junior faculty in developing their research and becoming successful clinician scientists.
Dr. Karaye is a member of the Global Burden of Disease Collaborator Network, comprising over 10,000 researchers worldwide who examine health outcomes in more than 152 countries. He was also appointed to serve as one of 11 members of the National Academies of Sciences, Engineering, and Medicine’s Climate and Economic Justice Committee, which advises the White House Council on Environmental Quality. The committee analyzes how advanced environmental health and geospatial data can inform community investment in the United States. Dr. Karaye has also served on several national expert panels, including those organized by the Gulf Research Program of the National Academies of Sciences Engineering and Medicine and the RTI Global Gender Center of the Research Triangle Institute. Dr. Karaye earned his medical degree from Bayero University Kano, and his master’s degree and DrPH in epidemiology from Texas A&M University. He completed his post-doctoral fellowship from the University of Delaware
Basic Science and Pediatric Anesthesiology Research
The Division of Pediatric Anesthesiology is dedicated to improving outcomes for our youngest patients. Our Pediatric Anesthesiologists are conducting several retrospective research studies that will allow us to have a better understanding of how to improve anesthesia care throughout the perioperative period to ensure the best postoperative outcomes. The results of one study were recently published in the British Journal of Anesthesia and demonstrate the association between increased use of dexmedetomidine and longer lengths of stay in the post-anesthesia care unit. Our Pediatric Anesthesiologists regularly collaborate with colleagues throughout the Children’s Hospital at Montefiore on interdisciplinary research projects that will have an impact on future patients’ perioperative health.
Recent Department Publications
Association of dexmedetomidine use with haemodynamics, postoperative recovery, and cost in paediatric anaesthesia: a hospital registry study
DOI:https://doi.org/10.1016/j.bja.2024.03.016 April 16, 2024
Associate Professor of Anesthesiology
As a K23 Mentored Patient-Oriented Research Career Development Award recipient, Dr. Chao's work focuses on expanding knowledge of early anesthetic effects in pediatric patients. Dr. Chao and his research team are conducting observational studies utilizing the electroencephalogram (EEG) during anesthesia in infants and young children to asses brain correlates of general and spinal anesthesia that could provide insight into our understanding of neurodevelopment. The long-term goal of this research is to improve patient care and enhance safety for all children requiring anesthesia.
As a graduate of the Clinical Research Training Program (CRTP) - a National Institutes of Health (NIH)/National Center for Advancing Translational Sciences (NCATS) funded program at Albert Einstein College of Medicine leading to a Master’s Degree in Clinical Research Methods - Dr. Jerry Chao designed observational studies of the effects of anesthesia on infants’ developing brains and parental perceptions of commonly employed anesthetic techniques, particularly regional anesthesia, for intraoperative and postoperative analgesia. Dr. Chao’s research focuses on obtaining and interpreting the non-invasive electroencephalogram (EEG) during general anesthesia and spinal anesthesia. He collaborates with and receives mentorship from a multidisciplinary team with expertise in epidemiology, pediatric neurology, biostatistics and computational neuroscience. Dr. Chao collaborates with national colleagues as well as the Montefiore Einstein Department of Neurology to better understand the mechanisms of sleep and anesthesia in infants and children. Dr. Chao has shared his research through peer-reviewed scientific abstracts, manuscript publications, and national presentations.
Critical Care Research and Quality Assurance
To ensure optimal patient care at the Surgical Intensive Care Units (SICU) at Montefiore Einstein, the Department of Anesthesiology has created a robust Critical Care Anesthesia Quality Assurance Program. This initiative is guided by routinely updated surgical and ICU data pulled directly from our hospital’s electronic health record so we can assess patient outcomes and modify SICU policies to ensure continuous improvement in care. Our work analyzing digital health data has already improved care in the Moses SICU through shortening the duration of invasive ventilation, utilizing opioid-sparing analgesia, lowering the incidence of respiratory failure, and reducing the proportion of deep sedation in intubated patients.
In addition to these measurable improvements in the SICU, the Department of Anesthesiology has led the development and implementation of a system-wide interdisciplinary difficult airway code – for which the team was awarded a Leadership Award in Patient Safety by MHS. The Department of Anesthesiology also served as the MHS champion for an interdisciplinary project to reduce the incidence of the Centers for Medicare and Medicaid Services (CMS) Patient Safety Indicators #11 and #12 – postoperative respiratory failure and perioperative venous thromboembolism, respectively. The former was successfully completed last year and garnered a First Prize from the Montefiore Center for Performance Improvement. The latter performance improvement project is ongoing with immense promise to reduce thromboembolic events through an effective, bundle intervention. Currently, Critical Care Anesthesiology Director of Quality Assurance Dr. Michael Kiyatkin is supporting our colleagues in the Cardiovascular Intensive Care units in an effort to decrease the risk of postoperative respiratory failure.
In addition to these quality assurance and performance improvement initiatives, the Department of Anesthesiology is engaged in multiple critical care research studies. In an ongoing observational study, researchers are evaluating the depth of sedation in mechanically ventilated ICU patients. Clinicians are often tempted to use sedatives and opioids in mechanically ventilated patients to alleviate their pain, anxiety, and agitation. However, our Digital Health Lab data shows that this practice – while applied with the best intentions – can be harmful to patients because they cannot be mobilized out of their bed. Research has shown that mobilization therapy allows patients who are critically ill to recover with better outcomes.
Assistant Professor, Anesthesiology
Dr. Kiyatkin is an anesthesiologist, intensivist, and clinical researcher who serves as the Director of Quality Assurance for the Division of Critical Care Anesthesiology. He joined Montefiore in 2019, obtained a Master of Science in Clinical Research Methods via the Einstein Clinical Research Training Program (CRTP) in 2022, and served as a 2023 Montefiore Center for Performance Improvement Fellow. Dr. Kiyatkin’s research interests are postoperative respiratory failure, postoperative triage, and implementation science, specifically design and implementation of clinical decision support.
During his CRTP work, Dr. Kiyatkin utilized a machine learning method to develop an automated prediction tool for respiratory failure after surgery. The resultant tool outperformed competing models and was designed with prospective implementation in mind. Physiologic and procedural data were at the core of the model, and missingness was carefully accounted for. This model is now being implemented system-wide for prospective use via a collaboration with the Montefiore Einstein Center for Health Data Innovations. Concurrently, Dr. Kiyatkin is working on an international expert consensus study for best practices for prediction and prevention of postprocedural respiratory failure. In addition to other ongoing observational studies related to respiratory failure and critical care triage after surgery, Dr. Kiyatkin is currently applying for foundation and federal funding for a pilot implementation study of a clinical decision support tool. This tool would automatically identify surgical patients at highest risk for respiratory failure and recommend to nurses and physicians via the electronic health record a bundle of perioperative best practices to prevent this complication.
Recent Department Publications
Development of an automated, general-purpose prediction tool for postoperative respiratory failure using machine learning: A retrospective cohort study
Journal of Clinical Anesthesia, 2023-11-01, Volume 90, Article 111194, Copyright © 2023 Elsevier Inc.
Clinical Trials
The Department of Anesthesiology provides support for faculty, residents, students, and pharmaceutical sponsors conducting research within the field of anesthesiology and its subspecialties at Montefiore and the Albert Einstein College of Medicine. The Department of Anesthesiology is currently working on six randomized controlled trials, three of which are sponsored by the National Institutes of Health.
One of the studies is testing whether suvorexant, a sleeping pill that is an orexin receptor antagonist, improves sleep in the cardiac ICU post-surgery. The researchers are studying if suvorexant can promote sleep in the ICU after cardiothoracic surgery and ultimately reduce delirium in patients. A second clinical trial, known as the PANDORA study, is a multi-center study sponsored by the National Institutes of Health. It is a randomized controlled trial examining the effects of a simple intervention — the administration of IV Acetaminophen (i.e. Tylenol) in the ICU — on the incidence and severity of postoperative delirium following cardiac surgery.
Our clinical research core assists with study design, protocol development, contract executions, budget development, data collection, and statistical analysis. The team works as a liaison between subspecialties within the department and other research organizations at Montefiore Einstein. Our staff is experienced in preparing IRB applications, preparing informed consents, submitting amendments, and fulfilling other various IRB and research requirements. Our clinical trial staff support researchers on how to obtain assistance from the Montefiore Institute for Clinical and Translational Research (ICTR) facilities such as the Montefiore Office of Clinical Trials (OCT), the Clinical Research Center (CRC), and the Biostatistics and Study Design Department. The OCT assists investigators in budget negotiations, contract executions, invoicing for services, subject recruitment, and retention planning. The CRC provides a space for expert staff to conduct outpatient research studies and assists in collecting, processing, and shipping biological specimens. The Biostatistics and Study Design Department offers expertise in designing complex study protocols and providing analytical solutions for preparing manuscripts.
See Anesthesiology Clinical Trials
Dr. Rudolph joined Montefiore Einstein in 2022 as a Research Fellow and subsequently became Lab Chief of the Anesthesiology Digital Health Lab. Dr. Rudolph is a talented digital health scientist who has led the lab’s team of researchers on many observational studies over the last two years. Her research has been published in high-impact factor journals, including on a range of topics including disparities in adverse postoperative discharge among different racial and ethnic groups, reducing same-day case cancellation rates through a bundle intervention, estimating current hospital costs associated postoperative reintubation and developing an automated tool to predict patients who have a high risk for thromboembolic events.
Dr. Rudolph came to Montefiore from University Hospital of Cologne in Germany, where she started an anesthesiology residency. Prior to that, Dr. Rudolph worked in public health leading a team of 80 employees in the Cologne Public Health Department on their COVID-19 Management. She attended medical school at the University of Muenster and spent one year as a doctoral candidate at Massachusetts General Hospital and Harvard Medical School – working in Dr. Eikermann’s laboratory. Dr. Rudolph completed her doctoral research thesis at University of Essen-Duisburg under Dr. Eikermann’s supervision. Dr. Rudolph will be joining the Montefiore Einstein Anesthesiology Residency Program as an intern beginning in July 2024.
Dr. Borngaesser joined the Anesthesiology Digital Health Lab at Montefiore Medical Center in 2023. His research focus lies in patient-centered perioperative anesthesiology, critical care medicine, and pain therapy. Dr. Borngaessar received his medical degree from Carl von Ossietzky Universität Oldenburg (Germany) and started his residency in Anesthesiology at the University Clinic of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy at Klinikum Oldenburg. Since 2015, he has conducted and published clinical research with a focus on nociception and neurophysiology as part of the working group Delirium and Postoperative Cognitive Dysfunction at Klinikum Oldenburg.
Ling Zhang, PhD is a highly talented data architect who supports the department's mission and vision for perioperative medicine. As Director of IT Innovation for the Department of Anesthesiology, Dr. Zhang creates innovative digital instruments that improve anesthesia providers' efficacy in clinical operations, research, and quality and safety. Dr. Zhang has led the creation of a database for procedural sedation, which allows our anesthesia providers to make better informed decisions. Dr. Zhang also works with our multidisciplinary colleagues including surgeons, non-surgical proceduralists, the Faculty Practice Group, and Surgical Services to create granular digital databases. She monitors procedural room efficiency and case cancellation rates and helps improve patient safety indicators through sophisticated data analytics. These innovative IT solutions allow the Department of Anesthesiology to continually provide enhanced clinical services and patient care across Montefiore Einstein. Dr. Zhang received her PhD in Biophysics from the International School for Advanced Studies in Trieste, Italy.
