Clin-STAR Journey Story

Finding a Home in Aging Research: A Vascular Surgeon Discovers Mentors and Research Methods in Geriatrics

James Iannuzzi, MD, MPH is a vascular surgeon whose research focuses on identifying patients at high risk for needing nursing home support or rehabilitation after surgery. Initially, "I was just thinking about it in terms of doing surgery on vascular patients," he says. "It didn't really click for me that I was doing aging research."

"But on average our patients are 70 to 75 years old. Everything that we're doing is in the context of studying older adults. So the principles of geriatrics are extremely important."

Dr. Iannuzzi earned his medical degree at Icahn School of Medicine at Mount Sinai in 2009. He spent 2009-2016 at the University of Rochester Medical Center, where he completed a residency in general surgery, served as chief resident and earned a master of public health degree. While at Rochester, he also was the inaugural research fellow at the Medical Center's Surgical Health Outcomes and Research Enterprise. In 2018, he completed a fellowship in vascular and endovascular surgery at Harvard Medical School's Massachusetts General Hospital.

While he was at Rochester, the surgical outcomes program focused on predictive analytics and risk factor assessment using large data sets. At the time, "There was a real explosion of this type of research," says Dr. Iannuzzi. "But data sets are constrained to the types of variables included in them. As that type of research has matured, I've realized that we're missing a lot of things."

Among the things left out is data on patients' mental health. It's well known that people with cognitive impairment, for example, are more likely than others to develop delirium after surgery and to be discharged to a skilled nursing facility. Their risk of heart attacks, falls and other poor outcomes also increases.

"In vascular surgery, we're just starting to understand this and how it impacts our outcomes," says Dr. Iannuzzi. "But there are a lot of barriers to assessing cognitive impairment in the surgical setting. It takes time and expertise that we don't currently have, and a high-volume surgical clinic is not really focused on that."

To address these issues, he planned a project to assess cognitive impairment efficiently in the clinic with an app or other tool, and he applied for a Grant for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR). Although his proposal was turned down, he was named a 2020 "Rising Star" in the Clinician Specialists’ Rising Stars in Aging Research Mentoring Program.

With this program, Dr. Iannuzzi received guidance from new mentors in aging research as well as other support from the National Institute on Aging, and he resubmitted his proposal. Instead of starting with an assessment tool, he now plans to step back and investigate the larger context for cognitive assessments through qualitative research. This approach entails interviewing patients and providers to understand their perspectives on how cognitive impairment may impact surgery, whether they think it's important to evaluate before surgery, and if so, what format and setting would be efficient and appropriate. Dr. Iannuzzi plans to apply for the upcoming The Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76).

In the meantime, Dr. Iannuzzi has begun research on the interaction between depression and cognitive impairment. Already he has found that depression in and of itself is a risk factor for being discharged to a skilled nursing facility or requiring rehabilitation after critical limb revascularization in patients with peripheral arterial disease, and after abdominal aortic aneurism repair.

These results came from analyzing large data sets. "But there's a lot of under-coding of depression," says Dr. Iannuzzi. It's likely that only the most severe cases are represented." To investigate the story behind the numbers, he recently mentored Kurt Linderman, a student in the Medical Student Training in Aging Research (MSTAR) Program. With access to patient charts and clinician notes, Linderman linked severity of depression among patients undergoing vascular surgery with delirium afterward. Results were presented at the 2021 Academic Surgical Congress.

Dr. Iannuzzi joined the faculty at UCSF in 2018, drawn in part by the Geriatrics Division. "People there were doing the same kind of research I was doing. Even so, I didn't know about the aging research community and get to be a part of it until I got here. It's been really exciting to have collaborators and mentors to help guide me."

He encourages early-career clinician-scientists to seek out people doing aging research in their local institutions, and through programs like Clin-STAR. "Aging research allows you to take that 30,000-foot view of the whole patient's experience, how it may impact your particular area of care, and also what matters to the patient. It's amazing how often we forget to ask that question, about what is the patient's goal? Then we can make sure that our treatments align with the goals of the patient."