Research Resident Spotlight - June 2024

Alexa Melucci, MD

PGY6

Tell us a little about your path to Surgery Residency. ​​​

My interest in surgery began with many visits to the orthopedic surgeon in high school for various soccer related knee injuries. As a result, I had six surgeries which ultimately ended my soccer career but were some of my first exposures to the field of surgery and these experiences solidified my desire to pursue medicine and surgery. I earned my BS in Biology, Vertebrae Physiology, and a minor in Kinesiology from Penn State in 2014 and matriculated directly into medical school at Rutgers Robert Wood Johnson. There I met my now husband, and we couples matched to the University of Rochester in 2018 - him into orthopedic surgery and me into general surgery.
 

What was your motivation to pursue research during your residency?

I did not have a dedicated research experience in medical school, so research was something I knew I wanted to pursue during my time in residency. Specifically, I wanted to learn how to ask the right research question and acquire a subset of skills to begin to answer it. As I am interested in surgical oncology, I initially thought basic science was where my interests lie. However, after six months I quickly realized it was not where I was going to excel. The department was extremely supportive in allowing me to shift gears to health services and outcomes-based research, which better aligned with my goals.
 

Who is your research mentor?

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Fergal Fleming, MD
Associate Professor of Surgery
Clinical Director, SHORE: Surgical Health Outcomes Reaching for Equity

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Jacob Moalem, MD
Professor of Surgery and Endocrinology
Director, Department of Surgery Quality and Safety
Opioid Reduction Program 
  

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Larissa Temple, MD
Professor of Surgery and Chief 
Division of Colorectal Surgery
Co-Director, Surgical Value Incubator Program

What does the role of mentorship in research mean to you?

A research mentor's role is vital to a mentee's academic and personal development. The mentor-mentee relationship is dynamic always adjusting to the various levels of support and guidance that a mentee may need for skill development and growth. Importantly, a research mentor knows their own skill set and strengths and is willing to connect mentees with other mentors to help achieve the mentee's goals.

What is your research focus?

My research focused on the outcomes of older adults with cancer after surgery. One project focused on the development of hospital acquired geriatric syndromes (malnutrition, delirium, etc.) after elective surgery for gastrointestinal cancer. We found older patients who undergo surgery for cancer are at risk for developing a syndrome in the hospital and development of the syndromes was associated with a higher risk of one-year mortality and significantly fewer days alive and out of hospital. Another project evaluating adherence to guideline care in older adults with rectal cancer found older patients were less likely to receive guideline¬ adherent care and a left-digit bias (disproportionate influence of left most age digit - i.e. 58-59-year-old treated differently than 60-year-old) was present.

What are your recent presentations/awards/manuscripts?

Awards:

University of Rochester Department of Surgery 4th Annual Research Symposium – Second Place in Clinical Outcomes, Spring 2024

University of Rochester Medical Faculty Group Healthcare Innovation Pilot Grant, Co-investigator, 2021-2023

Publications:

Melucci, A. D., Loria, A., Aquina, C. T., McDonald, G., Schymura, M. J., Schiralli, M. P., Cupertino, A., Temple, L. K., Ramsdale, E., & Fleming, F. J. (2024). New Onset Geriatric Syndromes and One-year Outcomes Following Elective Gastrointestinal Cancer Surgery. Annals of surgery, 279(5), 781–788. https://doi.org/10.1097/SLA.0000000000006108

Melucci, A. D., Erlick, M. R., Loria, A., Russell, M. M., Temple, L. K., & Poles, G. C. (2023). Surgical Informed Consent: A Scoping Review of Physician-facing Decision Support Tools. Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 4(1), e259. https://doi.org/10.1097/AS9.0000000000000259

Melucci, A. D., Loria, A., Ramsdale, E., Temple, L. K., Fleming, F. J., & Aquina, C. T. (2022). An assessment of left-digit bias in the treatment of older patients with potentially curable rectal cancer. Surgery, 172(3), 851–858. https://doi.org/10.1016/j.surg.2022.04.038

Melucci, A. D., Lynch, O. F., Wright, M. J., Baran, A., Temple, L. K., Poles, G. C., & Moalem, J. (2022). Evaluating Age as a Predictor of Postoperative Opioid Use and Prescribing Habits in Older Adults With Cancer. Journal of the American Medical Directors Association, 23(4), 678–683.e1. https://doi.org/10.1016/j.jamda.2022.01.081

Melucci, A. D., Chacon, A. C., Burchard, P. R., Tsagkalidis, V., Casabianca, A. S., Goyal, S., Switchenko, J. M., Kooby, D. A., Staley, C. A., Carpizo, D. R., & Shah, M. M. (2022). The Impact of Carbohydrate Antigen 19-9 on Survival in Patients with Clinical Stage I and II Pancreatic Cancer. Annals of surgical oncology, 29(13), 8536–8547. https://doi.org/10.1245/s10434-022-12497-x

Melucci, A. D., Liu, J. B., Brajcich, B. C., Collins, C. E., Kazaure, H. S., Ko, C. Y., Pusic, A. L., & Temple, L. K. (2022). Scaling and spreading the electronic capture of patient-reported outcomes using a national surgical quality improvement programme: a feasibility study protocol. BMJ open quality, 11(4), e001909. https://doi.org/10.1136/bmjoq-2022-001909

Melucci, A. D., Dave, Y. A., Lynch, O. F., Hsu, S., Erlick, M. R., Linehan, D. C., Moalem, J., & University of Rochester's Efforts to Decrease Unnecessary Controlled substances in Surgery (UReduces) Initiative (2023). Predictors of opioid-free discharge after laparoscopic cholecystectomy. American journal of surgery, 225(1), 206–211. https://doi.org/10.1016/j.amjsurg.2022.07.027

Melucci, A. D., Flodman, K., Loria, A., Swanson, H. L., Robinson, M. K., Hasselberg, M. J., Evans, L., Temple, L. K., & Fleming, F. J. (2023). Is there an outcome benefit? Patient engagement technology in addition to the electronic medical record patient portal following elective colorectal surgery. Surgical endoscopy, 37(12), 9275–9282. https://doi.org/10.1007/s00464-023-10478-z

Jacob, E. A., Melucci, A. D., Talbot, E. A., Fleming, F., Schiralli, M., Foster, C., Foster, L., Donovan, K., Simran, K., John, V. J., & Hellenthal, N. J. (2024). The Upstate New York Surgical Quality Improvement Opioid Reduction Project. The American surgeon, 90(5), 1100–1102. https://doi.org/10.1177/00031348231220583

Presentations:

Older Adults and Opioids Webinar Series, 2023: Oral Presentation - The impact of CA 19-9 on survival in patients with clinical stage I pancreatic cancer

Society of Surgical Oncology, 2023: Oral Presentation - Impact of Incident Hospital-Acquired Geriatric Syndromes on Short-term Outcomes following Gastrointestinal Cancer Resection

American Society of Clinical Oncology, 2022: On Demand Presentation - The impact of CA 19-9 on survival in patients with clinical stage I pancreatic cancer

American College of Surgeons Clinical Congress, 2021: Oral Presentation - Caloric Restriction Sensitizes Melanoma to Immune Checkpoint Inhibition

University of Rochester Medical Center, 2021: Grand Rounds Presentation – Minimizing Variation in Opioid Prescribing 

What are your future goals?

I am looking forward to rotating on surgical oncology in the upcoming years as a chief resident and providing care with a new lens based on my research experience. I hope to translate my findings to the clinical setting and continue to advance the perioperative care of adults with cancer.