Prevention and Consequences of Postoperative Delirium

After completing anesthesiology training, Charles Brown, IV, MD, found himself behind in accumulating pilot data and successful research endpoints to prepare himself for larger funding from the NIH. Fortunately, some internal funding from his institution, Johns Hopkins Medicine, and a 2015 IARS Mentored Research Award, provided him with the support and protected research time he needed to progress positively in his career as a clinician scientist. An Assistant Professor in Anesthesiology and Perioperative Medicine at the time, through the IMRA-funded study, Dr. Brown was able to pursue a topic of great importance to him, “Prevention and Consequences of Postoperative Delirium.” With this study, he was able to show a change in cognition at one month, emphasizing that delirium has long-term consequences and perioperative brain health is gravely important. Following this initial funded study, Dr. Brown quickly transitioned to independent funding, finding a research home in the National Institute of Aging. From a research perspective, he was able to expand his initial investigation from postoperative delirium to address more broadly the perioperative care of older adults, looking for biomarkers and optimization protocols that might improve care. Below, he shares his journey in anesthesiology, the evolution of his research and his hopes that perioperative medicine continues to expand and improve patient care.

1. What is your current position? How long have you been in this position?

I’m Associate Professor at Johns Hopkins. I’ve been faculty here since 2011 and I’ve probably been Associate for 4-5 years. I’m Deputy Vice Chair of Research for the Department. So that’s a current position. It was not a position when I was funded.

2. What was your role when you were first funded by IARS?

Assistant Professor.

3. What was the goal of your initial research project? Was it met?

My project was to look at postoperative delirium, looking at the association of delirium and cognitive change in a cohort study in aim 1 and in aim 2 was to conduct a trial on the depth of anesthesia to reduce delirium.

4. How did your findings impact patient care and impact the field of anesthesiology?

Both aims had papers in Anesthesiology. The first one showed an association with delirium with a change in cognition at one month. It further supports the notion that delirium is important and has longer term consequences, so furthering the notion of the importance of brain health.

The second one was a study that did not show a difference between intervention and control arm so that added to the accumulating evidence that modifying depth of anesthesia based on studied values was not effective at preventing delirium.

5. Has your research subject area evolved since the award?

I still definitely focus on perioperative care of older adults, so, delirium, cognition function are all parts of that. I’ve expanded into other associated areas. We now look at blood flow to the brain. We look at biomarkers in several different ways, including optimization protocols. The core is similar focused on delirium and cognition, but expanded in a number of ways.

6. How did the award affect your research/professional trajectory?

It was a really, really important award at that time. At sort of a longer answer, coming out of anesthesiology training, there’s not a ton of time for research. Compared to other specialties where you have a couple years doing fellowship, we are behind a little bit in terms of getting the pilot data, the publications ready for a K. The IARS award in conjunction with some internal Hopkins money, really gave me the time and the pilot data to be successful in expanding my research portfolio and then be successful in getting a K. I pretty quickly transitioned from having the IARS award to having my K.

The award provided a foundation, I was on my trajectory to get my K.

I transitioned to independent funding. I got the K76 which is a National Institute of Aging super K. It’s called the Beeson Award. In year 3, I got my R so I’ve been successful in getting mentored and then getting independent clinician-scientist funding.

7. How do you feel about having received the IARS Mentored Research Award?

It was great, especially as junior faculty and just starting out. These awards are crucial both to have the money to do the stuff and to have the time, and also being successful at getting a grant. It helps along that process as you learn and also a marker of your potential. It was a fabulous opportunity and I’m very grateful.

8. What would you like to convey to our donors, the people who made this award possible?

The award funds junior faculty at this really critical time in their career development where they are scraping for time and resources to do the projects of interest and for me, it was a pivotal time to have that award to be able to continue to focus on research. There’s always the ability to do more clinical work if research isn’t working out. I’m grateful to have the time and to be able to do the research. Doing both of those together is important, it’s a passion. Just conveying at this stage of a faculty career it’s a super important award. Even though in scale and scope, in number of years, and in dollar amounts, it’s smaller than an NIH award, at the time in one’s career, it’s incredibly important.

9. What drew you to anesthesiology and to your particular area of research?

For anesthesiology, I like taking care of critically ill patients. I like the procedural aspects but all of the aspects that come together. Cardiac anesthesiology in particular, it’s critically ill patients with cardiovascular physiology, intraoperative ECHO. I like all those aspects.

For the research, I certainly had patients with delirium and realized it’s something that’s common. It’s deleterious to patient outcome. Patients, families, physicians care about it. It’s an area that not one specialty owns. Atrial fibrillation is clearly cardiology. Delirium is something that anesthesiologists can contribute to, psychologists can contribute to, surgeons, it’s a multidisciplinary space which I really like.

Then the findings that we’ve had that are associated with these other important outcomes like cognitive change and functional change that are really important for older adults in the long term. With various grants that I’ve had, I’ve really gotten to know the National Institute of Aging better and I’ve really found a research home there. What they are interested in, their approach has dovetailed with what I think is important. Those are all the reasons that I’ve developed the focus area that I have.

10. What is something that someone would be surprised to learn about you?

I really like playing squash. I’ve gotten into it the past couple of years. It’s a super fun game. It’s social. It’s a good workout and it’s competition, so I really enjoy playing that.

I play a lot in the morning, so it’s a good way to start the day.

11. What do you hope for the future of anesthesia research?

My hope is that it expands and we can continue to attract physician scientists in the perioperative space. I think there’s going to be more and more opportunities and data that’s acquired in clinical care either with big data projects or ways to do pragmatic studies. My hope is that we continue to have a robust research presence. It helps improve care for patients, it helps improve the system, the field, intellectual stimulation, ability – it’s a win-win.

My own research is to continue to understand modifiable factors for these types of outcomes and design larger studies to try to intervene on them is the overall goal. The more I’m able to do those goals, the better.