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Ira Leeds

MD, MBA, ScM
Assistant Professor of Surgery ( Colon and Rectal); Clinical Member, Cancer Prevention and Control Program - Yale Cancer Center

Contact Information

Ira Leeds, MD, MBA, ScM

Office Location

Mailing Address

  • Yale School of Medicine

    Colorectal Surgery, PO Box 208062

    New Haven, CT 06520-8062

    United States

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Research Summary

I investigate how we as a healthcare system can address areas of clinical uncertainty where our internal decision-making based on experience and intuition may be imperfect. The clinical context often varies but my collaborators and I apply mixed methods to identify areas of imperfect clinical decision making (e.g., Big Data analysis of secondary data sets, local natural experiments, behavioral experiments) as well as investigate downstream solutions (e.g., clinical decision support, shared decision-making models, data visualization). These studies often reveal misalignment between clinical decision-making and optimal healthcare utilization, so more recently we also model these decision points using cost-effectiveness techniques to better inform where common clinical practice may ultimately be causing societal harm due to healthcare resource depletion.

Extensive Research Description

The overarching context of my research focuses on preoperative decision making between surgeons and patients with the intent to identify where the inputs and outputs of these decisions do not readily align with patient, surgeon, and societal goals.

The publications below demonstrate a consistent record of surgeons and patients having difficulty at the time of decision-making being able to simultaneously assess the individualized risk factors for worse postoperative outcomes for a given patient and a specific disease. Our hypothesis is that there is too much signal noise in patient's histories and clinical data combined with a distracting clinical atmosphere that impairs effective shared decision-making.

Other publications below describe various interventions employed (data visualization schemes, clinical decision support tools, rapid psychosocial assessment techniques) to either improve the inputs needed for high quality decision-making (i.e., enhanced information assessment and organization) or facilitate the outputs of decision-making (i.e., clinical decision support to align available data with intended outcome).

The importance of effective decision-making has been routinely demonstrated for high-complication diseases such as colorectal cancer and inflammatory bowel disease. The premise of many of our proposed interventions emphasizes addressing decision points in highly morbid diseases in patients who are also high-risk due to comorbidities or low physiologic reserve (i.e., frailty).

Finally, we test our interventions using a variety of cost-effectiveness models such as decision analysis decision trees and Markov model simulations to ascertain whether the interventions and decisions being made meet conventional means test for overall benefit to society and population health.

Coauthors

Research Interests

Adaptation, Physiological; Anal Gland Neoplasms; Colitis, Ulcerative; Colorectal Surgery; Cost-Benefit Analysis; Costs and Cost Analysis; Decision Making; Decision Making, Computer-Assisted; Decision Trees; Postoperative Complications; Postoperative Period; Preoperative Care; Colorectal Neoplasms; Risk Assessment; Decision Support Systems, Clinical; Surgical Oncology

Public Health Interests

Aging; Cancer; Clinical Guidelines; Clinical Trials; Health Care Financing

Selected Publications

  • Rescuing Failure to Rescue-Patient Safety Indicator 04 on the Brink of Obsolescence.Leeds IL, Kachalia A, Haut ER. Rescuing Failure to Rescue-Patient Safety Indicator 04 on the Brink of Obsolescence. JAMA Surgery 2021, 156: 115-116. PMID: 33026428, DOI: 10.1001/jamasurg.2020.2971.
  • Effects of patients' hospital discharge preferences on uptake of clinical decision support.Cox JC, Leeds IL, Sadiraj V, Schnier KE, Sweeney JF. Effects of patients' hospital discharge preferences on uptake of clinical decision support. PloS One 2021, 16: e0247270. PMID: 33684144, PMCID: PMC7939268, DOI: 10.1371/journal.pone.0247270.
  • On All Accounts: Cost-Effectiveness Analysis of Limited Preoperative Optimization Efforts Before Colon Cancer Surgery.Leeds IL, Drabo EF, Lehmann LS, Safar B, Johnston FM. On All Accounts: Cost-Effectiveness Analysis of Limited Preoperative Optimization Efforts Before Colon Cancer Surgery. Diseases Of The Colon And Rectum 2021, 64: 744-753. PMID: 33955409, PMCID: PMC8835996, DOI: 10.1097/DCR.0000000000001926.
  • Justifying Total Costs of Extended Venothromboembolism Prophylaxis After Colorectal Cancer Surgery.Leeds IL, Canner JK, DiBrito SR, Safar B. Justifying Total Costs of Extended Venothromboembolism Prophylaxis After Colorectal Cancer Surgery. Journal Of Gastrointestinal Surgery : Official Journal Of The Society For Surgery Of The Alimentary Tract 2020, 24: 677-687. PMID: 30945086, PMCID: PMC6776724, DOI: 10.1007/s11605-019-04206-z.
  • Early Discontinuation of Infliximab in Pregnant Women With Inflammatory Bowel Disease.Truta B, Leeds IL, Canner JK, Efron JE, Fang SH, Althumari A, Safar B. Early Discontinuation of Infliximab in Pregnant Women With Inflammatory Bowel Disease. Inflammatory Bowel Diseases 2020, 26: 1110-1117. PMID: 31670762, DOI: 10.1093/ibd/izz250.
  • Delay in emergency hernia surgery is associated with worse outcomes.Leeds IL, Jones C, DiBrito SR, Sakran JV, Haut ER, Kent AJ. Delay in emergency hernia surgery is associated with worse outcomes. Surgical Endoscopy 2020, 34: 4562-4573. PMID: 31741158, PMCID: PMC8710144, DOI: 10.1007/s00464-019-07245-4.
  • Cost-utility of colorectal cancer screening at 40 years old for average-risk patients.Azad NS, Leeds IL, Wanjau W, Shin EJ, Padula WV. Cost-utility of colorectal cancer screening at 40 years old for average-risk patients. Preventive Medicine 2020, 133: 106003. PMID: 32001308, PMCID: PMC8710143, DOI: 10.1016/j.ypmed.2020.106003.
  • Frailer Patients Undergoing Robotic Colectomies for Colon Cancer Experience Increased Complication Rates Compared With Open or Laparoscopic Approaches.Lo BD, Leeds IL, Sundel MH, Gearhart S, Nisly GRC, Safar B, Atallah C, Fang SH. Frailer Patients Undergoing Robotic Colectomies for Colon Cancer Experience Increased Complication Rates Compared With Open or Laparoscopic Approaches. Diseases Of The Colon And Rectum 2020, 63: 588-597. PMID: 32032198, DOI: 10.1097/DCR.0000000000001598.
  • The Effect on Trauma Care Secondary to the COVID-19 Pandemic: Collateral Damage From Diversion of Resources.Haut ER, Leeds IL, Livingston DH. The Effect on Trauma Care Secondary to the COVID-19 Pandemic: Collateral Damage From Diversion of Resources. Annals Of Surgery 2020, 272: e204-e207. PMID: 32452950, PMCID: PMC7467027, DOI: 10.1097/SLA.0000000000004105.
  • Increased Healthcare Utilization for Medical Comorbidities Prior to Surgery Improves Postoperative Outcomes.Leeds IL, Canner JK, Gani F, Meyers PM, Haut ER, Efron JE, Johnston FM. Increased Healthcare Utilization for Medical Comorbidities Prior to Surgery Improves Postoperative Outcomes. Annals Of Surgery 2020, 271: 114-121. PMID: 29864092, PMCID: PMC8559326, DOI: 10.1097/SLA.0000000000002851.
  • Does Perceived Resident Operative Autonomy Impact Patient Outcomes?Fieber JH, Bailey EA, Wirtalla C, Johnson AP, Leeds IL, Medbery RL, Ahuja V, VanderMeer T, Wick EC, Irojah B, Kelz RR. Does Perceived Resident Operative Autonomy Impact Patient Outcomes? Journal Of Surgical Education 2019, 76: e182-e188. PMID: 31377204, DOI: 10.1016/j.jsurg.2019.06.006.
  • Outcomes for Ulcerative Colitis With Delayed Emergency Colectomy Are Worse When Controlling for Preoperative Risk Factors.Leeds IL, Sundel MH, Gabre-Kidan A, Safar B, Truta B, Efron JE, Fang SH. Outcomes for Ulcerative Colitis With Delayed Emergency Colectomy Are Worse When Controlling for Preoperative Risk Factors. Diseases Of The Colon And Rectum 2019, 62: 600-607. PMID: 30451754, PMCID: PMC6456379, DOI: 10.1097/DCR.0000000000001276.
  • Cost Effectiveness of Meningococcal Serogroup B Vaccination in College-Aged Young Adults.Leeds IL, Namasivayam V, Bamogo A, Sankhla P, Thayer WM. Cost Effectiveness of Meningococcal Serogroup B Vaccination in College-Aged Young Adults. American Journal Of Preventive Medicine 2019, 56: 196-204. PMID: 30573332, PMCID: PMC6340776, DOI: 10.1016/j.amepre.2018.09.020.
  • Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients.Leeds IL, Meyers PM, Enumah ZO, He J, Burkhart RA, Haut ER, Efron JE, Johnston FM. Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients. Annals Of Surgical Oncology 2019, 26: 936-944. PMID: 30617868, PMCID: PMC8710142, DOI: 10.1245/s10434-018-07136-3.
  • Missed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery.Meyers PM, Leeds IL, Enumah ZO, Burkhart RA, He J, Haut ER, Efron JE, Johnston FM. Missed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery. Surgery 2019, 166: 177-183. PMID: 31160060, PMCID: PMC8828252, DOI: 10.1016/j.surg.2019.04.015.
  • Variation in the use of MRI for cervical spine clearance: an opportunity to simultaneously improve clinical care and decrease cost.Albaghdadi A, Leeds IL, Florecki KL, Canner JK, Schneider EB, Sakran JV, Haut ER. Variation in the use of MRI for cervical spine clearance: an opportunity to simultaneously improve clinical care and decrease cost. Trauma Surgery & Acute Care Open 2019, 4: e000336. PMID: 31392284, PMCID: PMC6660802, DOI: 10.1136/tsaco-2019-000336.
  • Are We Really Supposed to Start Giving Venous Thromboembolism Prophylaxis for a Month After Outpatient Surgery?Leeds IL, Haut ER. Are We Really Supposed to Start Giving Venous Thromboembolism Prophylaxis for a Month After Outpatient Surgery? JAMA Surgery 2019, 154: 1133. PMID: 31596432, DOI: 10.1001/jamasurg.2019.3753.
  • Cost-Benefit Limitations of Extended, Outpatient Venous Thromboembolism Prophylaxis Following Surgery for Crohn's Disease.Leeds IL, DiBrito SR, Canner JK, Haut ER, Safar B. Cost-Benefit Limitations of Extended, Outpatient Venous Thromboembolism Prophylaxis Following Surgery for Crohn's Disease. Diseases Of The Colon And Rectum 2019, 62: 1371-1380. PMID: 31596763, PMCID: PMC6788772, DOI: 10.1097/DCR.0000000000001461.
  • Quantification of Resident Work in Colorectal Surgery.Bailey EA, Johnson AP, Leeds IL, Medbery RL, Ahuja V, VanderMeer T, Wick EC, Irojah B, Kelz RR. Quantification of Resident Work in Colorectal Surgery. Journal Of Surgical Education 2018, 75: 564-572. PMID: 28986275, DOI: 10.1016/j.jsurg.2017.09.001.
  • Using Audience Response Systems for Real-Time Learning Assessments During Surgical Morbidity and Mortality Conference.Leeds IL, DiBrito SR, Jones CD, Higgins RSD, Haut ER. Using Audience Response Systems for Real-Time Learning Assessments During Surgical Morbidity and Mortality Conference. Journal Of Surgical Education 2018, 75: 1535-1543. PMID: 30523799, DOI: 10.1016/j.jsurg.2018.05.010.
  • Distinguishing Anal Squamous Cell Carcinoma and Rectal Squamous Cell Carcinoma in Secondary Data Sets.Leeds IL, Griffin JF, Fang SH. Distinguishing Anal Squamous Cell Carcinoma and Rectal Squamous Cell Carcinoma in Secondary Data Sets. Diseases Of The Colon And Rectum 2018, 61: e19. PMID: 29420432, PMCID: PMC5808605, DOI: 10.1097/DCR.0000000000001015.
  • The Modern Surgeon Scientist.DiBrito SR, Holscher CM, Haugen CE, Leeds IL, Overton HN, Jackson KR, King EA, Haut ER. The Modern Surgeon Scientist. Annals Of Surgery 2018, 268: e88-e89. PMID: 29629908, PMCID: PMC6355162, DOI: 10.1097/SLA.0000000000002756.
  • Process measures facilitate maturation of pediatric enhanced recovery protocols.Leeds IL, Ladd MR, Sundel MH, Fannon ML, George JA, Boss EF, Jelin EB. Process measures facilitate maturation of pediatric enhanced recovery protocols. Journal Of Pediatric Surgery 2018, 53: 2266-2272. PMID: 29801659, PMCID: PMC8710141, DOI: 10.1016/j.jpedsurg.2018.04.037.
  • Malnutrition increases the risk of 30-day complications after surgery in pediatric patients with Crohn disease.Ladd MR, Garcia AV, Leeds IL, Haney C, Oliva-Hemker MM, Alaish S, Boss E, Rhee DS. Malnutrition increases the risk of 30-day complications after surgery in pediatric patients with Crohn disease. Journal Of Pediatric Surgery 2018, 53: 2336-2345. PMID: 29843908, PMCID: PMC8841062, DOI: 10.1016/j.jpedsurg.2018.04.026.
  • Neoadjuvant Therapy for Rectal Cancer.Leeds IL, Fang SH. Neoadjuvant Therapy for Rectal Cancer. Diseases Of The Colon And Rectum 2018, 61: 883-886. PMID: 29994956, PMCID: PMC6044457, DOI: 10.1097/DCR.0000000000001139.
  • Surgical Gatekeeping - Modifiable Risk Factors and Ethical Decision Making.Leeds IL, Efron DT, Lehmann LS. Surgical Gatekeeping - Modifiable Risk Factors and Ethical Decision Making. The New England Journal Of Medicine 2018, 379: 389-394. PMID: 30044939, DOI: 10.1056/NEJMms1802079.
  • Eye of the beholder: Risk calculators and barriers to adoption in surgical trainees.Leeds IL, Rosenblum AJ, Wise PE, Watkins AC, Goldblatt MI, Haut ER, Efron JE, Johnston FM. Eye of the beholder: Risk calculators and barriers to adoption in surgical trainees. Surgery 2018, 164: 1117-1123. PMID: 30149939, PMCID: PMC8383120, DOI: 10.1016/j.surg.2018.07.002.
  • Limitations of the National Cancer Data Base to Evaluate Early-Stage Anal Cancer Treatment Outcomes.Leeds IL, Fang SH. Limitations of the National Cancer Data Base to Evaluate Early-Stage Anal Cancer Treatment Outcomes. JAMA Surgery 2018, 153: 690-691. PMID: 29710345, DOI: 10.1001/jamasurg.2018.0391.
  • How We Measure Surgical Trainee Performance Matters.Leeds IL, DiBrito SR, Sacks BC. How We Measure Surgical Trainee Performance Matters. JAMA Surgery 2018, 153: 864-865. PMID: 29898207, DOI: 10.1001/jamasurg.2018.1642.
  • The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction.Leeds IL, Canner JK, Efron JE, Ahuja N, Haut ER, Wick EC, Johnston FM. The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction. The Journal Of Surgical Research 2017, 220: 402-409.e6. PMID: 28923559, PMCID: PMC5712450, DOI: 10.1016/j.jss.2017.08.039.
  • Treating Wisely: The Surgeon's Role in Antibiotic Stewardship.Leeds IL, Fabrizio A, Cosgrove SE, Wick EC. Treating Wisely: The Surgeon's Role in Antibiotic Stewardship. Annals Of Surgery 2017, 265: 871-873. PMID: 27735819, PMCID: PMC5378652, DOI: 10.1097/SLA.0000000000002034.
  • Early Surgical Intervention for Acute Ulcerative Colitis Is Associated with Improved Postoperative Outcomes.Leeds IL, Truta B, Parian AM, Chen SY, Efron JE, Gearhart SL, Safar B, Fang SH. Early Surgical Intervention for Acute Ulcerative Colitis Is Associated with Improved Postoperative Outcomes. Journal Of Gastrointestinal Surgery : Official Journal Of The Society For Surgery Of The Alimentary Tract 2017, 21: 1675-1682. PMID: 28819916, PMCID: PMC6201293, DOI: 10.1007/s11605-017-3538-3.
  • Racial and Socioeconomic Differences Manifest in Process Measure Adherence for Enhanced Recovery After Surgery Pathway.Leeds IL, Alimi Y, Hobson DR, Efron JE, Wick EC, Haut ER, Johnston FM. Racial and Socioeconomic Differences Manifest in Process Measure Adherence for Enhanced Recovery After Surgery Pathway. Diseases Of The Colon And Rectum 2017, 60: 1092-1101. PMID: 28891854, PMCID: PMC5647878, DOI: 10.1097/DCR.0000000000000879.
  • Discharge decision-making after complex surgery: Surgeon behaviors compared to predictive modeling to reduce surgical readmissions.Leeds IL, Sadiraj V, Cox JC, Gao XS, Pawlik TM, Schnier KE, Sweeney JF. Discharge decision-making after complex surgery: Surgeon behaviors compared to predictive modeling to reduce surgical readmissions. American Journal Of Surgery 2017, 213: 112-119. PMID: 28029373, PMCID: PMC5362294, DOI: 10.1016/j.amjsurg.2016.03.010.
  • Gracilis Flap for Perineal Closures in Minimally Invasive Abdominoperineal Resection.Leeds IL, Taylor JP, Pozo M, Safar B, Sacks JM, Fang SH. Gracilis Flap for Perineal Closures in Minimally Invasive Abdominoperineal Resection. The American Surgeon 2017, 83: e194-196. PMID: 28637543.
  • Anal cancer and intraepithelial neoplasia screening: A review.Leeds IL, Fang SH. Anal cancer and intraepithelial neoplasia screening: A review. World Journal Of Gastrointestinal Surgery 2016, 8: 41-51. PMID: 26843912, PMCID: PMC4724586, DOI: 10.4240/wjgs.v8.i1.41.
  • Outcomes of abdominoperineal resection for management of anal cancer in HIV-positive patients: a national case review.Leeds IL, Alturki H, Canner JK, Schneider EB, Efron JE, Wick EC, Gearhart SL, Safar B, Fang SH. Outcomes of abdominoperineal resection for management of anal cancer in HIV-positive patients: a national case review. World Journal Of Surgical Oncology 2016, 14: 208. PMID: 27495294, PMCID: PMC4974747, DOI: 10.1186/s12957-016-0970-x.
  • Enhanced Recovery After Surgery Pathways and Resident Physicians: Barrier or Opportunity?Stone AB, Leeds IL, Efron J, Wick EC. Enhanced Recovery After Surgery Pathways and Resident Physicians: Barrier or Opportunity? Diseases Of The Colon And Rectum 2016, 59: 1000-1. PMID: 27602932, PMCID: PMC5367633, DOI: 10.1097/DCR.0000000000000623.
  • Preparing enhanced recovery after surgery for implementation in pediatric populations.Leeds IL, Boss EF, George JA, Strockbine V, Wick EC, Jelin EB. Preparing enhanced recovery after surgery for implementation in pediatric populations. Journal Of Pediatric Surgery 2016, 51: 2126-2129. PMID: 27663124, PMCID: PMC5373552, DOI: 10.1016/j.jpedsurg.2016.08.029.
  • Patient Symptomatology in Anal Dysplasia.Hicks CW, Wick EC, Leeds IL, Efron JE, Gearhart SL, Safar B, Fang SH. Patient Symptomatology in Anal Dysplasia. JAMA Surgery 2015, 150: 563-9. PMID: 25874644, DOI: 10.1001/jamasurg.2015.28.
  • Bundling for high-reliability health care.Leeds IL, Wick EC. Bundling for high-reliability health care. JAMA Surgery 2014, 149: 1053. PMID: 25162744, DOI: 10.1001/jamasurg.2014.389.
  • Does close temperature regulation affect surgical site infection rates?Leeds IL, Wick EC, Melton GB. Does close temperature regulation affect surgical site infection rates? Advances In Surgery 2014, 48: 65-76. PMID: 25293608, DOI: 10.1016/j.yasu.2014.05.001.
  • A win for all: faculty-student partnerships in surgical humanitarianism.Leeds IL, Srinivasan J, Pattaras JG, Master VA. A win for all: faculty-student partnerships in surgical humanitarianism. Bulletin Of The American College Of Surgeons 2013, 98: 12-7. PMID: 23441503.
  • International surgical clerkship rotation: perceptions and academic performance.Leeds IL, Hugar LA, Pettitt BJ, Srinivasan J, Master VA. International surgical clerkship rotation: perceptions and academic performance. American Journal Of Surgery 2013, 206: 280-6. PMID: 23481029, DOI: 10.1016/j.amjsurg.2012.10.034.
  • Inherent difficulties of measuring the burden of surgical disease in resource-poor settings.Leeds IL, Hugar LA, Lorentz CA, Srinivasan J, Pattaras JG, Master VA. Inherent difficulties of measuring the burden of surgical disease in resource-poor settings. World Journal Of Surgery 2013, 37: 2248-9. PMID: 23539196, DOI: 10.1007/s00268-013-2014-9.
  • Assessing clinical discharge data preferences among practicing surgeons.Leeds IL, Sadiraj V, Cox JC, Schnier KE, Sweeney JF. Assessing clinical discharge data preferences among practicing surgeons. The Journal Of Surgical Research 2013, 184: 42-48.e3. PMID: 23706559, PMCID: PMC3758431, DOI: 10.1016/j.jss.2013.03.064.
  • Risk factors for 30-day hospital readmission among general surgery patients.Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, Sadiraj V, Sweeney JF. Risk factors for 30-day hospital readmission among general surgery patients. Journal Of The American College Of Surgeons 2012, 215: 322-30. PMID: 22726893, PMCID: PMC3423490, DOI: 10.1016/j.jamcollsurg.2012.05.024.
  • Learning from Haiti.Creighton FX, Leeds IL, Master VA, Srinivasan JK. Learning from Haiti. Lancet 2011, 377: 2054. PMID: 21665039, DOI: 10.1016/S0140-6736(11)60409-1.
  • Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review.Leeds IL, Creighton FX, Wheatley MA, Macleod JB, Srinivasan J, Chery MP, Master VA. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review. BMC Research Notes 2011, 4: 317. PMID: 21884604, PMCID: PMC3224472, DOI: 10.1186/1756-0500-4-317.
  • Is it time to change guidelines for iron supplementation in malarial areas?Suchdev PS, Leeds IL, McFarland DA, Flores R. Is it time to change guidelines for iron supplementation in malarial areas? The Journal Of Nutrition 2010, 140: 875-6. PMID: 20147465, DOI: 10.3945/jn.109.118638.
  • Beyond absolutism: guiding principles needed for humanitarian medicine.Leeds IL. Beyond absolutism: guiding principles needed for humanitarian medicine. World Journal Of Surgery 2010, 34: 2507; author reply 2508. PMID: 20437046, DOI: 10.1007/s00268-010-0612-3.
  • Academic institutions as agents for international outreach.Leeds IL, Zaeh SE. Academic institutions as agents for international outreach. JAMA 2010, 304: 271-2; author reply 272. PMID: 20639559, DOI: 10.1001/jama.2010.987.
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