JUNE 2015 | VOLUME 100 NUMBER 6 | AMERICAN COLLEGE OF SURGEONS Bulletin Contents

FEATURES Global Surgery 2030: An introduction 10 John G. Meara, MD, DMD, MBA, FACS, and Sarah L. M. Greenberg, MD, MPH

Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development: Executive Summary of The Lancet Commission on Global Surgery Report 12

COVER STORY: The Distinguished Philanthropist Award: Celebrating a legacy of exceptional giving 16 Barbara L. Dean, Sarah B. Klein, and Kenneth W. Sharp, MD, FACS

Brandeis University Heller Leadership Program in Health Policy and Management provides an education on the business side of surgery 20 Tony Peregrin | 1

Surgeons uncover the keys to life by performing classical music 27 Jeannie Glickson

Connect with the College.

Twitter.com/AmCollSurgeons Facebook.com/AmCollSurgeons YouTube.com/AmCollegeofSurgeons Twitter.com/ACSTrauma Facebook.com/ACSTrauma Facebook.com/RASACS

Social Media Questions? For more information or if you have comments about the American College of Surgeons’ social media sites, send an e-mail to [email protected].

JUN 2015 BULLETIN American College of Surgeons Contents continued

COLUMNS A look at The Joint Commission: Print or digital Bulletin? A new direction for “A look at The The choice is yours 60 Looking forward 8 Joint Commission” 48 Dr. Turner is first woman SBAS David B. Hoyt, MD, FACS Carlos A. Pellegrini, MD, FACS, president-elect 61 What surgeons should know FRCSI(Hon) Commission on Cancer to hold two about...The transition to ICD-10 NTDB data points: Hit the road, educational programs in June 61 before October 1 compliance jacked—road rash injuries 49 Becker’s Hospital Review deadline 34 Richard J. Fantus, MD, FACS, and names Dr. Ko one of Sarah Kurusz; Chad Rubin, MD, Edmundo A. Rivera, MD 50 patient safety experts 62 FACS; and Lee Morisy, MD, FACS Dr. Ellner receives inaugural From residency to retirement: Big NEWS Roger Schenke Award data and GME: Expanding the scope from AAPL 62 ACS declares victory with passage of patient safety and QI training 40 of law repealing the SGR 51 2015 Resident Trauma Papers David C. Chang, PhD, MPH, MBA; Competition winners announced 63 Hartford Consensus III focuses Jordan D. Bohnen, MD, MBA; on empowering the public Wall Street Journal article features John T. Mullen, MD, FACS; to serve as first responders 52 enhanced recovery protocols 65 and Bob S. Carter, MD, PhD In memoriam: Dr. Lloyd MacLean, Chapter news 66 2 | ACS Clinical Research Program: ACS Past-President and “The Chief” Donna Tieberg New manual for cancer surgery at McGill 53 issued: Operative Standards for Jonathan L. Meakins, MD, FACS Cancer Surgery 43 SCHOLARSHIPS Linda W. Martin, MD, MPH, FACS; News from the ACS Communities 57 2015 Health Policy Scholars Nirmal K. Veeramachaneni, MD, Mallory Williams, MD, MPH, FACS announced 71 FACS; Matthew H. G. Katz, MD, Dr. John E. Hutton, Jr., ACS awards five Faculty Research FACS; Y. Nancy You, MD, MHSc, physician to President Reagan, Fellowships 73 FACS; Judy C. Boughey, MD, FACS; buried April 1 58 ACS awards six Resident Research Heidi Nelson, MD, FACS; and Kelly Scholarships 75 K. Hunt, MD, FACS Colonel James M. Salander, MD, FACS; Colonel Norman M. Rich, Your ACS benefits: The Surgeon MD, FACS; and Captain Eric A. MEETINGS CALENDAR Specific Registry and the ACS Member Elster, MD, FACS Calendar of events 76 Profile enhance your practice 45 Bianca Agregado and Connie Bura

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V100 No 6 BULLETIN American College of Surgeons The American College of Surgeons is dedicated CLINICAL CONGRESS to improving the care of the surgical patient and to safeguarding standards of care in an 2015 optimal and ethical practice environment. OCTOBER 4–8

EDITOR-IN-CHIEF Letters to the Editor McCORMICK PLACE | CHICAGO, IL Diane Schneidman should be sent with the writer’s DIRECTOR, DIVISION OF name, address, INTEGRATED COMMUNICATIONS e-mail address, and Lynn Kahn daytime telephone SENIOR EDITOR number via e-mail to Tony Peregrin dschneidman@facs. org, or via mail to EDITORIAL & PRODUCTION ASSISTANT Diane S. Schneidman, Matthew Fox Editor-in-Chief, Bulletin, American CONTRIBUTING EDITOR College of Surgeons, Jeannie Glickson 633 N. Saint Clair St., SENIOR GRAPHIC DESIGNER/ Chicago, IL 60611. PRODUCTION MANAGER Letters may be edited Tina Woelke for length or clarity. Permission to publish EDITORIAL ADVISORS letters is assumed Charles D. Mabry, MD, FACS unless the author Leigh A. Neumayer, MD, FACS indicates otherwise. Marshall Z. Schwartz, MD, FACS Mark C. Weissler, MD, FACS

FRONT COVER DESIGN Tina Woelke

Bulletin of the American College of Surgeons (ISSN 0002-8045) is published monthly by the American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. It is distributed without charge to Fellows, Associate Fellows, Resident and Medical Student Members, Affiliate Members, and to medical libraries and allied health personnel. Periodicals postage paid at Chicago, IL, and additional mailing offices. POSTMASTER: Send address changes to Bulletin of the American College of Surgeons, 3251 Riverport Lane, Maryland Heights, MO 63043. Canadian Publications Mail Agreement No. 40035010. Canada returns to: Station A, PO Box 54, Windsor, ON N9A 6J5. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211; tel. 312-202‑5000; toll-free: 800-621-4111; e-mail: [email protected]; website: facs.org. Washington, Achieving Your Personal Best: DC, Office is located at 20 F Street N.W. Suite 1000, Washington, DC. 20001-6701; tel. 202‑337-2701; website: www.tmiva.net/20fstreetcc/home. Improvement Based on Evidence Unless specifically stated otherwise, the opinions expressed and statements made in this publication reflect the authors’ personal observations and do not imply endorsement by nor official policy of the American College of Surgeons. ©2015 by the American College of Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmitted in any form by any means without prior written permission of the publisher. Library of Congress number 45-49454. Printed in the USA. Publications Agreement No. 1564382. Officers and Staff of the American College of Surgeons

Gerald M. Fried, MD, AMERICAN COLLEGE OF FACS, FRCSC Advisory Council SURGEONS FOUNDATION Officers Montreal, QC Martin H. Wojcik Executive Director Andrew L. Warshaw, MD, FACS James W. Gigantelli, MD, FACS to the Board Boston, MA Omaha, NE of Regents ALLIANCE/AMERICAN PRESIDENT COLLEGE OF SURGEONS Carlos A. Pellegrini, MD, FACS B. J. Hancock, MD, FACS, FRCSC (Past-Presidents) CLINICAL RESEARCH Seattle, WA Winnipeg, MB PROGRAM IMMEDIATE PAST-PRESIDENT Enrique Hernandez, MD, FACS Kathryn D. Anderson, MD, FACS Kelly Hunt, MD, FACS Chair Jay L. Grosfeld, MD, FACS Philadelphia, PA Eastvale, CA Indianapolis, IN Lenworth M. Jacobs, Jr., MD, FACS W. Gerald Austen, MD, FACS CONVENTION AND MEETINGS FIRST VICE-PRESIDENT Hartford, CT Boston, MA Felix Niespodziewanski Kenneth L. Mattox, MD, FACS L. Scott Levin, MD, FACS L. D. Britt, MD, MPH, Director Houston, TX Philadelphia, PA FACS, FCCM DIVISION OF EDUCATION SECOND VICE-PRESIDENT Norfolk, VA *Mark A. Malangoni, MD, FACS Ajit K. Sachdeva, MD, Edward E. Cornwell III, Philadelphia, PA John L. Cameron, MD, FACS FACS, FRCSC MD, FACS, FCCM Baltimore, MD Director *Raymond F. Morgan, MD, FACS Washington, DC EXECUTIVE SERVICES SECRETARY Charlottesville, VA Edward M. Copeland III, MD, FACS Gainesville, FL Jane J. Lee-Kwon, MPS William G. Cioffi, Jr., MD, FACS Leigh A. Neumayer, MD, FACS Director, Executive Services Providence, RI Tucson, AZ A. Brent Eastman, MD, FACS Rancho Santa Fe, CA Maxine Rogers TREASURER Marshall Z. Schwartz, MD, FACS Director, Leadership Operations David B. Hoyt, MD, FACS Philadelphia, PA Gerald B. Healy, MD, FACS Wellesley, MA FINANCE AND FACILITIES Chicago, IL Howard M. Snyder III, MD, FACS EXECUTIVE DIRECTOR Gay L. Vincent, CPA Philadelphia, PA R. Scott Jones, MD, FACS Director Charlottesville, VA Gay L. Vincent, CPA Beth H. Sutton, MD, FACS 4 | Chicago, IL HUMAN RESOURCES Wichita Falls, TX Edward R. Laws, MD, FACS AND OPERATIONS CHIEF FINANCIAL OFFICER Boston, MA *Andrew L. Warshaw, MD, FACS Michelle McGovern Boston, MA LaSalle D. Leffall, Jr., MD, FACS Director Washington, DC Officers-Elect Steven D. Wexner, MD, FACS INFORMATION TECHNOLOGY Weston, FL LaMar S. McGinnis, Jr., MD, FACS Howard Tanzman Atlanta, GA (take office October 2015) *Michael J. Zinner, MD, FACS Director Boston, MA David G. Murray, MD, FACS DIVISION OF INTEGRATED J. David Richardson, MD, FACS Syracuse, NY COMMUNICATIONS Louisville, KY Lynn Kahn PRESIDENT-ELECT *Executive Committee Patricia J. Numann, MD, FACS Syracuse, NY Director Ronald V. Maier, MD, FACS Carlos A. Pellegrini, MD, FACS JOURNAL OF THE AMERICAN Seattle, WA COLLEGE OF SURGEONS FIRST VICE-PRESIDENT-ELECT Board of Seattle, WA Timothy J. Eberlein, MD, FACS Walter J. Pories, MD, FACS Governors/ Richard R. Sabo, MD, FACS Editor-in-Chief Greenville, NC Bozeman, MT SECOND VICE- Executive DIVISION OF MEMBER SERVICES PRESIDENT-ELECT Seymour I. Schwartz, MD, FACS Patricia L. Turner, MD, FACS Committee Rochester, NY Director Fabrizio Michelassi, MD, FACS Frank C. Spencer, MD, FACS M. Margaret Knudson, MD, FACS Board of Regents New York, NY New York, NY Medical Director, Military Health CHAIR Systems Strategic Partnership *Mark C. Weissler, MD, FACS Karen Brasel, MD, FACS Girma Tefera, MD, FACS Chapel Hill, NC Portland, OR CHAIR VICE-CHAIR Executive Staff Director, Operation Giving Back *Valerie W. Rusch, MD, FACS James C. Denneny III, MD, FACS EXECUTIVE DIRECTOR PERFORMANCE IMPROVEMENT New York, NY Alexandria, VA David B. Hoyt, MD, FACS Will Chapleau, RN, EMT-P Director VICE-CHAIR SECRETARY DIVISION OF ADVOCACY John L. D. Atkinson, MD, FACS Kevin E. Behrns, MD, FACS AND HEALTH POLICY DIVISION OF RESEARCH AND Rochester, MN Gainesville, FL Frank G. Opelka, MD, FACS OPTIMAL PATIENT CARE Medical Director, Quality Clifford Y. Ko, MD, MS, FACS Margaret M. Dunn, MD, FACS Diana L. Farmer, MD, FACS and Health Policy Director Dayton, OH Sacramento, CA Patrick V. Bailey, MD, FACS Cancer: James K. Elsey, MD, FACS Steven C. Stain, MD, FACS Medical Director, Advocacy David P. Winchester, MD, FACS Atlanta, GA Albany, NY Christian Shalgian Medical Director Henri R. Ford, MD, FACS Joseph J. Tepas III, MD, FACS Director Los Angeles, CA Jacksonville, FL Trauma: Michael F. Rotondo, MD, FACS Julie A. Freischlag, MD, FACS Medical Director Sacramento, CA

V100 No 6 BULLETIN American College of Surgeons Author bios*

*Titles and locations current at the time articles were submitted for publication.

a b c

d e f g | 5

h i j

MS. AGREGADO (a) is Manager, Surgeon DR. CARTER (e) is professor of surgery DR. ELSTER (h) is professor and chairman, Specific Registry, American College of and chief of neurosurgery, department of Norman M. Rich department of surgery, Surgeons (ACS) Division of Research and surgery, University of California, San Diego. Uniformed Services University of the Health Optimal Patient Care, Chicago, IL. Sciences (USUHS) and Walter Reed National DR. CHANG (f) is associate professor Military Medical Center, Bethesda, MD. DR. BOHNEN (b) is a general surgery of surgery, department of surgery, and resident, department of surgery, director of health care research and policy DR. FANTUS (i) is vice-chairman, Massachusetts General Hospital, development, Codman Center, Massachusetts department of surgery; medical director, Harvard Medical School, Boston. General Hospital, Harvard Medical School. trauma services; and chief, section of surgical critical care, Advocate Illinois DR. BOUGHEY (c) is professor of surgery MS. DEAN (g) is Past-Director, Masonic Medical Center. He is clinical and vice-chair of research, department of ACS Executive Services, and professor of surgery, University of Illinois surgery, Mayo Clinic, Rochester, MN. She Volunteer, Committee on Annual College of Medicine, Chicago, and Past- is Chair, ACS Clinical Research Program Giving and Communications, ACS Chair, ad hoc Trauma Registry Advisory (ACS CRP) Education Committee. Foundation, Chicago, IL. Committee, ACS Committee on Trauma. MS. BURA (d) is Associate Director, ACS MS. GLICKSON (j) is Communications Division of Member Services, Chicago, IL. Associate, Division of Integrated Communications, Chicago, IL.

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JUN 2015 BULLETIN American College of Surgeons Author bios continued

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n o p q 6 |

qr m s t

DR. GREENBERG (k) is chief research MS. KLEIN (n) is Director, Donor Relations DR. MEARA (r) is director, Program in Global fellow, Paul Farmer Global Surgery and Communications, ACS Foundation. Surgery and Social Change, department of Fellowship, Program in Global Surgery global health and social medicine, Harvard and Social Change, department of global MS. KURUSZ (o) is Practice Affairs Medical School. He is plastic surgeon- health and social medicine, Harvard Medical Associate, Division of Advocacy and in-chief, department of plastic and oral School. She is a senior general surgery Health Policy, Washington, DC. surgery, Boston Children’s Hospital, MA. resident, department of surgery, Medical DR. MARTIN College of Wisconsin, Milwaukee. (p) is a general thoracic DR. MORISY (s) is a general surgeon, surgeon and assistant professor, Memphis, TN. He is a member of the ACS DR. HUNT (l) is Hamill Foundation department of surgery, University of General Surgery Coding and Reimbursement Distinguished Professor and chief, Maryland Medical School, Baltimore. Committee and is the ACS representative to surgical breast section, department DR. MEAKINS (q) is professor emeritus, the American Hospital Association Editorial of surgical oncology, University of Advisory Board of Coding Clinic for the University of Oxford, UK, and was the Texas MD Anderson Cancer Center, International Classification of Diseases, Houston, and Director, ACS CRP. Nuffield Professor of Surgery, University of Oxford. He is the past-Edward W. Tenth Revision, Clinical Modification. DR. KATZ (m) is assistant professor, Archibald Chair of Surgery, past- DR. MULLEN (t) is assistant professor of department of surgical oncology, professor, and past-chair of surgery, surgery and program director, department division of surgery, University of Texas McGill University; and past-surgeon-in- of surgery, Massachusetts General MD Anderson Cancer Center. chief, McGill University Health Centre, Hospital, Harvard Medical School. Montreal, QC. He is a past-ACS Regent.

V100 No 6 BULLETIN American College of Surgeons Author bios continued

u v w x

y z aa bb | 7

cc dd ee ff

DR. NELSON (u) is Fred C. Andersen DR. RUBIN (z) is a general surgeon in DR. VEERAMACHANENI (dd) is a Professor of Surgery and Chair, private practice in Columbia, SC. He general thoracic surgeon, University of department of surgery, Mayo Clinic, and is Chair, ACS General Surgery Coding Kansas Medical Center, Kansas City. Past-Program Director, ACS CRP. and Reimbursement Committee and is the ACS representative to the American DR. WILLIAMS (ee) is Lieutenant DR. PELLEGRINI (v) is The Henry N. Medical Association Specialty Society Colonel, U.S. Army, Joint Task Force Harkins Professor and Chair, department of Relative Value Scale Update Committee. Bravo, and MEDEL Trauma/General surgery, University of Washington, Seattle, Surgeon, Soto Cano Air Base. He is Editor, and Immediate Past-President of the ACS. DR. SALANDER (aa) is a vascular ACS Diversity Community, and Chair, surgeon at Suburban Hospital, Bethesda, ACS Committee on Diversity Issues. MR. PEREGRIN (w) is Senior Editor, MD, and associate professor, USUHS. Bulletin of the American College of Surgeons, ACS DR. YOU (ff) is assistant professor, section Division of Integrated Communications. DR. SHARP (bb) is professor of surgery and of colorectal surgery, department of vice-chair for faculty affairs, department of surgical oncology, and medical director, DR. RICH (x) is a vascular surgeon and surgery, Vanderbilt-Ingram Cancer Center, Familial High Risk Gastrointestinal professor of military medicine, USUHS, and Nashville, TN, and ACS Foundation Officer. Cancer Clinic, University of Texas director of the Vietnam Veterans Registry. MD Anderson Cancer Center. MS. TIEBERG (cc) is Manager, Chapter DR. RIVERA (y) is a surgical critical Services, ACS Division of Member Services. care fellow, Advocate Illinois Masonic Medical Center, Chicago, and a member of the American Burn Association.

JUN 2015 BULLETIN American College of Surgeons EXECUTIVE DIRECTOR’S REPORT

Looking forward

by David B. Hoyt, MD, FACS

he American College of Surgeons (ACS) has a long legacy of producing Teducational resources for surgeons and surgical residents seeking to deliver high-quality patient care. The latest exam- ple of these efforts came with the release of the first edition of Operative Standards for Cancer Surgery. This new manual, discussed in greater detail on page 43, represents a unique benefit of the decade-long relation- ship between the ACS and National Cancer Institute cooperative groups.

Conceptualization and development Operative Standards for Cancer Surgery is representative of the College’s ongoing 8 | tradition of developing protocols and edu- cational materials to assist surgeons and other health care professionals in the de- livery of safe, effective surgical care. Oth- er examples include the Advanced Trauma Life Support® student manual; the Ameri- can Joint Committee on Cancer’s Cancer Staging Manual, now in its eighth edition; our clinical guidelines program, Evidence- Based Decisions in Surgery; Resources for Optimal Care of the Injured Patient, now in its sixth edition; and an ACS quality manual that is in development for surgical quality officers, which outlines the processes that should be in place in surgical institutions to ensure the provision of quality care. The concept for Operative Standards for Cancer Surgery was first proposed approxi- mately three years ago by Heidi Nelson, MD, FACS, when she was Program Director of the ACS Clinical Research Program (ACS CRP), which is part of the Alliance for Clini- cal Trials in Oncology. The ACS CRP Cancer Care Standards Development Committee, chaired by the present Director of the ACS CRP, Kelly K. Hunt, MD, FACS, led the effort to develop the final product.

V100 No 6 BULLETIN American College of Surgeons EXECUTIVE DIRECTOR’S REPORT

The manual was envisioned as a response to the need for minimum evidence-based standards for various cancer procedures and as reference tool for clinical trials that include surgical interventions for four common disease sites: breast, colon, lung, and pancreas.

The manual was envisioned as a response to the When evidence and experience demonstrate that need for minimum evidence-based standards for vari- a procedure is essential for safe, effective, long-term ous cancer procedures and as a reference tool for clini- outcomes, it is important to teach that technique with cal trials that include surgical interventions for four precision and put it forth as an evidence-based standard. common disease sites: breast, colon, lung, and pancreas. As the project evolved, it became clear that this manual Procedures covered in Operative Standards for Cancer Sur- could also serve as an instructive text for surgical edu- gery include breast-conserving surgery, pancreaticoduo- cation and training. denectomy, and lobectomy. The focus is on describing Hence, this manual, using both text and illustra- technical elements critical to proper conduct of cancer tions, is not merely a surgical atlas, but rather is in operations where best practices can be demonstrated. many ways a textbook that emphasizes the critical The authors have attempted to use the best evidence steps in performing an operation and intraoperative available, and this evidence represents the opinions of decision making. It further can be used to provide a diverse and representative groups who care for cancer template for operative reports and it would be useful | 9 patients. Expert clinicians and researchers provided to the individual surgeon in analyzing his or her per- invaluable input that was used to develop the guide- formance measures. lines, and a Town Hall Meeting at the 2013 Clinical Defining those critical elements of each operation Congress provided an opportunity for attendees to that are essential for surgical success is the purpose of learn about how the standards were created. Operatives Standards for Cancer Surgery, and the areas covered have achieved this noble goal. Drs. Nelson and Hunt and the other surgeons who led the disease site Benefits for researchers, clinicians, and patients groups are to be commended for the work they have As is the case for all health care disciplines, the body done in producing this landmark approach to surgical of evidence of scientifically verifiable ways of perform- cancer care and for this latest addition to the College’s ing cancer procedures is growing. This reference tool resources for surgeons seeking to provide optimal care. will spare clinical trial investigators the difficulties of This effort will become the yardstick by which cancer establishing or re-establishing the basic principles of care is measured going forward and should be a stan- these operations with each new trial. Furthermore, hav- dard for how all of surgical care is taught. ♦ ing a set of protocols will minimize variability across study sites and improve adherence to best practices for patients receiving care both on and off a clinical trial. It should also be useful in addressing variability in clinical practice. Much of clinical surgery is based on principles of ablation, correction of anatomic deficits, and reconstruction. The effectiveness of cancer opera- tions has generally followed the principle of surgical removal of the malignancy. The technical elements that are critical to the proper conduct of a cancer opera- tion ensure the use of best practices and optimal long- If you have comments or suggestions about this or other issues, please term outcomes. send them to Dr. Hoyt at [email protected].

JUN 2015 BULLETIN American College of Surgeons THE LANCET COMMISSION ON GLOBAL SURGERY

Editor’s note: This introduction is based on the foreword to the report published in Surgery and The Lancet Global Health. This report is the second in a series of articles that The Lancet Commission on Global Surgery has submitted regarding its efforts. A progress report on the commission’s activities was published in the April issue of the Bulletin.

ollowing is an Executive Summary of The Lancet Commission on Global Surgery (LCoGS) report Global Surgery 2030: Fon global health care disparities. LCoGS’ vision is “universal access to safe, affordable surgical and anes- thesia care when needed.”1 At present, 5 billion people An introduction are unable to receive surgical interventions that could save lives or prevent disability.2 In an era in which we discuss the dawn of personalized medicine and genetic engineering with frequency and familiarity, how can more than half the world’s population live in a health care time warp, trapping them centuries in the past 10 | without access to quality care? by John G. Meara, MD, DMD, MBA, FACS, As the Executive Summary reveals, disparities in and Sarah L. M. Greenberg, MD, MPH global surgical care are due to inaccurate assumptions, competing priorities, and a lack of resolve. For years the public health community assumed that surgery was too costly and too complex, leading public health intel- ligentsia to concentrate on ostensibly more cost-effective interventions, including vaccines and infectious disease treatments—all of which are necessary but no more cost- effective than surgery.3 In addition, the surgical and anes- thesia community lacked a cohesive resolve to reverse the marginalization of surgery. Integration of surgery and anesthesia care is critical to achieving the emerging global health care goals of sustainable development and universal health cover- age. Without immediate attention and scale-up, lack of surgical care will not only continue to result in prevent- able death and disability but will also lead to an estimat- ed reduction of the gross domestic product of low- and middle-income countries by as much as 2 percent by 2030.4 This decrease will be crippling for fragile econo- mies struggling to emerge from poverty and instability. In January 2014, World Bank president Jim Yong Kim, MD, PhD, addressed these realities at the first Assem- bly of the LCoGS, stating that “surgery is an indivisible, indispensable part of health care.”5 Fortunately, Dr. Kim’s words landed on fertile ground, prepared by the hard

V100 No 6 BULLETIN American College of Surgeons THE LANCET COMMISSION ON GLOBAL SURGERY

work and dedication of numerous groups and individu- REFERENCES als, including the thousands of frontline providers in 1. Meara JG, Leather AJM, Hagander L, et al. Global LMICs. The year 2014 and early 2015 saw several world- surgery 2030: Evidence and solutions for achieving wide events unfold that complemented and catalyzed health, welfare, and economic development. Lancet. the work of LCoGS. A World Health Assembly Resolu- 2015. [Epub ahead of print.] 2. Raykar N, Alkire BC, Shrime MG, et al. Global access tion on essential surgery gained momentum with multi- to surgical care: A modeling exercise. Lancet Glob country support; in January it was passed by the World Health. 2015. [Epub ahead of print.] Health Organization Executive Board and at press time 3. Chao TE, Sharma K, Mandigo M, et al. Cost- was scheduled to go for a final vote in May.6 At the same effectiveness of surgery and its policy implications for time, 2015 has thus far marked a transition to a collec- global health: A systematic review and analysis. Lancet Glob Health. 2014;2(6):e334-e345. tion of health and development targets aimed broadly 4. Alkire BC, Shrime MG, Dare AJ, Vincent JR, Meara at poverty reduction, universal health care, and equity. JG. Global economic consequences of selected surgical The initial LCoGS launch took place in London on diseases: A modelling study. Lancet Glob Health. 2015. April 27 and 28, in collaboration with the Royal Soci- [Epub ahead of print.] ety of Medicine. The second launch followed shortly 5. Kim JY. Opening address at the inaugural meeting of The Lancet Commission on Global Surgery. First afterwards in Boston, MA, in May. These launches rep- Meeting of The Lancet Commission on Global Surgery. resent the culmination of more than two years of work January 17, 2014; Boston, MA. Available at: www. by hundreds of people in more than 110 countries, four globalsurgery.info/video/. Accessed April 16, 2015. international meetings, and multiple regional events— 6. World Health Organization. Strengthening | 11 all of which represents a broad, purposeful, and critical emergency and essential surgical care and anaesthesia as a component of universal health coverage. Report outreach effort. by the secretariat. November 28, 2014. Available at: The launch events in London and Boston signified the http://apps.who.int/gb/ebwha/pdf_files/EB136/ beginning of LCoGS’ education and advocacy efforts to B136_27-en.pdf. Accessed April 16, 2015. highlight the pivotal role of surgical care in strengthen- ing global health care systems. The formal commission report is only one part of the initial commission prod- uct. A dozen open-access, business-style teaching cases have been published to provide an educational frame- work focused on global surgery topics. In addition, 61 abstracts were presented at the launch in London and published in The Lancet. Numerous full-length articles are being published in The Lancet and in multiple other journals, highlighting the importance of international collaboration in combating surgery’s marginalization. The following Executive Summary of LCoGS’ report on Global Surgery 2030 encapsulates the commission’s findings regarding the state of global surgical care and strategies for reversing decades of neglect. The authors maintain that the delivery of surgery and anesthesia care must be included by health care providers, policy- makers, and funders as a central component of global health system improvement at the local level by local leaders with support from global partners. Only in this way will we be able to achieve health, welfare, and eco- nomic development for all. ♦

JUN 2015 BULLETIN American College of Surgeons THE LANCET COMMISSION ON GLOBAL SURGERY

Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development

Executive Summary of 12 | The Lancet Commission on Global Surgery Report

HIGHLIGHTS • Describes the growing concerns about health care disparities that led to the formation of LCoGS • Outlines the five key messages of LCoGS • Urges the development of broad-based health systems solutions and the allocation of appropriate resources

V100 No 6 BULLETIN American College of Surgeons THE LANCET COMMISSION ON GLOBAL SURGERY

Little has been written about the human and economic effect of surgical conditions, the state of surgical care, or the potential strategies for scale-up of surgical services in LMICs. To begin to address these crucial gaps in knowledge, policy, and action, the LCoGS was launched in January 2014.

Editor’s note: This executive summary of The Lancet Com- from now until 2030. Reduction of death and disability mission on Global Surgery was published online on April 27, hinges on access to surgical and anesthesia care, which 2015, by The Lancet.* It has been edited here to conform should be available, affordable, timely, and safe to ensure with Bulletin style and is reprinted with permission from good coverage, uptake, and outcomes. Elsevier. The full report can be accessed at TheLancet.com/ Despite growing need, the development and deliv- commissions/global-surgery. ery of surgical and anesthesia care in LMICs has been nearly absent from the global health discourse. Little emarkable gains have been made in global has been written about the human and economic effect health in the last 25 years, but progress has not of surgical conditions, the state of surgical care, or the Rbeen uniform. Mortality and morbidity from potential strategies for scale-up of surgical services in common conditions needing surgery have grown LMICs. To begin to address these crucial gaps in knowl- in the world’s poorest regions, both in real terms edge, policy, and action, The Lancet Commission on and relative to other health gains. At the same time, Global Surgery (LCoGS) was launched in January 2014. | 13 development of safe, essential, lifesaving surgical and The commission brought together an international, anesthesia care in low- and middle-income countries multidisciplinary team of 25 commissioners, supported (LMICs)† has stagnated or regressed. In the absence of by advisors and collaborators in more than 110 coun- surgical care, case-fatality rates are high for common, tries and six continents. easily treated conditions, including appendicitis, her- nia, fractures, obstructed labor, congenital anoma- lies, and breast and cervical cancer. Five key messages The LCoGS formed four working groups that focused on the domains of health care delivery and manage- Global health burdens ment; workforce, training, and education; econom- In 2015, many LMICs are facing a multifaceted burden ics and finance; and information management. The of infectious disease, maternal disease, neonatal disease, commission has five key messages—a set of indica- non-communicable diseases, and injuries. Surgical and tors and recommendations to improve access to safe, anesthesia care are essential for the treatment of many affordable surgical and anesthesia care in LMICs, and of these conditions and represent an integral component a template for a national surgical plan. Our five key of a functional, responsive, and resilient health system. messages are as follows: In view of the large projected increase in the incidence of cancer, road traffic injuries, and cardiovascular and • Approximately 5 billion people do not have access to safe, metabolic diseases in LMICs, the need for surgical ser- affordable surgical and anesthesia care when needed. vices in these regions will continue to rise substantially Access is worst in LMICs, where nine of 10 people can- not access basic surgical care. *Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: Evidence and solutions for achieving health, welfare, and economic de- velopment. Lancet. 2015; published online April 27. Available at: h t t p:// • An additional 143 million surgical procedures are needed dx.doi.org/10.1016/S0140-6736(15)60160-X. Accessed March 31, 2015. in LMICs each year to save lives and prevent disability. †LMICs: Although this term has been used throughout the report for brevity, the commission acknowledges that tremendous income diver- Of the 313 million procedures undertaken worldwide sity exists between and within this group of countries. each year, only 6 percent occur in the poorest countries,

JUN 2015 BULLETIN American College of Surgeons THE LANCET COMMISSION ON GLOBAL SURGERY

LCoGS GLOBAL SURGERY 2030 REPORT AUTHORS

*John G. Meara, MD, DMD, MBA, FACS, Boston, MA Chris Lavy, OBE, MD, MCh, FCS, FRCS, Oxford, UK *Andrew J. M. Leather, MB, BS, MS, FRCS, London, UK Ganbold Lundeg, MD, PhD, Ulaanbaatar, Mongolia *Lars Hagander, MD, PhD, MPH, Lund, Sweden Nyengo C. Mkandawire, MB, BS, MCh(Orth), FCS(ECSA), FRCS, Blantyre, Malawi Blake C. Alkire, MD, Boston, MA Nakul P. Raykar, MD, Boston, MA Nivaldo Alonso, MD, PhD, São Paulo, Brazil Johanna N. Riesel, MD, Boston, MA Emmanuel A. Ameh, MB, BS, FACS, FWACS, Zaria, Nigeria † Stephen W. Bickler, MD, FACS, San Diego, CA Edgar Rodas, MD, FACS, Cuenca, Ecuador Lesong Conteh, MSc, PhD, London, UK John Rose, MD, San Diego, CA Anna J. Dare, MB, BCh, PhD, London, UK Nobhojit Roy, MB, BS, MS, MPH, Deonar, India Justine Davies, MD, London, UK Mark G. Shrime, MD, MPH, FACS, Boston, MA Eunice Dérivois Mérisier, MD, Port-au-Prince, Haiti Richard Sullivan, MD, PhD, London, UK Shenaaz El-Halabi, MPH, Gaborone, Republic of Botswana Stéphane Verguet, MS, MPP, PhD, Boston, MA Paul E. Farmer, MD, PhD, Boston, MA David Watters, MCh, FRACS, FRCSEd, Melbourne, VIC, Austrialia Atul Gawande, MD, MPH, FACS, Boston, MA Thomas G. Weiser, MD, Stanford, CA Rowan Gillies, MB, BS, FRACS, St. Leonards, NSW, Australia Iain H. Wilson, MB, BCh, FRCA, Exeter, UK Sarah L.M. Greenberg, MD, Boston, MA Gavin Yamey, MB, BS, MPH, MA, MRCP, San Francisco, CA Caris E. Grimes, BSc, MB, BS, MRCS, London, UK Winnie Yip, PhD, Oxford, UK Russell L. Gruen, MD, PhD, MPH, Melbourne, VIC, Australia

Edna Adan Ismail, SRN, CMB, SCM, Hargeisa, Somaliland *Joint first authors Thaim Buya Kamara, MB, BCh, FWACS, Freetown, †Prof. Rodas died March 2; the authors dedicate the report to him. 14 | Sierra Leone

where more than a third of the world’s population lives. present and projected population demands, urgent Low operative volumes are associated with high case- investment in human and physical resources for sur- fatality rates from common, treatable surgical condi- gical and anesthesia care is needed. If LMICs were to tions. Unmet need is greatest in eastern, western, and scale up surgical services at rates achieved by the pres- central sub-Saharan Africa and south Asia. ent best-performing LMICs, two-thirds of countries would be able to reach a minimum operative volume • An estimated 33 million individuals face catastrophic of 5,000 surgical procedures per 100,000 population by health expenses to pay for surgical and anesthesia care 2030. Without urgent and accelerated investment in each year. An additional 48 million cases of catastrophic surgical scale-up, LMICs will continue to have losses expenditure are attributable to the nonmedical costs of in economic productivity, estimated cumulatively at accessing surgical care such as transportation, lodging, $12.3 trillion (2010 U.S. dollars, purchasing power par- and food. A quarter of the people who have a surgical ity) between 2015 and 2030. procedure will incur financial catastrophe as a result of seeking care. The burden of catastrophic expenditure • Surgery is an “indivisible, indispensable part of health for surgery is highest for LMICs and, within any coun- care.”‡ Surgical and anesthesia care should be an integral try, lands most heavily on poor people. component of a national health system in countries at all levels of development. Surgical services are a prereq- • Investing in surgical services in LMICs is affordable, uisite for the full attainment of local and global health saves lives, and promotes economic growth. To meet goals in areas as diverse as cancer, injury, cardiovascular disease, infection, and reproductive, maternal, neona- ‡Kim JY. Opening address to the inaugural “The Lancet Commission on tal, and child health. Universal health coverage and the Global Surgery” meeting. The World Bank. Jan 17, 2014. Boston, MA. Available at: www.globalsurgery.info/wp-content/uploads/2014/01/Jim- health aspirations set out in the post-2015 sustainable Kim-Global-Surgery-Transcribed.pdf. Accessed March, 31, 2015. development goals (SDGs) will be impossible to achieve

V100 No 6 BULLETIN American College of Surgeons THE LANCET COMMISSION ON GLOBAL SURGERY

CORE INDICATORS FOR MONITORING UNIVERSAL ACCESS TO SAFE, AFFORDABLE SURGICAL AND ANESTHESIA CARE WHEN NEEDED INDICATOR DEFINITION TARGET Percent of the population that can access, within 2 hours, a facility that can perform Access to timely A minimum of 80% coverage of essential surgical and emergency cesarean section, laparotomy, and essential surgery anesthesia services per country by 2030 treatment of open fracture (the Bellwether Procedures) Number of specialist surgical, anesthetic, and 100% of countries with at least 20 surgical, anesthetic, Specialist surgical obstetric physicians who are working, per and obstetric physicians per 100,000 population by workforce density 100,000 population 2030 80% of countries by 2020 and 100% of countries by Procedures performed in an operating Surgical volume 2030 tracking surgical volume; a minimum of 5,000 theater, per 100,000 population, per year procedures per 100,000 population by 2030 All-cause death rate prior to discharge among patients who have undergone a procedure 80% of countries by 2020 and 100% of countries by Perioperative mortality in an operating theater, divided by the 2030 tracking POMR; in 2020, evaluate global data rate (POMR) total number of procedures, presented as a and set national targets for 2030 percentage Proportion of households protected Protection against against impoverishment from direct 100% protection against impoverishment from OOP impoverishing out-of-pocket (OOP) payments for payments for surgical and anesthesia care by 2030 expenditure surgical and anesthesia care Protection against Proportion of households protected against 100% protection against catastrophic expenditure catastrophic catastrophic expenditure from direct OOP from OOP payments for surgical and anesthesia care expenditure payments for surgical and anesthesia care by 2030 Note: These indicators provide the most information when used and interpreted together; no single indicator provides an adequate representation of surgical and anesthesia care when analyzed independently.

| 15 without ensuring that surgical and anesthesia care is challenges—and a crucial component of a functional, available, accessible, safe, timely, and affordable. responsive, and resilient health system. The health gains from scaling up surgical care in LMICs are great and the economic benefits substantial. They accrue Meeting the challenges across all disease-cause categories and at all stages In summary, the Commission’s key findings show that of life, but especially benefit the world’s youth and the human and economic consequences of untreated young adult populations. The provision of safe and surgical conditions in LMICs are large and for many affordable surgical and anesthesia care when needed years have gone unrecognized. During the past two not only reduces premature death and disability, but decades, global health has focused on individual dis- also boosts welfare, economic productivity, capacity, eases. The development of integrated health services and freedoms, contributing to long-term development. and health systems has been somewhat neglected. As Our six core surgical indicators (see table, this page) such, surgical care has been afforded low priority in should be tracked and reported by all countries and the world’s poorest regions. global health organizations, such as the World Bank This report presents a clear challenge to this through the World Development Indicators, the World approach. As a new era of global health begins in 2015, Health Organization through the Global Reference the focus should be on the development of broad-based List of 100 Core Health Indicators, and entities track- health systems solutions, and resources should be allo- ing the SDGs. cated accordingly. Surgical care has an incontrovert- At the opening meeting of The Lancet Commis- ible, cross-cutting role in overcoming local and global sion on Global Surgery in January 2014, Jim Yong health challenges. It is an important part of the solu- Kim, MD, PhD, President of the World Bank, stated tion to many diseases—for both old threats and new “surgery is an indivisible, indispensable part of health care” and “can help millions of people lead healthier, ‡Kim JY. Opening address to the inaugural “The Lancet Commission on more productive lives.”‡ In 2015, good reasons exist Global Surgery” meeting. The World Bank. Jan 17, 2014. Boston, MA. Available at: www.globalsurgery.info/wp-content/uploads/2014/01/Jim- to ensure that access to surgical and anesthesia care Kim-Global-Surgery-Transcribed.pdf. Accessed March, 31, 2015. is realized for all. ♦

JUN 2015 BULLETIN American College of Surgeons DISTINGUISHED PHILANTHROPIST AWARD

The Distinguished Philanthropist

16 | Award:

Celebrating a legacy of exceptional giving

by Barbara L. Dean, Sarah B. Klein, and Kenneth W. Sharp, MD, FACS

V100 No 6 BULLETIN American College of Surgeons DISTINGUISHED PHILANTHROPIST AWARD

his year, the American College of Surgeons Petroleum Corporation, Houston, TX, for more than (ACS) Foundation will announce the 25th recipi- 30 years. Dr. Hammer’s success in business allowed Tent of the Distinguished Philanthropist Award. him to pursue his lifelong interest in art and to build Since 1989, the ACS has acknowledged individuals a collection that became a major museum in Los who have distinguished themselves through their Angeles, CA, after his death in 1990. exemplary investment in the mission of the College Dr. Hammer graduated from the College of Phy- and in philanthropy. Each recipient has contribut- sicians and Surgeons of Columbia University, New ed for different reasons, but each serves as a model York, NY, in 1921, but while waiting the six months donor—supporting not only the contributor’s person- before beginning his internship, he took a life- al passion, but also acting in alignment with the ACS changing trip to the former Soviet Union. His origi- values of promoting optimal patient care. nal plan was to help combat the typhus epidemic, but In 2010, the ACS Foundation Board of Directors instead he found the major health issue to be starva- assumed the responsibility of identifying and select- tion. Dr. Hammer acted on this discovery by intro- ing nominees with the oversight of its Management ducing the idea of trading American grain for furs Committee. (Prior to that time, the College’s Develop- and other goods from the Soviet Union. A career in ment Committee had collaborated with the ACS Hon- business ensued, along with a commitment to help ors Committee to recommend and select recipients.) strengthen Soviet-American relations. | 17 The criteria for nomination are as follows: Although some of his business, political, and international interests and dealings provoked con- • A record of service to the College and the Foundation troversy, Dr. Hammer’s extraordinary philanthropy • A leadership commitment to the practice of philanthropy financed research for a cancer cure. For many years, • A personal history of philanthropy to the College he donated more than 90 percent of his income to • Service to the larger not-for-profit community charitable causes. The ACS was one of those benefi- ciaries, and contributions from the Armand Ham- mer Foundation supported a traveling surgical schol- Notable award recipients arship in his honor. All past Distinguished Philanthropist Award recipients from 1989 through 2014 are listed on page 18. The fol- Dr. and Mrs. Jacobson lowing individuals are highlighted for their unique In 1993, the Honors Committee of the College select- contributions to the ACS Foundation’s ongoing growth ed Julius H. Jacobson II, MD, FACS, to receive the and development. prestigious Distinguished Philanthropist Award. In addition to their many philanthropic contributions Armand Hammer, MD to educational and arts institutions, Dr. Jacobson and The first Distinguished Philanthropist Award was his wife, Joan, are among the top donors to the ACS presented to Armand Hammer, MD, the internation- Foundation and, therefore, members of the Fellows ally known entrepreneur who chaired the Occidental Leadership Society’s Pinnacle Circle, with cumula- tive donations of greater than $1 million. Opposite: Distinguished Philanthropist Award winners, from left to right. Dr. and Mrs. Jacobson’s best-known contributions Top row: Drs. Hammer, Conley, Clowes, and Beahrs. Second row: Dr. and Mrs. Jacobson, Drs. Islami and Woods, and Dr. and Mrs. Clements. Third have led to the establishment of two annual ACS row: Dr. Lincke, Dr. and Mrs. Leffall, Drs. Jordan and Satitpunwaycha. awards—the Jacobson Innovation Award and the Fourth row: Dr. and Mrs. Berry, Dr. Kridelbaugh; the Drs. Hanlon, Joan L. and Julius H. Jacobson II Promising Investi- and Dr. Hobson. Fifth row: Dr. and Mrs. Jurkiewicz, Dr. Nora, Dr. and Mrs. Reiling, and Dr. and Mrs. Kenyon. Sixth row: The Drs. Russell, gator Award. In their 20th and 10th years, respectively, Dr. Brennan, Dr. Hanna, and Dr. and Mrs. Austen. each award honors surgical researchers. The Innova-

JUN 2015 BULLETIN American College of Surgeons DISTINGUISHED PHILANTHROPIST AWARD

Dr. Hammer Dr. and Mrs. Jacobson Dr. Clowes

tion Award honors living surgeons who have originated DISTINGUISHED PHILANTHROPIST new surgical technology or techniques, and the Promising AWARD RECIPIENTS Investigator Award recognizes outstanding surgeons who Patricia R. and W. Gerald Austen, MD, FACS (2014) are engaging in research, advancing the art and science of Dr. Elias S. Hanna (2013) surgery, and demonstrating early promise of significant contribution to the practice of surgery and the safety of Dr. Murray F. Brennan (2012) surgical patients. Drs. Thomas R.† and Nona C. Russell (2011) The awards rightfully bear the Jacobson name not only Dr. and Mrs. Norman M. Kenyon (2010) because the couple provided their funding, but because Dr. and Mrs. Richard B. Reiling (2009) they aptly describe Dr. Jacobson’s legacy, as well. Wide- ly renowned as the “father of microsurgery,” Dr. Jacob- † Dr. Paul F. Nora (2008) son said in a May 2005 interview with the Bulletin that Dr. and Mrs. Maurice J. Jurkiewicz† (2006) his greatest contribution to surgery was introducing the Dr. Robert W. Hobson II† and microscope to the general surgery operating room.* Mrs. Joan P. Hobson (2005) 18 | The Clowes and Islami families Drs. C. Rollins† and Margaret H. Hanlon† (2004) In the Distinguished Philanthropist Award’s history, Dr. William W. Kridelbaugh† (2003) two families have been selected for their backing of the Dr. and Mrs. Robert E. Berry (2002) ACS’ educational mission to support the scholarly aspira- Dr. Pon Satitpunwaycha (2001) tions of young surgeons, while memorializing a familial legacy: the Clowes (1991) and the Islami (1994) families. Dr. and Mrs. Paul H. Jordan, Jr. (1999) The George H. A. Clowes, Jr., MD, FACS, Memo- Dr. and Mrs. LaSalle D. Leffall, Jr. (1998) rial Research Career Development Award (Clowes Dr. and Mrs.† Eric T. Lincke (1997) Award), established with a gift of more than $1 million, was first awarded in 1992 and supports Dr. and Mrs. Neil C. Clements (1996) five-year research fellowships for promising surgi- Dr.† and Mrs. Scott W. Woods (1995) cal investigators. This generous gift came from The The Abdol Islami Family and Foundation (1994) Clowes Fund via the endorsement of Alexander W. Dr. Julius H. Jacobson II (1993) Clowes, MD, FACS, to honor the distinguished con- tributions of his father and his lifelong interest in † Dr. Oliver H. Beahrs (1992) the needs of young surgeons. Many of the awardees The Clowes Family and The Clowes Fund (1991) have gone on to careers in academic surgical research, Dr. John Conley† (1990) and several recipients are now surgical chairs and † are widely respected within the research commu- Dr. Armand Hammer (1989) nity. Included among the Clowes Award recipients Note: No awards were presented in 2000 and 2007. is Timothy Billiar, MD, FACS, chair, department of †Deceased surgery, George Vance Foster Endowed Professor, distinguished professor of surgery, University of Pitts-

*Schneidman D. Surgical innovation: “Renaissance man” endows award for surgical investigators. Bull Am Coll Surg. 2005;90(5):10-14. Available at: www.facs.org/~/media/files/publications/bulletin/2005/2005%20may%20 bulletin.ashx. Accessed May 13, 2015.

V100 No 6 BULLETIN American College of Surgeons DISTINGUISHED PHILANTHROPIST AWARD

Dr. Islami Dr. Lincke Drs. Russell burgh, PA, who remarked, “Winning [the Clowes Drs. Thomas and Nona Russell Award] was a great honor, which is all the more The 2011 Distinguished Philanthropist recipients, meaningful because it is a link to such an excellent Thomas R. Russell, MD, FACS, and Nona C. Russell, surgical investigator.” MD, were named for their distinctive service and gen- In 1990, the Islami family made a contribution to erosity. Drs. Russell made their first donation in 1990, the College in support of international guest schol- and subsequently provided more than 100 separate arships through the initial generosity of Abdol Isl- gifts to support the College’s programs. Their years ami, MD, FACS, and Mrs. Joan Islami. Passionate of service to the College, health care, and their com- advocates for providing educational opportunities munity are exemplary and inspired hundreds of Fel- to medical students from outside the U.S., Dr. and lows and friends to give to the Thomas R. Russell, Mrs. Islami’s contribution was supplemented by MD, FACS, Faculty Research Fellowship and other their children and colleagues. Proceeds from the non-revenue programs of the College. Islami Family Foundation originally financed an annual international guest scholarship; in recent years, funding was increased to include a sec- The tradition continues ond award. The Abdol H. Islami and Joan Islami All of the ACS Distinguished Philanthropist awardees | 19 International Guest Scholar Award was the first demonstrate generosity of spirit and a commitment named award within the College’s international to service. The task of selecting one finalist from the guest scholarship program, and its recipients have ranks of ACS donors each year can be challenging. A enjoyed many education and networking oppor- decision was made in 2015 to also recognize an orga- tunities through attendance at the annual Clinical nization with a record of giving and service that aligns Congress and visits to U.S. medical centers with an with the criteria of the Distinguished Philanthropist academic emphasis. Award recognizing individual donors. The announce- ment of both awards will occur later this year, and the Dr. and Mrs. Lincke Fellows Leadership Society of the ACS Foundation Several of the Distinguished Philanthropist Award will honor the awardees at the 2015 Clinical Congress, recipients have been honorably named for their service October 4–8 in Chicago, IL. and generosity to the College through a legacy gift; In the last 10 years alone, these donors and thou- these recipients include Dr. and Mrs. Eric T. Lincke sands of other philanthropic Fellows and friends have in 1997. By establishing a philanthropic contribution made possible more than $26 million in contributions to the ACS through their estate gift planning, they for ACS initiatives such as scholarships and fellowships, became members of the ACS Foundation’s Mayne Her- awards to promote surgical and outcomes research, the itage Society. Upon receiving the award, Dr. Lincke Archives, and lifelong learning. Without philanthropic said, “The gift comes from the heart, and two-thirds support, access to these valued assets by Fellows and of our estate is earmarked for philanthropy, which will residents would be uncertain. benefit several institutions. The College is an orga- The ACS Foundation salutes donors and volun- nization I believe in. I’ve been a member for 25 years teers who contribute to the advancement of the and continue to support it. I wish to see its valuable College’s goals to expand and enhance benefits goals perpetuated in the 21st century.”† for Fellows and optimal care for surgical patients throughout the world. We honor and recognize all †American College of Surgeons. Dr. And Mrs. Lincke to receive philan- who have supported these efforts through their phi- thropy award. Clinical Congress News. Sunday/Monday. 1997;48(1):3. lanthropy and service. ♦

JUN 2015 BULLETIN American College of Surgeons HELLER LEADERSHIP PROGRAM

20 | Brandeis University Heller Leadership Program in Health Policy and Management provides an education on the business side of surgery

by Tony Peregrin

V100 No 6 BULLETIN American College of Surgeons HELLER LEADERSHIP PROGRAM

“Today, delivering safe, efficient, high-quality care requires a broad range of conceptual, technical, analytical, and leadership skills that physicians can no longer master on their own....” —Dr. Chilingerian

ntil the 1990s, physician leaders were primarily have graduated from the Heller Leadership Program. self-taught managers, honing leadership skills In this article, four graduates of the program describe Uas part of their daily responsibilities, according how the course influenced their role as surgeon leaders. to Jon Chilingerian, PhD, health care management professor and founding program director at Brandeis University, Waltham, MA. “When I studied physi- Robert R. Lorenz, MD, MBA, FACS cians who became managers and hospital chief ex- ACS/American Academy of Otolaryngology–Head ecutives as part of my doctoral dissertation at MIT and Neck Surgery (AAO-HNS) Health Policy Scholar [Massachusetts Institute of Technology, Cambridge], most clinicians learned how to manage while on the “Brandeis is known for [its] approach to alternative job,” Dr. Chilingerian said. “Clinicians were tapped payment models, and I wanted to figure out how I for high-level leadership roles because they got along could be of assistance to the College in developing with people and because they built a successful clini- these models,” Dr. Lorenz said, medical director, pay- cal department that generated revenues. Gradually, as ment reform, risk, and contracting, Cleveland Clinic, | 21 opportunities and challenges arose [during the course OH. “This course was my first exposure, in a com- of their careers], these physician leaders would learn prehensive way, to the history of health care insur- about corporate strategy, conflict resolution, and in- ance payment and [Centers for Medicare & Medic- terpreting financial statements,” he explained. aid Services] payment methodology, and I found this Today, delivering safe, efficient, high-quality care quite helpful for understanding where we can go in requires a broad range of conceptual, technical, analyti- the future.” cal, and leadership skills that physicians can no longer As both a member of the ACS Health Policy and master on their own, according to Dr. Chilingerian. Advocacy Group and the current co-chair of the AAO- To respond to the need for health care professionals to HNS physician payment policy workgroup, Dr. Lorenz develop a more sophisticated business and health policy was engaged in health care policy development before acumen, Dr. Chilingerian helped establish the Heller attending the course in 2013.4 By participating in the Leadership Program in Health Policy and Management program, however, Dr. Lorenz acquired essential lead- at Brandeis. This program offers surgeons intensive train- ership skills to advocate for his colleagues to embrace ing in change management, conflict negotiation, finan- alternative payment models. cial literacy skills, and health care policy development. “A lot of these models are voluntary, and you have Originally presented at Brandeis’ Heller School for to be able to move physicians from their comfort Social Policy and Management, this annual six-day pro- zone, which is fee for service, toward some kind of gram provides surgeon leaders with the opportunity to risk-based payment format,” Dr. Lorenz said. “In participate in simulation exercises emphasizing effec- order to do that, you have to do a lot of convincing— tive leadership skills and to review case studies high- not just one or two people—but you have to convince lighting current national health policy issues.1,2 a body of professionals. That’s not just the president or The American College of Surgeons (ACS) has part- director of an organization, but it is also key opinion nered with 16 surgical specialty groups to help design leaders throughout the organization.” According to the course and award scholarships to surgeons who are Dr. Lorenz, Change Pro—the learning tool employed ACS Fellows and members in good standing of these by the Heller Leadership Program—was particularly organizations.3 At press time, more than 200 clinicians helpful toward this end.

JUN 2015 BULLETIN American College of Surgeons HELLER LEADERSHIP PROGRAM

“Our advocacy efforts need to keep the patient and patient care as its North Star, and if we can accomplish that, we’ll ultimately be successful in the evolution of health care delivery.” —Dr. Lorenz

The Change Pro simulation involves physicians able. Our advocacy efforts need to keep the patient and working in small groups with 120 “days” to convince patient care as its North Star, and if we can accomplish 24 members of an organization’s top management team that, we’ll ultimately be successful in the evolution of to adopt a Six Sigma quality improvement system.5 The health care delivery.” goal is to get as many adopters as possible, even if par- ticipants have no formal authority in the organization. “There is official influence and unofficial influence, and John Maa, MD, FACS the ability to understand and really leverage all those ACS Health Policy Scholarship for General Surgeons different roles was highlighted in the simulation. I had never been exposed to this concept before taking this After attending the Heller Leadership Program in course,” Dr. Lorenz said. 2009, Dr. Maa participated in more than 100 Capitol The Heller Leadership Program attracts a mélange Hill visits during a yearlong health policy sabbatical, of health care professionals, including private practi- which included a six-month tenure in the College’s 22 | tioners, academics, front-line surgeons not yet in lead- Washington, DC, office. ership positions, as well as seasoned surgical leaders, “In May of 2010, I arrived in the DC office to bring according to Dr. Lorenz. The mix also includes good the surgical perspective to the front lines of policy- subspecialty representation. “There was a tremendous making. The value to the DC ACS staff was to have amount of learning over meals and after hours where a surgeon who could share the practicing surgeon’s people talked about their own challenges within their insights into proposed legislation,” Dr. Maa said, subspecialty and within their organization. I don’t Immediate Past-President of the ACS Northern Cal- know of any other venues where that happens as effi- ifornia Chapter and chair, University of California ciently as it did through this course.” (UC) Office of the President Tobacco-Related Disease Dr. Lorenz said when the AAO-HNS introduces a Research Program Scientific Advisory Committee. policy on a national or regional level, he taps fellow “We worked on a number of projects, including the Heller scholars for feedback. “I will make contact with pediatric loan repayment program, the general sur- this network and say, ‘What are you doing in Texas?’ gery rural care bonus, and—the issue I became most or ‘How is this going in Florida?’” involved with—scope of practice regarding optom- He suggested surgeons new to health policy devel- etrists and ophthalmologists.” opment keep in mind that “advocacy is a marathon Before the Heller course, Dr. Maa was not involved and not a sprint,” and that there are likely to be more in public policy, focusing more on surgical program losses than wins. “Just because one initiative does not development, specifically the surgical hospitalist pro- meet with success, don’t let it dissuade you. You are in gram at UC San Francisco Medical Center—an inno- it for the long term, and right now it is awkward. We vative approach to the delivery of emergency surgical are getting paid for volume, but in an era in which we care. After being encouraged to pursue the fellowship are going to take on risk for disease prevention and by his mentor, former ACS Executive Director Thomas hospitalization readmission prevention, we’re going R. Russell, MD, FACS, Dr. Maa applied for the fellow- to be in alternative payment models that will be spe- ship five consecutive times. cifically in contradiction to fee for service. It is our “I believed that the Brandeis course would foster a professional responsibility to preserve the quality of deeper understanding of health policy outside of the care while managing this transition as best we are surgical arena and operating room [OR],” Dr. Maa said.

V100 No 6 BULLETIN American College of Surgeons HELLER LEADERSHIP PROGRAM

“In the OR, you’re making vital decisions for a single patient, but as a surgeon leader, your decisions can affect many more individuals simultaneously.” —Dr. Maa

“The course leaders are nationally recognized, with sig- tive record—surgeons understand the blood pressure nificant experience in Washington, DC, and I believed and heart rate information that is communicated in they would be excellent teachers and mentors.” the anesthesiologist’s notes. Similarly, for health eco- The Heller Leadership Program provided Dr. Maa nomic reports, surgeons should have a basic under- with successful strategies for managing health care standing of concepts such as net assets, liabilities, teams outside of the OR and the skills to make com- and profit margins, though it’s foreign to us. They plex management decisions with limited information. don’t really teach this in medical school or residency,” “In the OR, you’re making vital decisions for a sin- Dr. Maa explained. gle patient, but as a surgeon leader, your decisions can In his role at the UC Office of the President affect many more individuals simultaneously,” Dr. Maa Tobacco-Related Disease Research Program, Dr. Maa said. “An exercise that Dr. Chilingerian led was a theo- helps oversee the statewide tobacco tax grant funds retical business case modeled after the Challenger Space collected via Proposition 99. “We fund the tobacco Shuttle disaster that highlighted the steps and decisions control research, epidemiology, and educational pro- that contributed to the tragic outcome on that day. grams across the state of California. It is a very dif- | 23 Taught in the business school style, the activity illus- ferent world from the OR. Our meeting proceedings trated how to manage a negative outcome and how to are recorded, and the work is overseen by attorneys. determine what went wrong. We explored the decision- We carefully evaluate laws and provide scientific making process involved in terminating a project and feedback, which involves leading multidisciplinary issuing the press release. teams, having a long-range time frame, and carefully “The exercise underscored that when a surgeon analyzing budgets.” moves beyond the OR and seeks to make larger policy “Most importantly, what I’ve learned both through decisions, the input and perspectives of many different the Heller course and through my time in DC is the people are required. Ultimately, however, there will be [value] of time and patience. Progress in the public an executive who is responsible and accountable for the policy arena involves a lengthy time frame. In the OR, endeavor,” said Dr. Maa. “Being involved in leadership, events happen quickly. When a surgeon needs some- catalyzing change, and working in advocacy, public thing and requests it, the expectation is that it will be policy, and politics are essential to the future success available immediately to save the patient’s life. In the of the fields of medicine and surgery,” he added. “The public policy world, success requires substantially more skill sets required are different from those that produce time, as it can take years for cases to be reviewed and success in the OR.” for laws to be passed,” Dr. Maa said. Another important component of the course, For surgeons new to the public policy arena, according to Dr. Maa, was an overview of the history Dr. Maa said, learning to communicate with the public of health care economics in the U.S. and the competen- is key. “When you speak to Congress and to the general cies necessary to understand financial reports. public, or when you write letters or editorials, learn to “The program taught me to be thoughtful and be concise and to write in a language that the general analytical in interpreting the economic reports that public can comprehend,” Dr. Maa advised. “You have are being presented to you. First, surgeons should to also learn to communicate with policymakers— understand how these reports are prepared and their many of whom are lawyers—in their language that is format—and have a basic understanding of account- different from the vocabulary of surgery, if your intent ing principles. It’s similar to interpreting an opera- is for them to respond to you.”

JUN 2015 BULLETIN American College of Surgeons HELLER LEADERSHIP PROGRAM

“...[S]uccessful leadership in 2015 increasingly involves the ability to negotiate, build consensus, and work in teams.” —Dr. Roberts

Patricia L. Roberts, MD, FACS mittee of the American Society of Colon and Rectal ACS/American Society of Colon and Rectal Surgeons Research Foundation. And in 2013, Dr. Rob- Surgeons Health Policy Scholarship erts presented the keynote address at the 2013 Olga Jonasson Symposium at the University of Illinois, Chi- “As surgeons we often have a ‘command and con- cago, on the topic of leadership challenges for the next trol’ approach to leadership,” said Dr. Roberts, chair, generation of surgeon leaders. division of surgery, Lahey Hospital and Medical Cen- Leadership, strategic thinking, and negotiation ter (LHMC), Burlington, MA. “However, successful skills are essential for surgeon leaders, according to leadership in 2015 increasingly involves the ability to Dr. Roberts. “I also think emotional intelligence is key negotiate, build consensus, and work in teams.” Dr. to effectively working with people, particularly one’s Roberts’ experience as a 2008 health policy scholar ability to work in teams. In today’s health care environ- enhanced her ability to lead a number of initiatives, ment, it is increasingly less about the single surgeon including the restructuring of perioperative services and more about the dozens of member of the health 24 | at LHMC in 2012. care team and the ability to work together,” she said. As a result of the restructuring initiative, the OR is managed by an executive team that Dr. Roberts chairs. The team uses a shared governance model that Steven D. Schwaitzberg, MD, FACS includes the chair of the department of anesthesia, the ACS Health Policy Scholarship for General Surgeons associate chief nursing officer for perioperative ser- vices, and the vice-president of surgical services. This “What I learned from Jon Chilingerian is that group has implemented a number of processes that there is a science to change management,” said have enhanced OR throughput, including improved Dr. Schwaitzberg, professor of surgery, Harvard start time and turnover time, according to Dr. Roberts. Medical School; chief of surgery, Cambridge Health “I think every team has its own character,” Alliance, MA; and past-president, Society of American Dr. Roberts said. “You don’t have to be best friends Gastrointestinal and Endoscopic Surgeons. “Doctors with everyone on the team, but you do have to respect are very smart people. We think we know every- each other and communicate clearly and effectively. thing, but what I took from this [program] is that if All team members should [have the freedom] to bring you want to lead change, you have to study change.” issues to the group, engage in frank and open discus- A 2010 health policy scholar, Dr. Schwaitzberg was sions, and be able to reach an agreement and support working on an initiative that year to bring the surgi- each other.” cal checklist into the OR. “We were having trouble. As chair of surgery, Dr. Roberts currently leads I wouldn’t say it was going badly, but it clearly wasn’t more than 100 surgeons who perform an estimated going well. After taking the course, I realized I had 22,000 operations a year, and mentoring future sur- gone about this change management effort at my gical leaders is a large component of this role. “On a own hospital without the best processes in place. Jon personal level, the [Heller] program gave me greater taught us to define barriers, find the connectors to the insight into my leadership style and the need to iden- barriers, and identify potential champions, and this tify and develop the next generation of leaders in the allowed us to completely reboot how we were trying department,” Dr. Roberts said.6 In 2010 she received to implement the checklist. Using these techniques, the Mentor Award from the Young Researchers Com- we completely renovated our approach to getting

V100 No 6 BULLETIN American College of Surgeons HELLER LEADERSHIP PROGRAM

“If young surgeons want to be effective change agents in their environment, big or small, the study of leadership and change is a good investment of their time.” —Dr. Schwaitzberg

buy-in to the checklist. It’s 2015, and everybody uses in their institution and who may have seen their fair the checklist now, but in 2010 it was a big change,” share of chiefs come and go. Most people are a pleasure Dr. Schwaitzberg noted. and a breeze, but there will be a small percentage who Overcoming resistance to change through an have not jumped onto your vision or have set up their understanding of social dynamics is a fundamental own little fiefdom. Learning to deal with those chal- component of the Change Pro simulation mentioned lenges requires training and reinforcement. The goal earlier in this article and was a particularly meaningful is to lead people, which is very different than simply experience for Dr. Schwaitzberg. being in charge.” “Change Pro was amazing. What you learn is Conflict resolution, according to Dr. Schwaitzberg, that you can’t just walk into the [chief executive offi- is about persuasion and reason, and these skills are not cer’s] office and mandate [the implementation of a necessarily taught in residency and medical school. “If new initiative] across the company,” he said. “You young surgeons want to be effective change agents in have to find who the influencers are and identify the their environment, big or small, the study of leader- connections and the barriers. In this simulation, you ship and change is a good investment of their time,” | 25 learn a lot about each division’s leader, their charac- he explained. teristics, and who they are connected with. You learn In addition to change management and conflict res- about the formal network structure and the informal olution instruction, the Heller Leadership Program’s network structure—both of which are important to focus on advocacy and health care policy were espe- leading change.” cially germane to Dr. Schwaitzberg as the leader of one Resolving differences is typically an integral part of of the last publicly funded hospitals in Massachusetts. successful change management. Individual attitudes “How the legislature makes public policy has a dra- regarding a new process can facilitate, slow down, or matic impact on publicly funded hospitals, so I was erode the diffusion of, for example, a clinical idea or interested in the Heller program,” Dr. Schwaitzberg new medical technology. said. “I knew these policies impacted the hospital’s abil- “When we adopted the in-patient electronic medi- ity to even stay open. I actually applied for the scholar- cal record, there was a lot of distrust, discouragement, ship twice. The first time I wrote about what I thought and unrest. The process of leading the department the scholarship would do for me, and I didn’t get it. through this change involved conflict resolution and The second time I wrote about issues I thought were identifying who was going to have a problem with important in public policy, and that obviously resonated this—and who will love this? Who will influence much better with the review group.” change? The tools as outlined by the Heller program Dr. Schwaitzberg suggested the development of a have become a part of the way we do business on a follow-up to the Heller Leadership Program—a course daily basis,” Dr. Schwaitzberg said. available specifically to Heller course graduates featur- Another example of staff unrest that can occur in ing advanced study in the areas of change management, any health care system is the arrival of a new chief of conflict resolution, and advocacy. surgery. “One of the hardest things for a new chief is “Leading change effectively requires an investment to learn how to deal with conflict,” Dr. Schwaitzberg to study the process, and one of the great things about said. “A new chief comes into an organization—particu- the Heller course is that it gives you the opportunity to larly if they come in from the outside—and he or she engage in the kind of deep thinking that we rarely have has to deal with many people who are well entrenched time for in our daily lives,” Dr. Schwaitzberg noted.

JUN 2015 BULLETIN American College of Surgeons HELLER LEADERSHIP PROGRAM

Next level of specialized education REFERENCES Successful surgeon leaders understand the complexities 1. Brandeis University. The Heller School for Social Policy involved in managing change, negotiating and resolving and Management. Leadership Program for Health Policy conflict, and assisting the College and other organiza- and Management. Available at: http://heller.brandeis. tions with health policy and advocacy activities. Special- edu/executive-education/programs/leadership-hpm. ized education through the Heller Leadership Program html. Accessed February 27, 2015. 2. Steinberg SM, Zinner MJ, Ellison EC. Health policy is a proven way to develop surgeon leaders and enhance program produces surgeon advocates and leaders. Bull this leadership skill set. Am Coll Surg. 2014;99(3):21-27. Available at: bulletin. For graduates of this program seeking an advanced facs.org/2014/03/health-policy-program/. Accessed level of training in health care management, as well as February 27, 2015. other physicians interested in this topic, Brandeis Univer- 3. American College of Surgeons. Member services. Past health policy scholarship awardees. Available at: www. sity is developing The Heller School’s Executive Master facs.org/member-services/scholarships/health-policy/ of Business Administration (EMBA) for Physicians.7 The past-hp-winners. Accessed February 27, 2015. 26 | program, which admits its first cohort in January 2016, is 4. Cleveland Clinic. Resources for medical designed for practicing physicians who are currently in professionals. Robert Lorenz, MD. Available at: management positions and for those who are interested in http://my.clevelandclinic.org/staff_directory/staff_ display?doctorid=4447. Accessed February 27, 2015. pursuing these roles, according to Dr. Chilingerian. The 5. Brandeis University. The Heller School for Social Policy EMBA for Physicians is an accelerated 16-month program and Management. Leading change in complex systems: that integrates the student’s medical expertise with train- A simulation. Available at: http://heller.brandeis.edu/ ing in areas ranging from health policy and economics executive-education/pdfs/May2014MassMed/JON702/ to operational systems management, high-performance JON702AALeadingChangeinComplexSystems1.pdf. Accessed February 27, 2015. leadership, and health care innovation. 6. The American Society of Colon and Rectal Surgeons. For more information on the Heller Leadership Program ASCRS News. Spring 2009. Available at: www.fascrsnews. in Health Policy and Management, and The Heller School’s org/issues/2009Spring.pdf. Accessed February 27, 2015. EMBA for Physicians program, visit www.facs.org/member- 7. Brandeis University. The Heller executive education services/scholarships/health-policy and http://heller.brandeis. program. Available at: http://heller.brandeis.edu/ executive-education/physicians-emba/index.html. edu/executive-education/physicians-emba/index.html. ♦ Accessed March 23, 2015.

V100 No 6 BULLETIN American College of Surgeons SURGEONS PERFORM CLASSICAL MUSIC

Surgeons uncover the keys to life by performing classical music | 27

by Jeannie Glickson

JUN 2015 BULLETIN American College of Surgeons SURGEONS PERFORM CLASSICAL MUSIC

any surgeons are as captivated by the chord progression and harmonic bal- Mance of a symphony orchestra as they are by the challenges in the operating room (OR). The surgeons featured in this article demonstrate their surgical acumen in the OR, and away from the OR they reveal their unique talents as classical musicians. These classical musicians and surgeons recognize the value of both passions.

Blending two passions Peter F. Crookes, MD, FACS, proudly notes that he can hold his own as a classical violinist in a 28 | string quartet—and in an OR. Originally from Belfast, Ireland, Dr. Crookes has continued to improve his violin playing as he has pursued a practice in upper gastrointestinal and bariatric surgery. He is a professor and director of the medical student surgical clerkship at the Univer- sity of Southern California (USC) department of surgery, Keck School of Medicine, Los Angeles. “Scrubs trio” (from left): Violinist Brian Sung, MD, then a chief resident “I grew up in an impoverished working class at USC and now at Swedish Medical Center, Seattle, WA; Stephen P. family in Belfast, in Northern Ireland, and my Lee, MD, who performs laparoscopic surgery; and Dr. Crookes. parents had no money for formal education. Still, my four siblings and I all learned to play the violin,” he said. Dr. Crookes started playing at age 11, and music was the love of his early life. “As a kid, that’s what I did—I listened to classical music endlessly on our record player. I was totally immersed in music. Now, if I’d had more mon- ey, if I had come from a middle-class professional family, I would have wanted to go to a conser- vatory. That’s probably what I would have done with my life, but my parents could not afford to finance that kind of education.” In the 1970s, as Dr. Crookes yearned for a musical career, the British government was fund- ing free medical education to qualified students. On a full scholarship, Dr. Crookes was able to

V100 No 6 BULLETIN American College of Surgeons SURGEONS PERFORM CLASSICAL MUSIC

Dr. Kunitake attend the Queen’s University Belfast School of Medi- Wunderkind turned accomplished surgeon cine, Dentistry and Biomedical Sciences and completed Dr. Crookes treasures his associations with surgeons | 29 his surgical residency there. He came to the U.S. in and musicians alike. He goes back a few years with 1990 for a one-year fellowship at USC and has been a younger colleague, pianist Hiroko Kunitake, MD, here ever since. MPH. “Dr. Kunitake was a kind of a wunderkind as a Dr. Crookes’ life has been a blending of his two pas- kid in San Diego,” he said. Dr. Crookes happily recalls sions: surgery and music. “I think what my music play- that when Dr. Kunitake was a student at the Univer- ing has given me is a more human face as a surgeon,” sity of California, Los Angeles (UCLA) the two of them he said. “Music teaches you to listen, and listening to gave a combined academic lecture and recital as part classical music is rather like reading a long novel. You of a surgical biology club meeting associated with the have to understand the narrative. It’s not like listening American College of Surgeons (ACS) 2007 Clinical Con- to a three-and-a-half minute song on the radio. Classical gress in New Orleans, LA, a performance he hopes that music focuses your attention, and you have to listen to someday they can repeat in front of another audience. find out why things are developed. So being a musician Dr. Kunitake, who is today an assistant professor of has greatly enhanced my ability to listen as a surgeon.” surgery at the Boston University School of Medicine His musical background also gives him a strong and an Associate Fellow of the ACS, began pounding sense of history. “To appreciate the compositions of the keys of a piano at four-and-a-half years old. “My Bach, Brahms, Beethoven, and Mozart, you need an parents lived in a small town in Texas, and I took les- understanding of what was happening in Europe in sons from the local teacher,” she said. “My dad was in the 1700s and 1800s and then what was happening in the Navy, and we eventually moved to San Diego,” medicine,” Dr. Crookes explained. “Life in 19th cen- where she met piano teacher Jane Bastien, who guid- tury Europe was terrible for people in many ways. This ed Dr. Kunitake’s musical talents though high school. was before anesthesia. Diseases that are curable today Classical music was serious business in the Kuni- killed the great composers. Mozart died at age 35 of take household. “My two brothers and I all played the strep throat. Mendelssohn died from a series of strokes piano, and we spent a lot of time practicing. In high at age 38. Music and surgery are two important strands school, I probably spent four to six hours a day at the of society, and to understand history is to understand piano.” Practice proved challenging but deeply reward- where surgery was then and where we are today.” ing for Dr. Kunitake, and playing the piano became an

JUN 2015 BULLETIN American College of Surgeons SURGEONS PERFORM CLASSICAL MUSIC

essential part of her life. As she learned the important Prize-winning author Siddhartha Mukherjee, MD, role of discipline in any undertaking, she mastered the who noted the similarities of the two professions. piano and seriously considered dedicating her life to Observing the contributions of Prussian-born Aus- performing classical music. trian surgeon and musician Theodore Billroth, born “After high school, I applied to both music conser- in 1829, who pursued the two disciplines with “almost vatories and colleges. My parents really wanted me to equal verve,” Dr. Mukherjee wrote, “The profes- have a liberal arts education.” In 1992, Dr. Kunitake sions still often go hand in hand. Both push manual became a freshman at Harvard University, Boston, skill to its limit; both mature with practice and age; MA, where she majored in biochemical science but both depend on immediacy, precision, and oppos- continued to take piano lessons at the New Eng- able thumbs.”* land Conservatory of Music. After graduating from “Creating something with your hands is very grat- Harvard, Dr. Kunitake received a three-year fellow- ifying,” Dr. Kunitake said, noting that both disci- ship from the American Pianists Association, which plines require dexterity, and, at their most basic lev- supported her study and performances around els, are challenges of the hands as well as the mind. the country. “I absolutely enjoyed pursuing both interests, and it 30 | Dr. Kunitake then completed a doctorate in piano has turned out to be a wonderful, interesting road performance at the USC Thornton School of Music for me.” in Los Angeles. Soon after, an international piano Currently, playing the piano relieves many of contest would change the direction of her life: She the stresses of Dr. Kunitake’s surgical life. “Today, I and three other young U.S. pianists were selected play the piano for myself. I find it very soothing and to compete in the 2000 Chopin International Piano very satisfying,” she said. She also enjoys listening Competition in Warsaw, Poland. to other accomplished musicians play. As a Boston The event reaffirmed her love and appreciation resident, Dr. Kunitake holds a subscription to the for classical music. “This was a fantastic, eye-opening Boston Symphony Orchestra, where she can absorb experience for me,” Dr. Kunitake said. “It was just classical music as an avid listener. awesome to meet and listen to these outstanding musicians from around the world.” After the compe- tition, she turned her attention to medicine, because Overcoming social barriers science and medicine had always fascinated her. Becoming a surgeon requires overcoming any number “I had wanted to be a surgeon for a long time,” she of barriers. Alvin H. Crawford, MD, FACS, a pediat- said. “I attended medical school at UCLA, and com- ric spine surgeon in Cincinnati, OH, knows firsthand pleted my general surgical residency at Massachusetts about overcoming social obstacles. His musical inter- General Hospital in Boston.” This was followed by a ests began at age 11 as an African-American youngster fellowship in colorectal surgery at the University of in Memphis, TN. He originally played the trumpet Minnesota, Minneapolis. but switched to the clarinet, which he said was better Being a surgeon and a world-class musician are suited to his embouchure, referring to how a player not mutually exclusive. In Dr. Kunitake’s view, the applies the lips to the mouthpiece of a brass or wind two skill sets complement one another, a point sup- instrument. By the time he was in high school, he was ported by hematologist, oncologist, and Pulitzer spending many evenings backing up professional musi- cians when they came through town. He could read *Mukherjee S. The Emperor of All Maladies: A Biography of Cancer. New music and would rehearse with band members in the York, NY: Scribner; 2010. afternoon and perform with them in the evening. Music

V100 No 6 BULLETIN American College of Surgeons SURGEONS PERFORM CLASSICAL MUSIC

was his life, and he fully expected to make it his career. After high school, he received a full musical scholarship to Tennessee A & I University (now Tennessee State), a historically black institution in Nashville. There he did what he loved: He studied classical music during the day and played with local bands at night. Then one fateful day, his brother, thinking that he was reassuring him, told him that he would have no problem finding work as a high school band director after graduation. “I immediately thought, ‘But I don’t want to be a public school band director.’ I loved my high school band director but could not see that as my future. I loved challenges, and that idea just didn’t challenge me. Wasn’t there something else I could do?” The conversation led to an epiphany for the young | 31 man. He decided to find a new life course and set his eyes on medicine. He began taking prerequisite courses for medical school and eventually graduated in 1960 with a double major in music and chemistry. He turned the practice and discipline that he had applied to his clarinet playing to his undergraduate premedi- cal courses. At that time in the segregated South, African- American people were generally barred from attending state-supported medical schools. Dr. Crawford refused to concede to discrimination. Touting his high scores on the Medical College Admission Test, he protested the University of Tennessee Medical School’s refusal Dr. Crawford to admit him. Dr. Crawford rarely loses an argument, and he won this one. He was granted admission, and in 1964, he became the first African American to graduate from the school. Dr. Crawford admits that he wasn’t the most popular student on campus, but he never allowed himself to become a victim of discrimination. Despite the obstacles, he studied and worked hard and, all the while, he continued to play the clarinet. He began his residency at Chelsea Naval Hospital, MA, and complet- ed it at the combined Harvard University Orthopaedic Program. In 1977, Dr. Crawford began his career in Ohio as director of orthopaedic surgery at Cincinnati

JUN 2015 BULLETIN American College of Surgeons SURGEONS PERFORM CLASSICAL MUSIC

Children’s Hospital Medical Center, OH, and remained chief there for 29 years. Today Dr. Crawford is a widely respected academic orthopaedist who has given as much to the world as he has received. He has offered his orthopaedic teaching skills in such varied places as Germany, Sweden, Brazil, Colombia, Saudi Arabia, and West Africa. Specializing in treating scoliosis, Dr. Crawford is one of the nation’s foremost authorities on video-assisted thoracoscopic surgery, which allows surgeons to insert rods through small incisions to straighten the spine. He is also an authority on neurofibromatosis in children. He has achieved many firsts in his distinguished career. He was the first African-American president of the Scoliosis Research Society, an international society 32 | that studies spinal deformities, and is a past-president of the John Robert Gladden Orthopaedic Society. He is the founding director of the Crawford Spine Center at Cincinnati Children’s, and in 2004 he was honored with the dedication of the Crawford Chair in Pediatric Orthopaedics and a subsequent chair in spine surgery. Dr. Crawford’s clarinet playing took on a secondary role as he pursued a medical career, but now that he is a professor emeritus at the University of Cincinnati College of Medicine, he has the time to take clarinet lessons at the College-Conservatory of Music and play with a number of ensembles. He is a lead clarinetist in Cincinnati’s Queen City Concert Band, and he also plays with the University of Cincinnati Summer Com- munity Band. In addition, he plays the saxophone in the Undercover Big Band of Cincinnati. He was a guest student in jazz improvisation at the University Col- Dr. Rosenman lege Conservatory of Music this year and was recently appointed to the Dean’s Advisory Council of the Uni- versity of Cincinnati College Conservatory of Music. Playing with a band is a team sport, Dr. Crawford said. “In surgery and as a member of an ensemble, you go through a lot of the same things. You work as a member of a team in the operating room, and you play as a group. You maintain a key with other mem- bers of the band, and in surgery you need the rhythm and cooperation of the team, including the patient.”

V100 No 6 BULLETIN American College of Surgeons SURGEONS PERFORM CLASSICAL MUSIC

He doesn’t consider his successful pursuit of two returned to the cello, seeking to enhance his playing disciplines all that unusual. “A lot of physicians are seri- technique. For the first time since high school, he ous musicians,” he said. “In many ways, the required took private lessons. skills are similar.” “It was surprisingly easy for me to get back into it,” he said. “Actually, when I started playing again, I was better at it than I had been.” He now partici- Rediscovery and rejuvenation pates in two quartets and earnestly fits three days of John E. Rosenman, MD, FACS, a vascular surgeon in practice a week into his schedule. Burlingame, CA, who attended the University of Cali- “When I practice the cello, I’m completely out- fornia, San Francisco, School of Medicine, grew up in side my work life,” he said. “It’s a place where I am a family of musicians and a home filled with classical completely engaged outside all of my responsibili- music. “Playing music was a tradition in my family,” ties.” Now that he is in his mid-60s, and his surgical he said. “My mother was a musician. My father was a practice has slowed a bit, he finds time each summer surgeon and also a musician, and my siblings were all to spend a week at a musical workshop for amateur musicians. We had an ensemble in our house. We all musicians. In the summer of 2014, he lived in a dorm grew up constantly playing and listening to music.” In and attended a workshop at Scripps College in Cla- that respect, nothing has changed for Dr. Rosenman. remont, CA. His wife plays the flute and cello, and their children “For me, it’s like Christmas in summer,” Dr. | 33 are all musically inclined, although only his son is a Rosenman said. “You are absorbed in music for one professional musician. week. It takes you completely away from your pro- When Dr. Rosenman took up the cello at age fessional life.” eight, he quickly discovered his own connection to Amateur musicians get to know each other music. Playing the cello became a challenge and a pas- through the workshops, which are offered in many sion, and he pursued it enthusiastically. “I didn’t play major U.S. cities and internationally. “You see a lot with an orchestra in high school,” he said. “Primar- of physicians there, but not as many surgeons. Sur- ily, I played chamber music with family and friends.” gery is generally so time-consuming, and it’s hard to Private lessons helped him develop his craft, and he commit to any kind of regular schedule.” considered becoming a professional musician for a Most of Dr. Rosenman’s patients are aware of his time. He began undergraduate school at Oberlin musical skills. “In vascular surgery, many patients College, OH, which offers both a music conserva- are long-term, and you take care of them year after tory curriculum and a liberal arts program. “Half- year. I’ve known many of my patients for years, and way through my first semester there, I realized that they are really interested in my cello playing,” he said. I wouldn’t be in the top tier of musicians,” he said. “I was more interested in academic topics, and I decided that music would be a better avocation.” Academics Creating beauty soon consumed his life. “I misconstrued how little Performing classical music is ultimately about creat- time I would have to devote to my cello,” he said. ing something of beauty, which surgeons do in their Then came medical school and surgical training, own time and in their individual style. Surgeons marriage, and three children. “I was so overwhelmed employ the kind of discipline that has propelled their with the process of becoming a surgeon and hav- careers and turn that concentration into their music. ing three little children at home that I didn’t touch The task requires focus, practice, and passion. Their the cello for a very long time.” About 25 years ago, passions, both surgical and musical, make the world after a 10-year hiatus, as he settled more comfortably a better place. ♦ into his professional and personal life, Dr. Rosenman

JUN 2015 BULLETIN American College of Surgeons WHAT SURGEONS SHOULD KNOW ABOUT...

The transition to ICD-10 before October 1 compliance deadline

by Sarah Kurusz; Chad Rubin, MD, FACS; and Lee Morisy, MD, FACS

re you prepared for modification (ICD-9-CM) specific information about the the transition to the as the standard code set for diagnosis. The flexibility of AInternational Classification reporting diagnoses and the ICD-10 code set allows for of Diseases, 10th Revision inpatient procedures in 2003. expanding and including new (ICD-10)? Health care providers ICD is a diagnostic tool technologies and diagnoses. It throughout the U.S. currently for epidemiology, health also encompasses additional use ICD-9, whereas health management, and clinical information about injuries care providers in the rest of purposes, which offers a and ambulatory and managed the world use ICD-10. In 2009, systematic recoding, analysis, care. ICD-10 will combine the U.S. Department of Health interpretation, and comparison diagnosis and symptom and Human Services published of mortality and morbidity data codes to better define certain a regulation requiring U.S. collected in different countries. conditions, increase specificity providers to transition to It also is used to monitor the through greater code length 34 | ICD-10; the latest compliance incidence and prevalence of for identification of disease date for the transition has diseases and other health care processes to aid in research, been set for October 1, 2015. problems around the world. and provide the ability to Although Congress has Currently, ICD-9-CM specify laterality. The College intervened and delayed previous includes both diagnosis and urges Fellows to begin deadlines, it is unlikely to give procedural codes. Similar to preparing now, as the change providers another extension. ICD-9, ICD-10 comprises two is expected to be disruptive. The American College of categories of code sets. The Surgeons (ACS) encourages first is ICD-10-CM, which members to become familiar providers will use in both the Is it necessary to with the new code sets, to inpatient and outpatient setting upgrade to ICD-10? understand the differences to report diagnoses. The second Yes—the conversion to between ICD-9 and ICD-10, is the ICD-10 procedure coding ICD-10 is a HIPAA code- and to prepare for how the system (ICD-10-PCS), which set requirement. Providers, change may affect day-to-day will be used only to code for including physicians, are HIPAA practice management. Indeed, hospital inpatient procedures.2 “covered entities,” which the effect on billing processes means that they must comply could be profound because the with HIPAA requirements. In transition expands the selection What will ICD-10 identify? addition, conversion to ICD-10 is of diagnosis codes from a The ICD-10 code set reflects mandatory in order for providers small pool to nearly 68,000.1 advances in medicine to receive payment for the and uses current medical services they render. A failure to terminology. The code format convert to ICD-10 will negatively What is the ICD? is expanded, which means affect payment. Although The Health Insurance Portability that providers will be able to HIPAA code-set requirements and Accountability Act (HIPAA) include greater detail within only apply to HIPAA electronic identified ICD-9 clinical the code to provide more transactions, it would be too

V100 No 6 BULLETIN American College of Surgeons WHAT SURGEONS SHOULD KNOW ABOUT...

TABLE 1. DIFFERENCES BETWEEN ICD-9-CM AND ICD-10-CM CODE SETS ICD-9-CM ICD-10-CM 3 to 5 characters in length 3 to 7 characters in length Approximately 13,000 codes Approximately 68,000 current codes Character 1 is alpha; characters First character may be alpha (E or V) or 2 and 3 are numeric; characters numeric; characters 2–5 are numeric 4–7 are alpha or numeric Limited space for new codes New codes can be added Limited code detail Specific code detail No laterality Includes laterality

burdensome on the health familiar with both CPT and care industry to use ICD-10 What are some specific ICD-10-CM codes to be paid, in electronic transactions and differences between and with ICD-10-PCS for the ICD-9 in manual transactions. ICD-9-CM and ICD-10-CM? hospital to be reimbursed Payors are expected to require The differences between the for inpatient procedures. ICD-10 codes to be used in ICD-9-CM and ICD-10-CM code Hospital coders often ask for other transactions, such as on sets may not be immediately clarification of documentation, paper, through a dedicated fax evident. Table 1 on this page as most surgeons know. machine, or via the phone.2 provides an overview of Familiarity with ICD-10 The bottom line is that characteristics with which will make this experience hospitals and third-party payors to become familiar while much less burdensome. | 35 should be ready for ICD-10, so transitioning to ICD-10-CM. surgeons and other health care The expanded code format of professionals should be as well. ICD-10-CM means that coders Is ICD-10 currently will have the ability to include being updated? greater details within the A code freeze has been How does the transition code, and greater detail means placed on both the ICD-9 and to ICD-10 affect hospital- that the code can provide ICD-10 code sets while the employed surgeons? more specific information transition to ICD-10 occurs. The transition will affect about the diagnosis. The code freeze will end when hospital-employed surgeons implementation of ICD-10 takes very similarly to private effect October 1, 2015. Regular practice surgeons. Although Will ICD-10-CM replace updates to ICD-10 will begin employed surgeons will be able Current Procedural on October 1, 2016. No updates to rely on their institutions Terminology (CPT)* coding? have been made to ICD-9 since or health systems to train No, the implementation of October 1, 2013, as the code set their staff, they will still ICD-10-CM does not affect is no longer being maintained. need to provide their billing CPT coding for outpatient The ICD-10 Coordination and coding staff with the procedures. ICD-10-PCS codes and Maintenance Committee, documentation and paperwork are for hospital inpatient the Centers for Medicare necessary to accurately procedures only. Surgeons’ & Medicaid Services (CMS) code claims using ICD-10. offices and hospitals will committee responsible for continue to use CPT codes approving code changes to *All specific references to CPT codes and to report services and the ICD, has continued to descriptions are © 2014 American Medical procedures in outpatient and meet twice a year during the Association. All rights reserved. CPT and CodeManager are registered trademarks office settings. However, of the American Medical Association. most surgeons will have to be continued on page 38

JUN 2015 BULLETIN American College of Surgeons CODING AND PRACTICE MANAGEMENT CORNER

TABLE 2. ICD-10 CROSSWALK FOR GENERAL SURGERY This crosswalk has been developed by the ACS and may be used as a basic guide for comparing a selection of frequently reported general surgery procedures between ICD-9 and ICD-10. Note that accurate coding is the responsibility of the provider. This crosswalk is intended only as a resource to assist in the billing process.

ICD-9 (non- ICD-9 ICD-9 description ICD-10 ICD-10 description specified)

569.0 Anal and rectal polyp K62.0 Anal polyp

K62.1 Rectal polyp

569.1 Rectal prolapse K62.2 Anal prolapse

K62.3 Rectal prolapse

569.2 Stenosis of rectum and anus K62.4 Stenosis of anus and rectum

569.3 Hemorrhage of anus and rectum K62.5 Hemorrhage of anus and rectum

569.4 Other specified disorders of the rectum and anus

569.41 Ulcer of anus and rectum K62.6 Ulcer of anus and rectum

569.42 Anal or rectal pain K62.89 Other specified diseases of anus and rectum

36 | 569.43 Anal sphincter tear (healed) (old) K62.81 Anal sphincter tear (healed) (nontraumatic) (old)

569.44 Dysplasia of anus K62.42 Dysplasia of anus

569.49 Other K62.49 Other specified diseases of anus and rectum 569–Other disorders of 569.5 Abscess of intestine K63.0 Abscess of intestine the intestine 569.6 Colostomy and enterostomy complications

Colostomy and enterostomy complications, 569.60 K94.00 Colostomy complication, unspecified unspecified

K94.10 Enterostomy complication, unspecified

569.61 Infection of colostomy or enterostomy K94.02 Colostomy infection

K94.12 Enterostomy infection

Mechanical complication of colostomy and 569.62 K94.03 Colostomy malfunction enterostomy

K94.13 Enterostomy malfunction

569.69 Other complications K94.09 Other complications of colostomy

K94.19 Other complications of enterostomy

569.7 Complications of intestinal pouch

569.71 Pouchitis K91.850 Pouchitis

569.79 Other complications of intestinal pouch K91.858 Other complications of intestinal pouch

continued on next page

V100 No 6 BULLETIN American College of Surgeons CODING AND PRACTICE MANAGEMENT CORNER

ICD-10 CROSSWALK FOR GENERAL SURGERY (CONTINUED)

ICD-9 (non- ICD-9 ICD-9 description ICD-10 ICD-10 description specified)

553.0 Femoral hernia

Unilateral or unspecified (not specific as Unilateral femoral hernia, without obstruction or 553.00 K41.90 recurrent) gangrene, not specified as recurrent Unilateral femoral hernia, without obstruction or 553.01 Unilateral or unspecified, recurrent K41.91 gangrene, recurrent Bilateral femoral hernia, without obstruction or 553.02 Bilateral (not specified as recurrent) K41.20 gangrene, not specified as recurrent Bilateral femoral hernia, without obstruction or 553.03 Bilateral, recurrent K41.21 553– gangrene, recurrent Other hernia of abdominal 553.1 Umbilical hernia K42.9 Umbilical hernia without obstruction or gangrene cavity without mention of 553.2 Ventral hernia obstruction | 37 or gangrene 553.20 Ventral (unspecified) K43.9 Ventral hernia without obstruction or gangrene

553.21 Incisional K43.2 Incisional hernia without obstruction or gangrene

553.29 Other K43.9 Ventral hernia without obstruction or gangrene

Unspecified abdominal hernia without obstruction K46.9 or gangrene Diaphragmatic hernia without obstruction or 553.3 Diaphragmatic hernia K44.9 gangrene

459.1 Postphlebitic syndrome

Postphlebitic syndrome without Postthrombotic syndrome without complications of 459.10 I87.009 complications unspecified extremity 459– Postthrombotic syndrome with ulcer of unspecified Other 459.11 Postphlebitic syndrome with ulcer I87.019 disorders lower extremity of the Postthrombotic syndrome with inflammation of 459.12 Postphlebitic syndrome with inflammation I87.029 circulatory unspecified lower extremity system Postphlebitic syndrome with ulcer and Postthrombotic syndrome with ulcer and 459.13 I87.039 inflammation inflammation of unspecified lower extremity Postphlebitic syndrome with other Postthrombotic syndrome with ulcer and 459.19 I87.039 complications inflammation of unspecified lower extremity

JUN 2015 BULLETIN American College of Surgeons WHAT SURGEONS SHOULD KNOW ABOUT...

ADDITIONAL ICD-10 RESOURCES freeze. At these meetings, the public is allowed to comment • The American Academy of • The Centers for Medicare & on whether new diagnosis Professional Coders’ ICD-10 Medicaid Services (CMS) website: and procedure codes should website: www.aapc.com/icd-10/ www.cms.gov/Medicare/ be created in order to capture • The American Health Coding/ICD10/index. new technology or disease. html?redirect=/ICD10; and New code requests will be Information Management evaluated for implementation Association ICD-10 website: the CMS eHealth University website: www.cms.gov/eHealth/ in ICD-10 on or after www.ahima.org/topics/icd10 October 1, 2016.3 The ACS eHealthUniversity.html • The American Hospital has representation every step Association central office • The Healthcare Information of the way and is already Management Systems Society working to improve ICD-10. 38 | ICD-10 website: www. ahacentraloffice.org/ ICD-10 website: www.himss. org/resourcelibrary/TopicList. codes/ICD10.shtml What steps should I take aspx?MetaDataID=1115 • The American Medical to begin implementing ICD-10 in my practice? Association ICD-10 website: • Online tool for converting The implementation of www.ama-assn.org/ama/pub/ ICD-9 codes to ICD-10: www.icd10data.com/ ICD-10 will require coordination physician-resources/solutions- of multiple aspects of a surgical managing-your-practice/ practice. An important first step coding-billing-insurance/ in the ICD-10 implementation hipaahealth-insurance- process is to conduct a practice portability-accountability-act/ impact assessment, which will transaction-code-set-standards/ be useful in bringing awareness icd10-code-set.page to the areas of the practice that will be most affected by the transition to ICD-10. It includes an analysis of how the practice will accept, process, and translate coded data under the ICD-10 system. An impact assessment may evaluate how ICD-10 will affect the following aspects of your practice:

• Systems and vendor contracts: Ensure vendors can accommodate ICD-10 needs

V100 No 6 BULLETIN American College of Surgeons WHAT SURGEONS SHOULD KNOW ABOUT...

and find out how and when pages 36–37, can help determine REFERENCES the vendor plans to update how a particular ICD-9 code 1. American Medical Association, existing systems; review new will translate to ICD-10. ICD-10 code set to replace ICD-9. and existing vendor contracts The crosswalk was published Background. Available at: www. ama-assn.org/ama/pub/physician- and evaluate vendor offerings in the February issue of the resources/solutions-managing-your- 4 and capabilities against the Bulletin. Surgeons should practice/coding-billing-insurance/ organization’s expectations continue to monitor the ACS hipaahealth-insurance-portability- ICD-10 website leading up to accountability-act/transaction-code- • Business practices: Once ICD-10 the October 1 implementation set-standards/icd10-code-set.page. Accessed April 22, 2015. is implemented, determine date for more ICD-9-to- 2. American Medical Association, how the new codes ICD-10 coding examples and ICD-10 code set to replace ICD-9. will affect processes for other important information. FAQs. Available at: www.ama-assn. referrals, authorizations/ Additional ICD-10 resources are org/ama/pub/physician-resources/ pre-certifications, patient located in the sidebar on page 38. solutions-managing-your-practice/ | 39 coding-billing-insurance/hipaahealth- intake, physician orders, and While ICD-10 may seem insurance-portability-accountability- patient encounters more burdensome than ICD-9, act/transaction-code-set-standards/ the system has its benefits. It icd10-code-set.page. Accessed April • Productivity: Train staff to will be more specific, more 22, 2015. accommodate the substantial compatible with electronic 3. American Medical Association, ICD-10 code set to replace ICD-9. increase and specificity in code health record systems, and will ICD-9 and ICD-10 code freeze. sets, physician workflow and help clarify the true diagnosis Available at: www.ama-assn.org/ patient volume changes, and for the surgical patient. ♦ ama/pub/physician-resources/ the amount of time needed for solutions-managing-your-practice/ testing coding-billing-insurance/hipaahealth- insurance-portability-accountability- Editor’s note act/transaction-code-set-standards/ • Reimbursement structures: Accurate coding is the responsibility icd10-code-set.page. Accessed April Coordinate with payors on of the provider. This article is 22, 2015. contract negotiations and intended only as a resource to 4. Gokak S. ACS develops ICD-9 to new policies that reflect the assist in the billing process. ICD-10 crosswalk to assist in billing. expanded code sets Bull Am Coll Surg. 2015;100(2):31-35.

What resources are available to aid in this transition? The ACS has developed an ICD- 9-CM to ICD-10-CM crosswalk of the most frequently reported general surgery diagnosis codes to assist surgeons with the transition to ICD-10. Table 2,

JUN 2015 BULLETIN American College of Surgeons FROM RESIDENCY TO RETIREMENT

Big data and GME: Expanding the scope of

patient safety and QI training by David C. Chang, PhD, MPH, MBA; Jordan D. Bohnen, MD, MBA; John T. Mullen, MD, FACS; and Bob S. Carter, MD, PhD

n 2012, the Accreditation of the important skills and lessons own hospitals, residents using Council for Graduate Medical these new tools offer to GME. big data may first ask, “What is IEducation (ACGME) mandated the scale of the problem that I that training programs “engage am considering? Is it a problem residents in patient safety and Ownership over QI and of variation across practitioners, quality improvement [QI] decision making hospitals, or regions? If so, are activities” and created the Clinical Accessing and studying big data there indicators that suggest Learning and Environment can increase residents’ sense of what might correlate with this Review, a national program to ownership over the development variation, and are any of the oversee efforts to engage residents and exploration of a QI covariates potentially modifiable in these and other key areas.1-3 hypothesis and provide important in a way that improves quality 40 | Subsequently, many discussions insights into the decision- broadly?” Residents engaged in among medical educators have making processes that underlie big data QI research will learn centered on how to integrate QI priorities. Residents may be the decision-making processes training in patient safety and QI asked to select a QI project from for initial data abstraction and into residency programs.4,5 Most a list of existing project ideas, but analysis necessary to refine current QI curricula are delivered they often are not privy to the QI questions and to propose in the form of didactic lectures internal organizational decisions meaningful solutions. This or hands-on clinical QI projects that lead to the prioritization training will enhance the ability at the local hospital level.6 of one QI effort over another— of future physician leaders to The increasing availability they are only tasked with further prioritize and advocate for of “big data” generated through designing, implementing, and the collection of the granular data electronic health records, large studying a QI intervention. necessary to test QI hypotheses health care outcomes databases, Reviewing pertinent literature and strategic improvement and so on, has created a new may improve the understanding initiatives. The Quality In- and potentially complementary of the quality problem at hand, Training Initiative, launched approach to engage surgical but without access to the by the American College of residents, in addition to the more initial data, residents may not Surgeons National Surgical common approach of classroom appreciate the assumptions Quality Improvement Program lectures or other clinical didactics and calculations used to frame (ACS NSQIP®), is an example about quality and patient safety. the problems. Providing access of a step in this direction.9 The value of big data in clinical to large data sources and the care and in research has been training necessary to use well documented, but the them shifts ownership of a QI Gaining perspective application of these modern, question to the individuals By providing population-level evolving tools to GME training designing the interventions. perspectives, big data can also has received far less attention.7,8 For example, when asked to be used to identify new targets This column summarizes some investigate readmission to their for QI, as well as elucidate

V100 No 6 BULLETIN American College of Surgeons FROM RESIDENCY TO RETIREMENT

The value of big data in clinical care and in research has been well documented, but the application of these modern, evolving tools to GME training has received far less attention.

potential limitations. Until the work. An important concept in in helping to increase the national past decade, most health care QI is the observed-to-expected acceptance of QI policies. For quality and outcomes research (O/E) ratio. Although health care instance, the goal of a recent was confined to single institutions professionals aim to prevent all Centers for Medicare & Medicaid or small multi-institutional series, patient harm, the limitations Services (CMS) policy to penalize limiting both their inferential in scientific knowledge and the hospitals for readmissions is power and generalizability. often unpredictable nature of sometimes misinterpreted as However, with the availability disease and treatment suggest CMS wanting to penalize all of large health care datasets— that a certain percentage of hospitals for all readmissions, such as those found in ACS imperfect outcomes may be when this policy will only target NSQIP, the Healthcare Cost and unavoidable. Big data provides a hospitals with readmissions that Utilization Project’s Nationwide lens through which we can better are “higher than expected,” a | 41 Inpatient Sample (NIS), as well appreciate and develop evidence- metric that can only be discerned as specialty-specific registries— based standards, allowing us to when big data is analyzed. we can now aggregate data quantify the degree to which a across large numbers of health particular outcome may have care organizations to identify been avoidable. This concept Generating new ideas new opportunities for QI. For of “expected outcomes”— for interventions example, the Cystic Fibrosis or essentially a principle of By analyzing different physician Foundation’s national registry “acceptability of negative practice patterns, care pathways, has been used to identify outliers outcomes”—is difficult to and hospital organizational in care, prompting some of the appreciate at the local hospital structures across hundreds or best health care institutions level. We can identify poor even thousands of different to identify potential areas of outcomes and use root-cause surgeons, hospitals, and improvement.10 In much the analyses to determine why regions of the country, big same way as the appeal of fine they occurred, but it is difficult data may provide novel ideas art can be appreciated at a slight to know which outcome was for QI initiatives that extend distance—if the viewer stands “expected” for a given case. beyond patient selection or too close, all they might see By identifying and comparing technical refinement issues. For are the brushstrokes and miss “apples to apples” through such example, surgical outcomes the point of the art work—so processes as risk adjustment have been shown to vary too can health care quality be and propensity score matching, widely between surgeons with more fully appreciated when residents can begin to appreciate different experience levels, or viewed on a broader scale. the concept of acceptability between surgeons from different The population-level behind the O/E ratios. subspecialties. At the local level, perspectives gained from big data A better understanding of this QI efforts may focus on studying also lend important insights into acceptability principle can have the differences in technique or the potential limitations of QI important systemic implications resource utilization. However,

JUN 2015 BULLETIN American College of Surgeons FROM RESIDENCY TO RETIREMENT

Big data provides a lens through which we can better appreciate and develop evidence-based standards, allowing us to quantify the degree to which a particular outcome may have been avoidable.

when examined across hospitals or across regions of REFERENCES the country through the lens of big data, new system- 1. Accreditation Council for Graduate Medical Education. level interventions, such as new care pathways or Bylaws. Article II, Section 2b. P1. Effective July 1, 2013. maintenance of competency strategies, may emerge as Available at: www.acgme.org/acgmeweb/tabid/171/ GraduateMedicalEducation/Policies.aspx. Accessed additional approaches to improving patient outcomes. October 14, 2014. 2. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system—rationale and benefits. Promoting rigorous evaluation N Engl J Med. 2012;366(11):1051-1056. A successful QI initiative must include an evaluation 3. Accreditation Council for Graduate Medical Education. Policies and procedures. Subject 16.00, component, and big data provides a platform to teach Sections 16.10-16.20. P68-69. Approved 9.27.2014. trainees about data-driven QI process evaluation. Available at: www.acgme.org/acgmeweb/tabid/171/ Important concepts such as risk adjustment and O/E GraduateMedicalEducation/Policies.aspx. Accessed ratios are best taught with actual data. Residents can October 14, 2014. learn to identify and capture data that are necessary for 4. Myers JS, Nash DB. Graduate medical education’s new 42 | focus on resident engagement in quality and safety: Will project evaluation, design evidence-based evaluation it transform the culture of teaching hospitals? Acad Med. strategies, and critically analyze and interpret the data. 2014;89(10):1328-1330. This process is a logical extension of the evidence-based 5. Weiss KB, Bagian JP, Nasca TJ. The clinical learning medicine concept into QI. Rather than assuming that environment: The foundation of graduate medical a given QI intervention will work, big data enables education. JAMA. 2013;309(16):1687-1688. 6. Wong BM, Etchells EE, Kuper A, Levinson W, Shojania and encourages the trainee to rigorously evaluate KG. Teaching quality improvement and patient safety to the data both before and after the intervention trainees: A systematic review. Acad Med. 2010;85(9):1425- to determine whether it did or could work. 1439. 7. Murdoch TB, Detsky AS. The inevitable application of big data to health care. JAMA. 2013;309(13):1351-1352. 8. Jain SH, Rosenblatt M, Duke J. Is big data the new Conclusion frontier for academic-industry collaboration? JAMA. Big data has important implications for the tripartite 2014;311(21):2171-2172. mission of academic medical centers to support 9. Sellers MM, Reinke CE, Kreider S, et al. American excellent clinical care, research, and education. We College of Surgeons NSQIP: Quality in-training should recognize the value that big data offers for initiative pilot study. J Am Coll Surg. 2013;217(5):827-832. 10. Greenwood V. Can big data tell us what clinical trials our educational mission and design specific offerings don’t? New York Times. October 3, 2014. Available at: within the context of our education programs to allow www.nytimes.com/2014/10/05/magazine/can-big-data- trainees to learn about big data research tools and their tell-us-what-clinical-trials-dont.html?_r=0. Accessed applications to QI and patient safety. Though big data May 12, 2015. and the tools used in their systematic analysis have historically been reserved for dedicated health services researchers, they are increasingly available to our trainees and warrant increased attention as a means to engage learners in lifelong QI endeavors, which our nation’s health care system so desperately needs. ♦

V100 No 6 BULLETIN American College of Surgeons ACS CLINICAL RESEARCH PROGRAM

New manual for cancer surgery issued: Operative Standards for Cancer Surgery

by Linda W. Martin, MD, MPH, FACS; Nirmal K. Veeramachaneni, MD, FACS; Matthew H. G. Katz, MD, FACS; Y. Nancy You, MD, MHSc, FACS; Judy C. Boughey, MD, FACS; Heidi Nelson, MD, FACS; and Kelly K. Hunt, MD, FACS

urgical resection of a manual that details the critical on and off a clinical trial. As the solid tumors remains elements of cancer surgery as project matured, it became clear Sthe cornerstone of first envisioned by Heidi Nelson, that this manual could serve many multidisciplinary care for MD, FACS (co-author of this purposes, ranging from surgical patients with early-stage and article). The resulting textbook, education to providing a basis for advanced malignancies. Although Operative Standards for Cancer operative report templates and organizations such as the Surgery, is now complete and quality improvement databases. National Cancer Institute and will be available for purchase The committee chose to focus National Comprehensive Cancer in July at the Wolters Kluwer on four specific disease sites for Network publish guidelines and website, www.lww.com/acs. the first edition of the manual— | 43 treatment algorithms for the breast, colon, lung, and pancreas. care of cancer patients, none of For each disease site, several these protocols addresses the Development of the manual common operative procedures fundamental question of what The manual was conceived that the committee agreed were constitutes the critical elements of in response to the need for a important to describe were an operative procedure for cancer standardized description of chosen. The manual is not a resection. Overall, standards “minimum standards” for various surgical atlas; rather, the emphasis for oncologic resections are cancer operations to serve as a is on oncologic fundamentals surprisingly lacking. Quality reference for clinical trials that and the critical elements in the control in clinical trials involving include surgical interventions. conduct of an operation and surgery has been inconsistent More specifically, the idea was to intraoperative decision making. and makes comparison across create a standards manual that In addition, the committee studies inaccurate or impossible. could serve as a reference in the participants who developed To address the technical development of clinical trials the manual identified areas of aspects of standardizing that include operations such controversy and posed several key surgical care, the American as breast-conserving surgery, questions that were then analyzed College of Surgeons Clinical pancreaticoduodenectomy, or using a systematic review of Research Program, a program lobectomy, rather than require current literature. These may of the Alliance for Clinical investigators to establish or re- serve as the basis for a new clinical Trials in Oncology and the establish the basic principles trial within each disease site. College, formed the Cancer of these operations with the A leadership committee Care Standards Development development of each new trial. was assigned to address each Committee. For the last three The goal was to minimize disease group. This leadership years, the committee, led by Kelly variability across study sites and group included a section editor, K. Hunt, MD, FACS (co-author of improve adherence to minimum a methodologist, and an art/ this article), worked to develop standards for patients treated both illustrations editor. Surgeons

JUN 2015 BULLETIN American College of Surgeons ACS CLINICAL RESEARCH PROGRAM

with expertise in each disease decisions that are made from and will include procedures site were recruited from all of the skin incision to skin closure, in melanoma, gastric cancer, national societies and cooperative and the recommendations are esophageal cancer, rectal groups for the broadest possible based on the strongest available cancer, and thyroid cancer. representation. International evidence. Because randomized Frank Detterbeck, MD, FACS, 44 | experts also were invited to trials have not addressed all of FCCP, professor of surgery participate in each section. Much the components of operations (section of thoracic surgery); of the initial work was done on within each disease site, it chief, thoracic surgery; surgical conference calls, followed by was important to draw on director, thoracic oncology; and collaborative writing over the the experience and consensus associate director, clinical affairs, next year and a half. This work of the experts writing the Yale Cancer Center, New Haven, culminated in the completed individual chapters. Identifying CT, described the role of the textbook, which will also be the lack of evidence on certain manual best in the introduction available as an online resource. topics has been an unintended to the chapter on lung cancer:* consequence of writing this manual and has galvanized The purpose of this section is to The final product the authors into establishing describe a minimal standard for The manual provides concrete standards where none currently the actions that should be taken recommendations on the exist. With the participation in the surgical care of [lung] can- proper conduct of operations of more than 120 surgeons in cer patients, with the ultimate goal and detailed information this first edition, it is perhaps of improving the quality of care on the oncologic principles, the best resource currently these patients receive. In this way, avoidable pitfalls, and quality available on the proper conduct the aim…is to “raise the floor” of the evidence on which these of an operation for cancer of the rather than define the absolute recommendations are based. breast, colon, lung, and pancreas. ceiling of what can be achieved; The manual is focused on the In anticipation of continued further improvement is always evolution in surgical oncology, possible. This standard should *American College of Surgeons Clinical these initial four disease site serve as a guide for surgeons who Research Program, Alliance for Clinical sections will be updated every are focused on delivering high- Trials in Oncology. Operative Standards two to three years. Planning quality care to achieve the best for Cancer Surgery: Volume I: Breast, Lung, Pancreas, Colon. Philadelphia, PA: is already under way for the outcomes for their patients. ♦ Lippincott, Williams, and Wilkins; 2015. second edition of the manual

V100 No 6 BULLETIN American College of Surgeons YOUR ACS BENEFITS

The Surgeon Specific Registry and the ACS Member Profile enhance your practice

by Bianca Agregado and Connie Bura

he American College for the individual health of Surgeons’ (ACS) top care professional. Examples priority is providing include the following: T The ACS Division of Member value for its Fellows, Associate Fellows, and Resident and • Submit surgical measures to Services has developed this Medical Student Members. the 2015 Centers for Medicare new “Your ACS benefits” Current member benefits & Medicaid Services (CMS) column to provide provide opportunities and Physician Quality Reporting members with updates resources in the areas of System (PQRS). In 2017, health every other month on the education, research, quality, care providers will be subject advocacy, publications, to penalties based on 2015 member perquisites. | 45 scholarships, networking, data. Options for CMS PQRS committees, and communities. participation in the SSR include The ACS Division of Member the following: Services has developed this new “Your ACS benefits” column ȖȖ 2015 PQRS General Surgery to provide members with Measures Group updates every other month on the member perquisites. This ȖȖ 2015 PQRS individual measures inaugural column looks at two ACS member databases: the ȖȖ 2015 ACS SSR Qualified Clinical Surgeon Specific Registry (SSR) Data Registry (QCDR)— and the ACS Member Profile. Trauma measures

• Meet American Board of Surgery The SSR Maintenance of Certification The SSR is a web and mobile Part 4, which requires surgeons software application and to participate in an outcomes database that allows surgeons to registry or quality assessment track their cases and outcomes program. in a convenient, easy-to-use manner. The SSR builds on the • Use the SSR as an individual ACS Case Log system, enabling health care provider case log. surgeons not only to log and keep track of their cases, but • Enter and edit cases online and also participate in an increasing via a mobile device (iPhone, iPad, number of regulatory programs and Android).

JUN 2015 BULLETIN American College of Surgeons YOUR ACS BENEFITS

Many members who have used the SSR have found that the registry is a valuable benefit; in fact, according to a member survey conducted in November 2014 of 2,232 members, 64 percent of the Fellows who reported using the SSR rated it as highly valuable.

• Enter cases in the registry as part of your Fellow or within a matter of minutes based My Profile and the Associate Fellow application. on key clinical data variables. Find a Surgeon Site You can use key features The new ACS website, of the member profile • Review benchmark and real-time launched in the summer to do the following: online reports. of 2014, allows members 46 | to access and update their • Edit your contact information ACS members can access online profiles more easily. and specify whether you want and use the SSR free of charge. These data feed into the patients to be able to contact you Many members who have used Find a Surgeon site that through the site. the SSR have found that the your colleagues and, most registry is a valuable benefit; importantly, patients who • Upload your photo. If you don’t in fact, according to a member are searching for a qualified have a current photo available to survey conducted in November surgeon use to connect with upload, visit the My Profile booth 2014 of 2,232 members, you. Members who log in to at the annual Clinical Congress 64 percent of the Fellows who the website and then access the to get a professional photo taken reported using the SSR rated it Find a Surgeon site can search and where staff will upload it as highly valuable. The College for colleagues and retrieve directly to your profile. The anticipates that surgeons will their contact information, photo will be provided to you on find the SSR of increasing value including their e-mail a flash drive, free of charge. as regulatory requirements addresses. E-mail addresses continue to mount. are not displayed to the public. • Inform patients about yourself To use this member resource, In addition, members can and your practice philosophy. members will need to register search for colleagues through for the system by logging in the ACS Communities. • Identify and select your with a user name and password. To date, more than 10,000 subspecialties and areas of Participants will then be taken members have updated some clinical concentration from a to an account creation page. If component of their Member comprehensive list. you have already registered for Profile. Updating your profile the SSR, log in to the system is quick and easy. There are • Display information about and enter your cases. For eight profile sections, some your hospital and/or academic more information about the of which are pre-populated appointments and society SSR, contact [email protected]. with information provided memberships.

V100 No 6 BULLETIN American College of Surgeons YOUR ACS BENEFITS

• Edit your pre-populated also promoted by the National “Welcome Dr. [Your Name].” training and society membership Institutes of Health, the Click on “Welcome” and select information as well as update National Cancer Institute, and “My Profile.” From here you your specialty and board the American Cancer Society. can click on the pencils in the certification information. Most patients are either looking right hand corner of each section for surgeons to perform a to begin editing and adding • Select options to display your specific procedure or a health information to your profile. birth date, gender, and/or race. care professional within their Users have the ability to save geographic area. However, content as they work within • Choose how you want the patients can also search by a the tool, and have the option of information displayed—to the range of variables, including reviewing the finished product public, to members only, or kept name, state/city/zip code, by logging out and searching | 47 private. country, distance, specialty, for his or her name in the Find subspecialty, areas of clinical a Surgeon site. Members are The ACS will send you concentration, and gender. The encouraged to visit his or her a weekly e-mail indicating results will display all of the profile at least once a year and how many individuals have information you have requested whenever contact information viewed your profile. as “public” in your Profile; from requires updating. While logged The ACS is working on your that point, patients can send you in, users have the opportunity to behalf to raise awareness and a direct e-mail communication. review all of the other exclusive help patients understand the Monthly page views members-only benefits that are meaning of ACS membership— on the Find a Surgeon site available, such as My CME, that Fellows pledge to place range between 12,000 to the Affinity Program offerings, the welfare and rights of 18,000 searches, making and the FACS logo that is their patients above all else, it one of the most visited available for download. ♦ to respect each patient’s pages on the ACS website. autonomy and individuality, To update your profile, and to work to advance their go to facs.org and click on professional knowledge and “Member Login,” located in skills throughout their careers. the upper right-hand corner of Patients who enter a search the Web page. Enter your user such as “need a qualified name (your member ID) and surgeon” or “looking for a password. If you do not have surgeon” in a search engine this information available, such as Google will be presented contact [email protected] and a with the ACS Find a Surgeon College staff member will send site as one of their top search it to you. Once logged in, the returns. The facs.org website is “Member Login” tab will read,

JUN 2015 BULLETIN American College of Surgeons A LOOK AT THE JOINT COMMISSION

A new direction for “A look at The Joint Commission”

by Carlos A. Pellegrini, MD, FACS, FRCSI(Hon)

or quite some time now, this topics, such as surgeon fatigue health care for the public column has brought Joint and sleep deprivation, enhanced in collaboration with other FCommission-related news and patient recovery after surgery, stakeholders by evaluating health information to surgeons. In the and the effect of accountable care institutions and inspiring last year, the column has covered care organizations on surgeons. them to excel in providing a variety of relevant topics, Since joining the Board of safe and effective care. including guidelines related to the Commissioners, I have had A total of 21 Commissioners prevention of retained surgical the opportunity to become are appointed by The Joint items, surgical site infections, more familiar with The Joint Commission’s five member and wrong site surgery, as well Commission and its initiatives organizations: the ACS, as the important role of surgeons to improve patient safety and American Hospital Association, in standards development and quality of care—issues that American Medical Association, 48 | on-site survey processes. are top priorities for surgeons. American College of Physicians, Through this column, I look and American Dental forward to identifying additional Association. Representatives Expanded topics ways that The Joint Commission from six additional groups serve As a new member of The and surgeons can work together as public members and four as Joint Commission’s Board of to ensure optimal patient safety at-large members representing Commissioners, appointed by the and reach the goal of zero harm. behavioral health care, home American College of Surgeons care, long-term care, and nursing (ACS), I have come to believe care. As health care continues that the connection between The Insider’s perspective to expand, it is increasingly Joint Commission and surgeons In addition to covering topics important for members of the could be expanded beyond these related to patient safety and health care community to topics. With that in mind, I quality care, I look forward strengthen their relationships would like “A look at The Joint to informing ACS members with one another and to work Commission” to take a new about my responsibilities and collaboratively to bring about direction over the coming year. activities as a member of The positive change for patients. My intention is to continue to Joint Commission’s Board I hope you’ll enjoy the new keep Bulletin readers informed of Commissioners. As the direction of “A look at The of relevant developments in commission’s governing body, Joint Commission” and find surgical care, patient safety, the board provides policy this column to be a valuable and related Joint Commission leadership and oversight. Board resource in your everyday initiatives and resources but, members serve three-year terms, practice. I invite your questions, at the same time, I also plan to renewable for up to nine years. comments, and suggestions contribute my own thoughts and Each member of the board on topics related to The Joint opinions with regard to those governs with a dedication to Commission, and can be reached topics as they affect surgeons The Joint Commission’s mission at [email protected] ♦ and to add perspectives on other to continuously improve

V100 No 6 BULLETIN American College of Surgeons NTDB DATA POINTS

Hit the road, jacked—road rash injuries

by Richard J. Fantus, MD, FACS, and Edmundo A. Rivera, MD

oad rash is an alliteration tangential surface can wreak protocols are applied, principle that is entrenched in havoc on exposed dermal areas. tenets of wound care should be RAmerican slang and The degree of injury ultimately used to obtain the best functional heard with frequency on depends on the bodies in motion, and cosmetic outcomes. spring and summer trauma the speed of the skin when it rounds. The term is distinct, hits the road, the texture and descriptive, and diagnostic, but condition of the surface, and the Outcomes it refers to more than an allergic sliding distance. In the spring and To examine the occurrence reaction to asphalt. It is unclear summer months, the frequency of motorcycle-related road whether the term was born of kinematic activities prone to rash injuries in the National in the hospital or is rooted in road rash tend to increase. The Trauma Data Bank® (NTDB®) the motorcycle, skate, or some activity that comes to mind first research dataset for 2013, other speed-loving subculture. would be motorcycling. Even hospital admissions records were Nevertheless, any activity that with an entire industry based searched using the International involves speed, skin, and asphalt on apparel designed to protect Classification of Diseases, Ninth | 49 has a potential for road rash. motorcyclists, no federal laws Revision, Clinical Modification or regulations mandate their diagnoses codes. Specifically use—and only 19 states and the searched were records for Factors affecting District of Columbia require all motorcycle-related injuries degree of injury motorcyclists to wear helmets. containing an external cause of The word “asphalt” derives Road rash injuries, as with injury code (E-code) E810–816 and from the Greek “asphaltos,” thermal injuries, classify in E818 (motor vehicle traffic related) which is actually of Phoenician terms of depth. These wounds and either a post-decimal value origin. Homer gave the name can include a combination of of 0.2 for injured motorcyclist, Asphaltites to a lake in Palestine, deep abrasions, avulsions, and or 0.3 for injured passenger on a now known as the Dead Sea, lacerations. Patients may require motorcycle. These records were which had been an ancient hospital admission for adequate then searched for a diagnosis code source of asphalt or bitumen.* pain control, assistance with 910.0–917.0 and 919.0 (abrasion Asphalt provides the maximum wound care, and therapies if or friction burn for varying parts amount of traction between the injuries span joints. Deeper of the body). A total of 20,407 tires and other road-bound injuries that fail to heal may records were found; 17,054 surfaces. Unfortunately, the same require excision and grafting. records contained a discharge tractive forces used to generate Healed injures also are prone status, including 13,554 patients motion between a body and a to hypertrophic changes. discharged to home, 1,974 to acute Other considerations would care/rehab, and 1,126 to skilled *Transactions of the American Institute of Mining be tattooing that occurs when nursing facilities; 400 died. These Engineers, Volume XVIII. New York, NY. American Institute of Mining Engineers; 1890. bituminous particles become patients were 88.5 percent male, †Vrints I, Hondt M, Van Brussel M, embedded in the dermis after typically 40.1 years of age, had an Nanhekhan L. Immediate debridement ® re-epithelialization and produce average hospital length of stay of of road rash injuries with Versajet † hydrosurgery: Traumatic tattoo prevention? discolorations of the skin. After 5.8 days, an average intensive care Aesthetic Plast Surg. 2014;38(2):467-470. Advanced Trauma Life Support® unit length of stay of 5.8 days, an

JUN 2015 BULLETIN American College of Surgeons NTDB DATA POINTS

FIGURE 1. HOSPITAL DISCHARGE STATUS

FIGURE 2. DRUG AND ALCOHOL TESTING PERCENTAGES

50 |

average injury severity score of 7,000 to potentially 600,000 during In addition, information is 13.1, and were on the ventilator the first week of August as bikers available on the website about for an average of 7.1 days. Of those from across the nation attend the how to obtain NTDB data for tested for alcohol (12,235) or drugs annual rally commemorating the more detailed study. If you are (7,466), 29.5 percent were positive event’s 75th anniversary.‡ Riding interested in submitting your for alcohol and more than half a two-wheeled, high-performance trauma center’s data, contact (52.1 percent) were positive for transportation device is Melanie L. Neal, Manager, drugs. (See figures, this page.) challenging in and of itself; this NTDB, at [email protected]. ♦ Motorcycle rallies will be in summer, don’t hit the road jacked abundance between Memorial if you want to avoid spilling and Day and Labor Day, and bike sliding your way to road rash. Acknowledgement enthusiasts have many options Throughout the year, we Statistical support for this article when it comes to scale and locale. will be highlighting these data has been provided by Chrystal The population of Sturgis, SD, for through brief reports in the Caden-Price, Data Analyst, NTDB. example, will soar from roughly Bulletin. The NTDB Annual Report 2014 is available on the ‡ Sturgis Motorcycle Rally. Available at: www.sturgismotorcyclerally. ACS website at www.facs.org/ com. Accessed March 30, 2015. quality-programs/trauma/ntdb.

V100 No 6 BULLETIN American College of Surgeons NEWS

ACS declares victory with passage of law repealing the SGR

| 51

The landslide vote in Congress to permanently repeal the and thousands of letters to pass H.R. 2, the Medicare SGR. H.R. 2 passed in the and calls to Capitol Hill. Access and Children’s Senate 92–8 and in the House The College is committed Health Insurance Program 392–37. President Obama to working with Centers for Reauthorization Act of 2015, signed it into law on April 16. Medicare & Medicaid Services this spring ushered in much- The new law stopped officials on the implementation needed Medicare reforms. implementation of a 21 percent of the policies authorized in the Especially noteworthy is the SGR cut that was scheduled to legislation that stress quality of repeal of the flawed sustainable take effect April 1. The hard- care for Medicare beneficiaries. growth rate (SGR) formula fought victory was achieved Details regarding the legislation used to calculate Medicare through the advocacy efforts and what surgeons can expect in physician pay. The American of the ACS and other medical the future will be published in College of Surgeons (ACS) associations, as well as through the July issue of the Bulletin. ♦ led a multi-year campaign to Fellows’ participation in garner lawmakers’ support meetings with lawmakers

JUN 2015 BULLETIN American College of Surgeons NEWS

Hartford Consensus III focuses on empowering the public to serve as first responders

The Joint Committee to Create • Professional first responders: ACS FELLOW PARTICIPANTS a National Policy to Enhance Law enforcement, emergency IN HARTFORD CONSENSUS III Survivability from Intentional medical service personnel, fire Richard Carmona, MD, MPH, FACS, Mass-Casualty and Active fighters, and rescue workers 17th U.S. Surgeon General Shooter Events, founded by the Alasdair K. T. Conn, MD, FACS, FRCSC, American College of Surgeons • Trauma professionals: chief emeritus, department of emergency medicine, Massachusetts (ACS), held its third Hartford Hospitalists; emergency General Hospital, Boston Consensus meeting April 14, department physicians, 2015, in Hartford, CT. Chaired by nurses, and technicians; Alexander Eastman, MD, MPH, FACS, Major Cities Police Chiefs Association; ACS Regent Lenworth M. Jacobs, and trauma surgeons chief of trauma, Parkland Memorial Jr., MD, MPH, FACS, professor Hospital, University of Texas of surgery; director, Trauma Southwestern Medical Center, Houston Institute; and vice-president Empowering immediate Lenworth M. Jacobs, Jr., MD, MPH, of academic affairs, Hartford responders FACS, professor of surgery; director, Hospital, the meeting focused on An emphasis of the Hartford Trauma Institute; and vice-president implementation of strategies for Consensus III is on empowering of academic affairs, Hartford Hospital 52 | effective hemorrhage control. the public to provide lifesaving, John Holcomb, MD, FACS, chief, division The full Hartford Consensus first-line care. The Hartford of acute care surgery, University of III report will be published in Consensus III also calls for Texas Health Science Center at Houston the July issue of the Bulletin. educating individuals and Norman McSwain, MD, FACS, medical director, prehospital Briefly, however, the Hartford communities about the use of trauma life support, Tulane Consensus III centers on effective external hemorrhage University, New Orleans, LA strategies for preparing control techniques and for Peter Rhee, MD, MPH, FACS, professor individuals at the scene of a ensuring access to bleeding of surgery, department of surgery, mass-casualty event to serve control bags in public places in University of Arizona, Tucson as immediate responders the same way that automatic Ronald Stewart, MD, FACS, Chair, using the group’s THREAT external defibrillators are now ACS Committee on Trauma; system. THREAT involves accessible to the public. For chair, department of surgery, the following: example, the document calls University of Texas Health for extending Good Samaritan Science Center at San Antonio • Threat suppression protections to individuals who ACS President Andrew L. Warshaw, • Hemorrhage control use tourniquets and lifesaving MD, FACS, FRCSEd(Hon), surgeon-in- chief emeritus, Massachusetts General • Rapid Extrication to safety devices to control the bleeding of Hospital, and the W. Gerald Austen • Assessment by medical providers victims at mass-casualty events. Distinguished Professor of Surgery, • Transport to definitive care A number of ACS Fellows Harvard Medical School, Boston in addition to Dr. Jacobs Leonard Weireter, MD, FACS, Vice-Chair, The Hartford Consensus participated in the Hartford ACS Committee on Trauma; Arthur and calls for a seamless, Consensus III, a list of whom Marie Kirk Family Professor of Surgery, integrated response from can be found in the sidebar. ♦ Eastern Virginia Medical School, Norfolk the following groups: Jonathan Woodson, MD, FACS, Assistant Secretary of Defense for • Immediate responders: Individuals Health Affairs, U.S. Department of Defense, Washington, DC present at the incident

V100 No 6 BULLETIN American College of Surgeons NEWS

In memoriam: Dr. Lloyd MacLean, ACS Past-President and “The Chief” at McGill

by Jonathan L. Meakins, MD, FACS

North American surgery lost one academic surgeons and a program to chief of surgery at of its great leaders last winter. wonderful role model for all of the Ancker Hospital in St. Paul, Lloyd Douglas MacLean, MD, the surgeons in his department. MN, where his clinical and PhD, FACS, FRSC, Past-President academic career flourished. of the American College of In 1962, he was recruited to Surgeons (ACS), died in his Early promise McGill University, Montreal, QC, sleep on January 14 at age 90. Born in Calgary, AB, in 1924, to serve as professor of surgery Dr. MacLean was an Dr. MacLean achieved an and chief of surgery at the Royal | 53 outstanding clinician whose exceptional academic record, and Victoria Hospital. In his 27 years investigative interests touched he financed his undergraduate in that position, Dr. MacLean on all of the important surgical and medical school education established what was considered the developments that occurred at the University of Alberta, premier academic surgery program in his lifetime. Early studies in Edmonton, on scholarships. in Canada. He achieved universal gastric physiology, transplant Following a rotating internship recognition, becoming the immunology, infection, and in Alberta, he entered the Archibald Professor of Surgery nutrition preceded his interests surgical training program at at McGill, a Fellow of the Royal in septic shock and organ failure, the University of Minnesota, Society of Canada, an Officer clinical transplantation, host Minneapolis, where he thrived in of the Order of Canada, and resistance, and the physiologic the intellectual and investigative the 1988 Sims Commonwealth evaluation of the critically ill atmosphere promulgated by Travelling Professor. He surgical patient. His evaluations Owen H. Wangensteen, MD, received the Canada Gairdner of the clinical results of bariatric PhD, FACS, chief of surgery. Wightman Award, along with surgery were leading edge and By the completion of his honorary degrees from McGill established the bar for others in residency and after earning a and the University of Alberta this currently relevant clinical doctorate in physiology in 1957 and visiting professorships field. He was a pioneer in clinical as a Markle Scholar in Medical to most Canadian medical transplantation, the development Sciences, Dr. MacLean had schools, as well as many U.S. of surgical critical care units, authored 32 papers, many of and international institutions. and the study of bariatric which were published in the surgery. All of these interests, New England Journal of Medicine, among others, are reflected in The Lancet, and basic science Leadership in fractious times his bibliography, which spans journals. Board-certified in Dr. MacLean held high office in more than 350 publications. He general and thoracic surgery, he many surgical associations. He was one of Canada’s leading was promoted from the residency was president of the American

JUN 2015 BULLETIN American College of Surgeons NEWS

Dr. MacLean (left) accepting the Surgical Forum Volume XL dedication from Douglas W. Wilmore, MD, FACS, then- Chair of the Committee for the Forum on Fundamental Surgical Problems, at the 1989 Clinical Congress.

Surgical Association, the Committee (1983–1990); were physicians who operated— Central Surgical Association, Executive Committee (1987– not simply technicians. None the International Surgical 1992); the Member Services of us heard, “What do you Group, and the James lV Liaison Committee (1990– mean, you got a medical Association of Surgeons. 1992); and Health Policy and consult?” more than once. Much of his energy dedicated Reimbursement Committee to surgical organizations, (consultant, 1984–1986, and 54 | though, was focused on the member, 1993–2000). Influence on McGill’s culture ACS. In the 1960s, Dr. MacLean Dr. MacLean was Chair The Surgical Forum was an was heavily involved with the of the ACS Clinical Congress integral component of the Pre- and Post-Operative Care Program Committee from residency program in Minnesota Committee and the writing 1985 to 1992. These were and, under Dr. MacLean’s of the first ACS Manual of fractious years due to an leadership, participation in the Preoperative and Postoperative increase in specialization and forum became a significant part Care. For the next six years, surgical disciplines seeking of serving and training in the he served on the Committee more program time and department of surgery at McGill. on Fundamental Surgical independence. His diplomatic For residents and junior staff, Problems, the Surgical Forum skills were evident as the meeting the March 15 deadline Committee, of which he served College’s meetings were always for submitting abstracts for the as Vice-Chair. In 1989, his successful, and peacefully Surgical Forum was integrated 29th year of participation, the evolved into the 1990s. into the rhythm of the year. Surgical Forum was dedicated He was elected ACS Presentation and participation to him. Additionally, he was President in 1993, and were a part of the department’s ACS Secretary (1982–1983) his Presidential Address, culture. In the late 1970s, more and served three consecutive “Wangensteen’s Surgical than half of the Canadian Forum three-year terms on the ACS Forum: A legacy of research,” is papers were from McGill staff. Board of Regents (1983–1992), worth reexamining. The speech Dr. McLean was a leader culminating in his service outlined Dr. Wangensteen’s whose integrity, scholarship, and as Vice-Chair of the Board career, explaining how a devotion to the physiological of Regents (1991–1992). He restless intellect that constantly approach to patient care and also served on the Honors questioned the causes of the outcomes data epitomized the Committee (1981–1987); clinical problems facing his caring academic surgeon. A Organization Committee patients would find solutions. key characteristic that surfaced (1981–1985); Central Judiciary Dr. MacLean believed surgeons in morbidity and mortality

V100 No 6 BULLETIN American College of Surgeons NEWS

Drs. MacLean at the 1992 Clinical Congress. conferences was Dr. MacLean’s emerged, including his modesty, to be nominated for any ability to be chair one minute quick sense of humor, decision- further recognition, saying, and a regular surgeon with a making skills, and a remarkable “Let’s spread them around.” complication the next. When he ability to crystallize a problem, He said that he did not get had a patient who experienced paper, or situation into an paid after 6:00 pm and would a complication, as happens to often-hilarious sentence. return home with his boundless all of us, he could relinquish His wit was situational and energy and extraordinary sense the chair and allow himself difficult to translate out of of humor, but also with a full | 55 to be quizzed about the case, context, but examples from the briefcase of work to be completed accepting that there might have operating room include: “Let after dinner. His personal been a better approach, as we me introduce my opponents life was full with golf, tennis, all had to do from time to time. for this operation” and, “Here, gardening, cycling, hiking, And when it was time to move let me help you…just kidding.” skiing, and photography of the on to the next case, he resumed Following a difficult meeting children and grandchildren his authority as chair. Thus, he with the other department as they grew and prospered. created a level playing field. heads, he was known to burst Dr. MacLean leaves his into the office with, “I have wife of 60 years, Eleanor Colle, made enough enemies for MD, four sons, a daughter, “The Chief” one day, I am going home.” and 10 grandchildren, along There was never any doubt that When we were offered a with extraordinary memories Dr. MacLean was “The Chief”— position in the department, for those of us who had the and was referred to as such. The the conversation was brief: good fortune to have worked winter issue of the department “You will start (date) and for and with him. ♦ of surgery’s newsletter, The share an office with . Now Square Knot, recorded the see about the details.” Before reflections of his residents and you could say “thank you,“ he their interactions with him.* was dictating the letter to the Aside from his acknowledged dean and a funding source. qualities as department chair, His modesty came through in a number of common themes many ways. We always learned of his awards or presidencies McGill University department of surgery. The indirectly, if at all. Following Square Knot. Winter 2015. Available at: www. medicine.mcgill.ca/squareknot/SquareKnot_ receipt of an international Winter2015.pdf. Accessed May 11, 2015. award, he repeatedly refused

JUN 2015 BULLETIN American College of Surgeons ® SELECTED READINGS in GENERAL SURGERY

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* The American College of Surgeons (ACS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing Subscribe today! medical education for physicians. The ACS designates this enduring material for a maximum of 80 AMA PRA Category 1 Credits™ annually. Physicians www.facs.org/publications/srgs should claim only the credit commensurate with the extent of their or call 800-631-0033 participation in the activity.

AMERICAN COLLEGE OF SURGEONS | DIVISION OF EDUCATION Blended Surgical Education and Training for Life

2014 SRGS Bulletin Ad_NOV2014.indd 1 10/7/2014 9:22:38 AM NEWS

News from the ACS Communities

by Mallory Williams, MD, MPH, FACS

| 57 Note: In the summer of 2014, the community by expanding the sharing our perceptions of the American College of Surgeons (ACS) traditional concepts of diversity human experience, so that launched an online platform for beyond gender, religion, race, our privilege of performing members of the organization to and ethnicity to include sexual surgery is magnified as we share their interests and concerns. orientation, disability, body embrace the humanity of Nearly a year later, more than shape, and all differences each of our patients. Through 100 ACS Communities are now that may be embodied in our enhanced awareness and active. In the coming months, the families, friends, patients, co- empathy, we seek to inspire Bulletin will periodically publish workers, and colleagues. quality in both our surgical a brief message from the Editor The community is engaged practices and health care of a community. To begin this in a continuous, reaffirming organizations and therefore series, this article focuses on conversation focused on better position ourselves as the ACS Diversity Community. the value proposition of surgeon leaders to serve our diversity in all of its forms. A patients with skill and fidelity. Fellows of the ACS Diversity multidisciplinary social media I invite you to join the Community are thought framework including social Diversity Community. Simply leaders who are committed science, business management, log in to ACS Communities, to engaging in collaborative psychology, entertainment, hover over “Communities” discussions informed by leadership development, and on the blue bar, and select their unique experiences and diversity science are used “Browse All Communities.” ongoing exposures in diversity to stimulate conversations. When the list of communities with the intent of maximizing Leadership is a consistent appears, click the green our capabilities as surgeon theme that permeates most “Join” button next to the leaders. The members of this discussions. The goal of Diversity Community. ♦ community are dedicated to our community is to create creating a transformative online value for each Fellow by

JUN 2015 BULLETIN American College of Surgeons NEWS

Dr. John E. Hutton, Jr., physician to President Reagan, buried April 1

by Colonel James M. Salander, MD, FACS; Colonel Norman M. Rich, MD, FACS; and Captain Eric A. Elster, MD, FACS

Retired Brigadier General John Washington, DC, in 1963, he very high level of competency E. Hutton, Jr., MD, FACS, was entered the U.S. Army and in a critical specialty, as a buried with full military completed a rotating internship, teaching chief and was awarded honors at Arlington National general surgery residency, and the Order of Military Medical Cemetery April 1. He died vascular surgery fellowship at Merit. He was a diplomat of the December 19, 2014, of Walter Reed National Military Diploma in the Medical Care of complications from Parkinson’s Medical Center, Bethesda, MD. Catastrophes under the auspices disease and Lewy body dementia Military assignments included of The Worshipful Society of 58 | at a military retirement facility a tour in Vietnam as the Chief Apothecaries of London. in Washington, DC, at age 83. of Surgery and Professional Services at the 91st Evacuation Hospital; Chief of General Physician to President Reagan Distinguished service to country and Vascular Surgery and Dr. Hutton was White House Dr. Hutton was born in New Residency Program Director, physician and was appointed York, NY, September 9, 1931, Letterman Army Medical Physician to President Ronald the son of John and Antoinette Center; Chief, Department of Reagan in January 1987. He also Hutton. He graduated Surgery, Walter Reed National was director of the White House from Wesleyan University, Military Medical Center; Medical Unit, which comprised Middletown, CT, in 1953, and Vascular Consultant to the several physicians, nurses, and in September of that year was Surgeon General; Commander other health care professionals. commissioned as an Officer of the 47th Field Hospital, He provided emergency care in the U.S. Marine Corps. He Honduras; and Commanding to the President and First Lady, served primarily as an Infantry General, Madigan Army as well as approximately 1,500 Officer, with a secondary Medical Center, Tacoma, WA. White House staff and visiting specialty as a Naval Aviation His military awards include dignitaries. He had an office in Tactical Observer, and served the Distinguished Service Medal; the Old Executive Office Building, in both the Mediterranean Bronze Star; Meritorious Service plus a small office in the White and far eastern theaters. Medal with oak leaf cluster; the House. He visited the Reagans a In 1957, then-Captain Hutton Joint Services, Army, and Navy number of times in their home resigned his regular commission Commendation Medals; the near Los Angeles, CA, after and entered Columbia University, Vietnam Cross of Gallantry; President Reagan left office, and New York, NY, to complete the Vietnam Honor Medal 1st Dr. Hutton served as a pallbearer pre-medical education. After Class; and various theater and at the President’s funeral. graduating from the George campaign medals. He held the Dr. Hutton held a variety of Washington School of Medicine, “A” prefix, which refers to a academic positions, including

V100 No 6 BULLETIN American College of Surgeons NEWS

[Dr. Hutton] was a Fellow of the ACS; he delivered the Opening Address, On a President’s Health, at the 1989 Clinical Congress under the ACS Presidency of Oliver H. Beahrs, MD, FACS.

associate clinical professor Dr. Hutton’s major interests of surgery, University of were in the field of vascular Outside interests California, San Francisco, and trauma surgery, with He had many interests, including from 1978−1981; associate publications in both fields. He photography. Several of his professor of surgery and vice- was a Fellow of the American photos were featured on the chairman, department of College of Surgeons (ACS); he cover of Yachting Magazine and surgery, Uniformed Services delivered the Opening Address, in a series of yachting calendars. University of the Health Science On a President’s Health, at the While in San Francisco, CA, (USUHS), 1981–1984; clinical 1989 Clinical Congress under he sang in the Grace Cathedral professor of surgery, USUHS the ACS Presidency of Oliver Choir. He also was a second and George Washington H. Beahrs, MD, FACS. He also degree black belt in karate. University (1986−2001); and was a member of the American Survivors include his wife of Tulane University School Association for the Surgery of 53 years, Barbara Joyce Hutton of of Medicine, New Orleans, Trauma, the Society for Vascular Silver Spring, MD; four children— LA, 1988. His final academic Surgery, the Society for Clinical John E. Hutton III of Jacksonville, assignment was as professor of Vascular Surgery, the Bay FL; Wendy Little of Olympia, surgery and chief, division of Surgical Society (Honorary), the WA; James Hutton of Phoenix, general surgery, department of Chesapeake Vascular Society, and MD; and Beth Shiau of Aiea, HI— | 59 surgery, USUHS (1993−2010). the Military Vascular Society. and eight grandchildren. ♦

AMERICAN COLLEGE OF SURGEONS | DIVISION OF EDUCATION AMERICAN COLLEGE OF SURGEONS Blended Surgical Education and Training for Life DIVISION OF EDUCATION

“Your Lung Operation” provides patients with the knowledge and training to support full participation and optimal recovery. Safety measures such as site marking, ID band checks, and pneumonia prevention strategies are demonstrated to support the surgeon and health care professional in meeting all CMS and Joint Commission guidelines YOUR LUNG for safe surgical procedures and optimal recovery. OPERATION The program is free to members and contains: Education for a Better Recovery ● A 20-page booklet and 30-minute DVD with information on preoperative prep, cancer staging, procedure overview, potential risks, discharge, and home care. ● Information sheets, including lung images, medication lists, exercise and pulmonary rehab activity guides, quit smoking resources, and survivorship plans. PARTNERS IN YOUR SURGICAL CARE© ● Additional resources, including a patient evaluation form. ● For nonmembers, this program can be purchased individually, or bulk pricing is available. ● Hospital broadcast rights are also available for purchase. To order, visit www.facs.org/education/patient-education.

This Surgical Patient Education Program is a collaborative by the American College of Surgeons with the Society of Thoracic Surgery, the American Association for Thoracic Surgery, the Association of periOperative Registered Nurses, and the Commission on Cancer.

THIS PROGRAM IS FUNDED IN PART BY A GRANT FROM ETHICON ENDO-SURGERY.

YourLungOp_Half Horizontal_Bulletin_2_6_15.indd 1 2/6/2015 11:19:34 AM JUN 2015 BULLETIN American College of Surgeons NEWS

Print or digital Bulletin? The choice is yours

| AMERICAN COLLEGE OF SURGEONS

| VOLUME 100 NUMBER 5 MAY 2015 Bulletin

Going green

in the OR

60 |

For the last three years, the print version, the staff in your profile. Scroll down to the American College of the ACS Division of Integrated “Subscription Preferences.” There Surgeons (ACS) has offered an Communications are now in you can indicate your preferred online version of the Bulletin, the process of developing an delivery method for the Bulletin. which can be accessed at even more reader-friendly You can also opt-in to the bulletin.facs.org or from the design for the online edition. online version of the Journal of the ACS website (facs.org) under The new design will make American College of Surgeons (JACS) “Publications.” One advantage the publication easily read on by following the same steps. of reading the Bulletin online mobile devices and is expected JACS articles go online almost is that you can read it as early to be completed this summer. immediately after they have as a week before you would As more of you move toward been accepted for publication and receive the print edition. And reading the digital version of the weeks before they appear in print. each month, we will send you Bulletin, you may be interested If you still want to receive the a direct link to the latest issue in ending your subscription print version of the Bulletin and/ when it appears online. to the print edition. To stop or JACS, no action is needed on In light of a recent survey receiving the print version, go your part. Keep in mind that even of ACS members that revealed to the ACS website and log in. if you select the online versions, that a number of you would Once you have logged in, go you may still receive one or prefer to read the Bulletin online to “My Profile” and select edit two print publications before rather than continue to receive (the pencil icon) at the top of the changes go into effect. ♦

V100 No 6 BULLETIN American College of Surgeons NEWS

Dr. Turner is first woman SBAS president-elect Patricia L. Turner, MD, FACS, Director, Division of Member Services, American College of Surgeons (ACS), was recently elected the first woman president-elect of the Society of Black Academic Surgeons (SBAS). The election took place at the SBAS Annual Scientific Assembly, in Chapel Hill, NC, cohosted by the University of North Carolina Chapel Hill department of surgery, and chaired by Anthony A. Meyer, MD, PhD, FACS, FRCS, Governor of the ACS North Carolina Chapter. Dr. Turner’s one-year term as president of the SBAS will begin at next year’s annual meeting, which will be cohosted with The Ohio State University and chaired by Robert S. D. Higgins, MD, MSHA, FACS, program director, The Ohio State University Medical Center, Columbus. Dr. Turner Dr. Turner will preside at the 2017 SBAS annual meeting in Chicago, IL, cohosted by the University of Chicago and chaired by Jeffrey B. Matthews, MD, FACS, Dallas B. Phemister Professor of Surgery, and chair, department of surgery, University of Chicago Medicine. Dr. Turner is an adjunct associate professor in surgery at Northwestern University Feinberg School of Medicine, Chicago, and a clinical associate professor of surgery at the University of Chicago. SBAS nurtures the involvement and development of academic surgeons, providing a robust and research-oriented annual scientific forum. View the SBAS website at www.sbas.net/. ♦

Commission on Cancer to hold two educational programs in June | 61

The American College of Surgeons Commission common questions and concerns regarding on Cancer (CoC) will sponsor two educational CoC standards and compliance. programs at the Swissôtel Chicago, IL. A half- This conference will examine the following: day workshop on June 17 will focus on the National Cancer Data Base (NCDB) quality • Chapter 3 in the CoC’s Cancer Program Standards tools. Participants in Maximizing NCDB Data 2012: Ensuring Patient Centered Care, Continuum of to Improve Your Cancer Program Today will Care Services. Participants will gain clarification learn how cancer program administrators on the standards, learn how to demonstrate and oncologists can use the registry data compliance, and distinguish how each of the for clinical decision making. NCDB staff 2015 phase-in standards will be evaluated for will present examples of tool development, compliance during the survey process. expectations, and current uses of the NCDB quality tools. The registration fee is $350. • Chapter 4 in the CoC’s Cancer Program Standards Find more information and register online 2012: Ensuring Patient Centered Care, Patient at www.facs.org/quality-programs/cancer/ Outcomes. Attendees will learn to identify coc/events/survey-savvy/ncdb-workshop. the components of successful prevention and The second program, Survey Savvy, screening programs (Standards 4.1 and 4.2), June 18–19, will offer an in-depth review of as well as differentiate what are appropriate the information that an institution’s cancer and compliant studies of quality and quality committee needs to coordinate a high- improvements (Standards 4.7 and 4.8). quality, patient-centered, multidisciplinary cancer program. Developed by CoC The registration fee is $850. Find more staff and committee leadership, this information and register online at www.facs.org/ program addresses a cancer program’s quality-programs/cancer/coc/events/survey-savvy. ♦

JUN 2015 BULLETIN American College of Surgeons NEWS

Becker’s Hospital Review names Dr. Ko one of 50 patient safety experts Clifford Y. Ko, MD, MS, MSHS, FACS, Director, American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®), and Director, ACS Division of Research and Optimal Patient Care, has been named one of 50 experts leading the field of patient safety in the U.S. by the 2015 Becker’s Hospital Review. This third edition of the list includes individuals at national organizations, universities, and health care systems working to improve patient safety. The 2015 list includes names of advocates, professors, researchers, administrators, and health care providers who have won awards, published articles, and led initiatives to reduce medical Dr. Ko injuries and ensure patient safety. In addition to his role with ACS NSQIP, Dr. Ko is a practicing colon and rectal surgeon and a professor at the University of California, Los Angeles (UCLA) Schools of Medicine and Public Health and holds the Robert and Kelly Day Chair in Surgical Outcomes at UCLA. He is also a research affiliate at the RAND Corporation. The Becker’s Hospital Review editorial team considered nominations and selected leaders through an editorial review process. See the full list of recipients on the Becker Hospital Review website at http://goo.gl/X5Eetm, and view Dr. Ko’s profile on the website at http://goo.gl/IwriLC. ♦

Dr. Ellner receives inaugural 62 | Roger Schenke Award from AAPL The American Association for of 22 hospitals that meets Physician Leadership (AAPL) regularly to share quality presented the inaugural Roger outcomes, including successes Schenke Award to Scott J. and best practices for the Ellner, DO, MPH, FACS, at benefit of all patients in the its annual meeting April 18 in state. Many of the CtSQC Las Vegas, NV. Dr. Ellner is hospitals use the American president of the Saint Francis College of Surgeons National Medical Group, vice-chairman Surgical Quality Improvement of the department of surgery, Program to improve outcomes Dr. Ellner with the award and director of surgical quality in key areas of surgical care at Saint Francis Hospital and and provide the best value— Medical Center, Hartford, CT. health outcomes achieved Dr. Ellner has implemented per dollar spent—to patients, named for Roger Schenke, who training for all perioperative hospitals, and health plans. in 1975 founded the American teams and instituted evidence- The Roger Schenke Award, Association for Physician based protocols to virtually created in 2014 for the 40th Leadership, which has grown eliminate the risk of human anniversary of the AAPL, to more than 11,000 members error in the operating rooms honors individual vision, and serves physicians at all at Saint Francis and was commitment, and innovation stages of their careers through instrumental in founding the in creating education and leadership education, career Connecticut Surgical Quality training programs to improve support, and policy advocacy. Collaborative (CtSQC). The patient safety and enhance Learn more online at www. CtSQC is a statewide group physician leadership. It is physicianleaders.org. ♦

V100 No 6 BULLETIN American College of Surgeons NEWS

2015 Resident Trauma Papers Competition winners announced

| 63 Ronald M. Stewart, MD, FACS, Chair of the COT (far left), with winning COT paper authors (from left) Drs. Berry, Kollisch-Singule, Nehra, and Langness; Dr. Weireter is on the far right.

The American College of and Nebraska) and the ACS Mediates the Neural Stem Cell Surgeons (ACS) Committee are funding the competition. Response to Intestinal Injury on Trauma (COT) announced Submissions begin at the state the 15 winners of the 38th or provincial level, and winners • First Place, Clinical Investigation: annual Residents Trauma are then judged at regional Deepika Nehra, MD, Massachusetts Papers Competition at its competitions. Each region is then General Hospital, Boston, Annual Meeting, March 12–14, eligible to submit two abstracts to PGY-7 (COT Region 10): Acute in Chicago, IL. Each winner a panel of COT judges, who make Rehabilitation after Trauma: received $500, with an additional the final selection for presentation Does It Really Matter? $500 awarded to the second- at the Scientific Session of the place winners in each category, COT Annual Meeting. Leonard J. • Second Place, Basic Laboratory and an extra $1,000 awarded to Weireter, MD, FACS, Norfolk, VA, Research: Michaela C. Kollisch- the two first-place winners. Vice-Chair of the COT and Chair Singule, MD, State University The competition is open to of the COT Regional Committees, of New York at Stony Brook surgical residents and trauma moderated the session. Medical University, Syracuse, fellows. Submissions describe The 2015 competition PGY-4 (COT Region 2): Impact original research in the area of winners are as follows: of Chest Wall Recruitment in trauma care and/or prevention Prevention of Acute Respiratory in one of two categories: basic • First Place, Basic Laboratory Distress Syndrome laboratory research or clinical Research: Simone M. Langness, investigation. The Eastern MD, University of California, San • Second Place, Clinical Investigation: and Western States COTs, Diego, postgraduate year (PGY)-4 Cherisse Berry, MD, University of Region 7 (Iowa, Kansas, Missouri, (COT Region 9): The Vagus Nerve Maryland, Baltimore, PGY-9 (COT

JUN 2015 BULLETIN American College of Surgeons NEWS

All resident papers presenters. Front row (from left): Drs. Sexton, Kollisch-Singule, Nehra, Chung, Saeman, van Laarhoven, Langness, and Chow. Middle row: Drs. Berry and King. Top row (from left): Drs. Moore, Ross, Rissi, Halaweish, and Rice.

Region 3): Prospective Evaluation Hemorrhagic Shock Improves a Traumatic Intracranial of Post-Traumatic Vasospasm Neurological Recovery Hemorrhage Study (PTV) and Post-Injury Functional Outcome Assessment: Is • Melody R. Saeman, MD, • Captain Jonathan J. Sexton, MD, Cerebral Ischemia Going University of Texas Southwestern Johns Hopkins Community Unrecognized in TBI Patients? Medical School, Dallas, PGY-5 Physicians Suburban Hospital, (COT Region 6): Alteration of Bethesda, MD (COT Region 13): Additional selected surgical the Circadian Network following Administration of FTY720 64 | residents and the papers they Traumatic Brain Injury during Tourniquet-Induced Hind presented are as follows: Limb Ischemia-Reperfusion • Haniee Chung, MD, Barnes Injury Attenuates Morbidity and • Elizabeth King, MD, Boston Jewish Hospital, St. Louis, Mortality in a Rodent Model University Medical Center, PGY-5 MO, PGY-5 (COT Region 7): (COT Region 1): Valproic Acid The Problem of Age: The Role • Eduardo Rissi Silva, MD, Hospital Mitigates the Inflammatory of the Immune Response to das Clinicas, Sao Paulo, Brazil Response in Murine Acute Severe Injury in the Elderly (COT Region 14): Prospective Lung Injury at the Expense Evaluation of a Protocol of of Bacterial Clearance • Hunter B. Moore, MD, Whole-Body CT Based Only University of Colorado, in Mechanism of Injury in • Samuel W. Ross, MD, MPH, Denver, PGY-3 (COT Region 8): Major Trauma Patients Carolinas Medical Center, Hyperfibrinolysis Is Driven Charlotte, NC, PGY-4 (COT by Hemorrhagic Shock • Jacqueline van Laarhoven, MD, Region 4): Hemodilution: Fact and Attenuated by Plasma Ratboud University, Netherlands or Fiction? A Prospective, Resuscitation: The Role of (COT Region 15): Associated Randomized Control Trial Plasma First Resuscitation in Thoracic Injury in Patients with to Quantify the Effect of Critically Injured Patients a Clavicle Fracture: An Analysis Blood Loss and Crystalloid of 1478 Polytrauma Patients Resuscitation on Hemoglobin • Timothy J. Rice, MD, Hamilton General Hospital, ON (COT • Felix Che-Lok Chow, MB, BS (HK), • Ihab Halaweish, MD, University Region 12): A Randomized, MHKICSBCS, University of Hong of Michigan, Ann Arbor, Double-Blinded, Placebo- Kong, Queen Mary Hospital (COT PGY-5 (COT Region 5): Early Controlled Pilot Trial on the Region 16): Clinical Parameters Resuscitation with Fresh Efficacy of Early Enoxaparin: Predicting In-Hospital Mortality in Frozen Plasma for Traumatic The Optimal Timing of Geriatric Patients following Severe Brain Injury Combined with Thromboprophylaxis in Trauma: A 15-Year Experience ♦

V100 No 6 BULLETIN American College of Surgeons NEWS

Wall Street Journal article features enhanced recovery protocols Enhanced recovery protocols are changing nutritional guidance, painkilling and anesthetic surgical patients’ perioperative care and medication, and early mobilization. improving outcomes, according to an article The ACS National Surgical Quality in the March 30 The Wall Street Journal (WSJ). Improvement Program (ACS NSQIP®) is Laura Landro, who writes the WSJ column pursuing an initiative for increased acceptance of “The Informed Patient,” interviews Traci enhanced recovery protocols throughout surgery. Hedrick, MD, FACS, co-author of a study in Profiled in the article is a positive patient care the February online edition of the Journal of the enhanced recovery experience at Duke University American College of Surgeons. Dr. Hedrick’s team Medical Center, Durham, NC. In addition, at the University of Virginia Health System, “Kaiser Permanente Northern California is Charlottesville, found that when used in currently introducing the enhanced recovery colorectal surgery patients, enhanced recovery protocol in its 21 medical centers, focusing first contributed to reducing length of hospital stay on colorectal surgery and hip fracture patients. by 2.2 days compared with a control group. It plans to expand the program soon to total Furthermore, complications were reduced by 17 joint replacement,” Ms. Landro reports. percent, patient satisfaction with pain control Ms. Landro writes of this “national initiative led increased by 55 percent, and overall estimated by experts including Julie Thacker [MD, FACS], cost savings was $7,129 per patient. View an assistant professor of surgery at Duke University American College of Surgeons (ACS) press School of Medicine and medical director of the release reporting on the study results at www. enhanced recovery program at Duke University facs.org/media/press-releases/jacs/colorectal0205. Hospital, which has been able to reduce hospital Enhanced recovery protocols are designed to stays and readmissions with the approach.” achieve early recovery after surgical procedures For details on ACS NSQIP’s role in by maintaining organ function and minimizing enhanced recovery, contact [email protected]. | 65 the stress caused by the procedure. The key Read the full text article and view the news elements include preoperative counseling, video online at http://goo.gl/JHQXWW. ♦

A PUBLICATION OF THE AMERICAN COLLEGE OF SURGEONS PROFESSIONAL ASSOCIATION (ACSPA) A PUBLICATION OF THE AMERICAN COLLEGE OF SURGEONS PROFESSIONAL ASSOCIATION (ACSPA) A PUBLICATION OF THE AMERICAN COLLEGE OF SURGEONS PROFESSIONAL ASSOCIATION (ACSPA) Influencing THE ACS HealthInfluencing Policy THE ACS inHealth Washington Policy andin Washington the States ADVOCATE and the States Each month, rely on the Each month, rely on the ACS advocacy e-newsletter: ACS advocacy e-newsletter:  To keep you informed  To keep you informed  To keep you informed  To learn the College’s position on pertinent issues  To learn the College’s position on pertinent issues  To learn the College’s position on pertinent issues  To see how your involvement can make a difference.  To see how your involvement can make a difference.  To see how your involvement can make a difference. Downloadable from most digital communications devices VisitDownloadable www.facs.org/publications/newsletters/acs-advocate from most digital communications devices Visit www.facs.org/publications/newsletters/acs-advocate

Advocacy Summit • AMA House of Delegates/Surgical Caucus • Cancer • Chapter Advocacy • Training • Coding • Electronic Advocacy Summit • AMA House of Delegates/Surgical Caucus • Cancer • Chapter Advocacy • Training • Coding • Electronic AdvocacyHealth Records Summit • e-Prescribing • AMA House • Grassroots of Delegates/Surgical Efforts • Health CaucusInformation • Cancer Technology • Chapter • AdvocacyLegislative • TrainingAction • CenterCoding • • Legislative Electronic Health Records • e-Prescribing • Grassroots Efforts • Health Information Technology • Legislative Action Center • Legislative HealthAdvocacy Records • Liability • e-Prescribing • Lobby Day • GrantGrassroots Program Efforts • Medicaid • Health • MedicareInformation • Medicare Technology Physician • Legislative Payment • ActionPediatric Center Issues • Legislative• Physician Advocacy • Liability • Lobby Day Grant Program • Medicaid • Medicare • Medicare Physician Payment • Pediatric Issues • Physician AdvocacyQuality Reporting • Liability • Political• Lobby Day Action Grant Committee Program (• SurgeonsMedicaid PAC)• Medicare • Quality • Medicare and Patient Physician Safety Payment • Relative • Pediatric Value Update Issues Committee• Physician Quality Reporting • Political Action Committee (SurgeonsPAC) • Quality and Patient Safety • Relative Value Update Committee (RUC)Quality • Socioeconomics Reporting • Political • Surgery Action State Committee Legislative (Surgeons Action CenterPAC) •(SSLAC) Quality • andSurgical Patient Quality Safety Alliance • Relative • Trauma Value and Update EMS •Committee Workforce (RUC) • Socioeconomics • Surgery State Legislative Action Center (SSLAC) • Surgical Quality Alliance • Trauma and EMS • Workforce (RUC) • Socioeconomics • Surgery State Legislative Action Center (SSLAC) • Surgical Quality Alliance • Trauma and EMS • Workforce ACS Advocate Half Page for Bulletin_2_6_15.indd 1 2/6/2015 11:47:38 AM ACS Advocate Half Page for Bulletin_2_6_15.indd 1 2/6/2015 11:47:38 AM ACS Advocate Half Page for Bulletin_2_6_15.indd 1 JUN 2015 BULLETIN American2/6/2015 College 11:47:38 ofAM Surgeons NEWS

Chapter newsnews

by Donna Tieberg

Participants of the WIS Breakfast at the Louisiana Chapter Meeting, including (from left) Ms. Zuniga; Samire Almeida, resident at Universidad Federal do Pará; Dr. Moore; and Dr. Soto.

Sustaining Surgical Quality Commission on Cancer groups Louisiana Chapter Improvement. In addition, Tara each held meetings, as did the 66 | annual meeting features Leystra-Ackerman, State Affairs Louisiana Chapter Women in mock oral exam Associate, and Frank G. Opelka, Surgery (WIS) Committee. The Louisiana Chapter of MD, FACS, Medical Director The WIS Committee Chair, the American College of for Quality and Health Policy, Eliana A. Soto, MD, FACS, Surgeons (ACS) held its annual ACS Division of Advocacy and welcomed meeting attendees. meeting January 16−18 at the Health Policy, spoke about WIS member Rachel L. Moore, InterContinental Hotel in New issues under their purview in the MD, FACS, chief, section of Orleans. This year’s event College’s Washington office. metabolic surgery, Louisiana featured opening remarks by This year’s annual meeting Health Sciences Center, New Louisiana Chapter President included many educational Orleans, introduced featured Barry Landry, MD, FACS. ACS sessions, Resident Paper speaker Kathleen Zuniga, President Andrew L. Warshaw, Awards, a Poster Competition, partner with Carr, Riggs & MD, FACS, FRCSEd(Hon), and the Sixth Annual Surgical Ingram, LLC, who spoke on provided an update on College Jeopardy Bowl, moderated balancing a demanding full-time activities and commented on again by Donnie F. Aultman, career with raising a family. the strengths of the chapter. MD, FACS, assistant vice- A mock oral exam was offered Also in attendance from the chancellor, graduate medical the day before the Louisiana College was James Wadzinski, education designated Chapter annual meeting. The Director of Operations, ACS institutional official, Louisiana event was open to Fellows and National Surgical Quality State University Health postgraduate year (PGY)-4 Improvement Program (ACS Sciences Center, Shreveport. residents; 20 examiners and NSQIP®), and Susan Chishimba, The grand prize winner of the 14 residents participated, and Business Development Associate, 2015 Resident Jeopardy Bowl 10 chapter members donated ACS NSQIP. Mr. Wadzinski was Tulane University School the use of their hotel rooms shared the podium with Scott of Medicine, New Orleans. for the four-and-a-half-hour J. Ellner, DO, MPH, FACS, Representatives from the program. The event ended who spoke on Identifying and local Committee on Trauma and with a social hour for meeting

V100 No 6 BULLETIN American College of Surgeons NEWS

Attendees at the North Texas Chapter meeting, including (from left) Dr. Watkins; Michael S. Truitt, MD, FACS, North Texas Chapter President, Methodist Dallas Medical Center; Subhasis Misra, MB, BS, FACS, North Texas Program Co-Chair, Midwestern Regional Medical Center, Amarillo, TX; and Jeffrey P. Lamont, MD, FACS, Program Chair, Texas Oncology, Dallas.

Attendees at the Connecticut Chapter meeting, including (from left) Scott H. Kurtzman, MD, FACS; Gary J. Price, MD, FACS; Kathleen A. LaVorgna, MD, FACS; Dr. Bailey; Scott J. Ellner, DO, MPH, FACS; and Valerie J. Vitale, MD, FACS, President, Hartford County Medical Association. | 67 participants, College staff, and and social events, and Resident participating. Assisting the some chapter members. and Associate members. All Chapter Council with annual Jordan Chapter members will meeting preparations was be encouraged to volunteer for new Chapter Administrator Jordan Chapter holds the proposed new committees Carrie Steffen. first council meeting based on personal interest. This year the North Texas as a new chapter Abdul Naser Al Shunaigat, MB, Chapter offered financial The Jordan Chapter of the ACS BS, FACS, Chapter Treasurer, assistance to 12 resident hosted its first official council introduced a discussion of chapter surgeons and medical students meeting February 18 at the Jordan dues during the council meeting. traveling to the meeting from Hospital in Amman. The meeting Osama Hamed, MB, BS, FACS, institutions outside Dallas. Each followed the chartering of the Chapter Secretary, encouraged recipient was compensated chapter by the Board of Regents all present to attend the first for up to two nights hotel on February 7. Presiding officers annual meeting of the chapter, accommodations and given $200 at the meeting were Abdalla Yunis which took place April 25. to offset the cost of travel. Bashir, MB, BCh, FACS, ACS Representing the College at Governor, and Chapter President the meeting was Kenneth L. Mahmoud Abu-Khalaf, MB, North Texas Chapter meeting Mattox, MD, FACS, ACS Second BCh, FACS. Also discussed at the offers travel awards Vice-President, who offered council meeting were activities The 2015 ACS North Texas an update on ACS activities planned by the chapter for the Chapter meeting took place along with an overview on upcoming year and the formation February 20–21 at the Cityplace best practices for using the of standing committees in the Conference Center in Dallas, online ACS Communities. areas of education, membership with more than 150 surgeons, In addition, the North finance, communications, issues residents, and medical students Texas Chapter meeting

JUN 2015 BULLETIN American College of Surgeons NEWS

Dr. Robinette (at podium) addresses chapter members and ACS staff at the first annual meeting of the revitalized Alaska Chapter.

A view of the Cook Inlet, from the top of the Hotel Captain Cook in Anchorage. Most of the population of Alaska surrounds Cook Inlet.

featured the annual Resident Society, sponsored a Lobby Day Paper Competition, a Poster March 11 in Hartford. Several Revitalized Alaska Chapter Exhibition, and a Resident ACS Fellows were in attendance elects officers, holds Jeopardy Competition. The and advocated on legislation first annual meeting 2015 Winner for Best Overall being debated in the statehouse, On March 14, the Alaska Chapter Paper was Jeffrey R. Watkins, including bills that would held its first meeting since the 68 | MD, a PGY-4 general surgery establish a legal definition of mid-1980s, with newly elected resident at Methodist Dallas surgery, increase coverage for Chapter President Danny R. Medical Center. Dr. Watkins bariatric surgery, and mandate Robinette, MD, FACS, presiding was awarded $250 for his truth in advertising. The day over the day’s educational and paper “Keyhole Mesh in Large opened with Connecticut Chapter social events. The meeting took Paraesophageal Hernias: A Safe members commenting on the place at Hotel Captain Cook in Technique with Low Rates of activities of the Connecticut Anchorage, named for Captain Dysphagia.” Best Poster was Surgical Quality Collaborative James Cook, who was the first awarded to Bharti Jasra, MD, and the Enhanced Recovery person credited with mapping PGY-5, at the University of after Surgery initiative, and a the state’s jagged coastline. A Texas, Southwestern Medical national legislative update from total of 20 Fellows attended the Center, Dallas, for “Failure of Patrick V. Bailey, MD, FACS, meeting, and a combined total of a Breast Density Notification Medical Director of Advocacy, 28 Fellows, guests, sponsors, and Law to Impact the Screening of ACS Division of Advocacy and College staff participated in an Women with Dense Breasts.” Health Policy. The day’s activities evening reception and dinner. A trophy was given to the also included a conversation Patricia L. Turner, MD, Resident Jeopardy Competition with State Comptroller Kevin FACS, Director, ACS Division of winners, the team from the Lembo. Chapter members were Member Services, provided an department of surgery at Texas briefed on the current legislative update on ACS activities and gave Tech University, Lubbock. environment, and then adjourned a presentation on Abdominal to attend individual meetings Wall Reconstruction. Meg Gilley, with state legislators, including Congressional Lobbyist, ACS Connecticut Chapter holds Senate Majority Leader Bob Division of Advocacy and Health 2015 Lobby Day in Hartford Duff (D). The day concluded Policy, offered an overview of The Connecticut Chapter of with a luncheon featuring the College’s legislative activities. the ACS, in conjunction with leaders from both sides of the Also in attendance was Donna the Connecticut State Medical Connecticut General Assembly. Tieberg, ACS Chapter Services

V100 No 6 BULLETIN American College of Surgeons NEWS

R. Phillip Burns Surgical Society established in Tennessee A large crowd of friends and colleagues were on hand to celebrate the establishment of the R. Phillip Burns Surgical Society February 23 in Chattanooga, TN. This new society recognizes the contributions that Dr. Burns, a Fellow and Past First Vice-President of the ACS, has made to surgical education and provides “a forum for the advancement of surgical training in Tennessee as well as to promote collegiality among surgeons.” Left: Attendees at the inaugural meeting included (from left): Kenneth W. Sharp, MD, FACS, Vanderbilt University Medical Center; Laura E. Witherspoon, MD, FACS, University Surgical Associates, Chattanooga; Dr. Burns, University Surgical Associates; ACS President- Elect J. David Richardson, MD, FACS; and Harold (David) Head, MD, FACS (retired), Signal Mountain, TN.

Manager, who worked with Alaska Fellows together The series kicked off March 18 Dr. Robinette as administrator include changes to medical with “Protect Your Chapter’s for the Alaska Chapter meeting reimbursements, the evolving History: Archiving 101,” hosted and chapter activities during political climate, and threats to by Adam Carey, MA, MLIS, the revitalization period. both national and state trauma ACS Archivist. Other titles and | 69 In addition, guest speaker funding. The chapter plans to presenters included When Board Mika N. Sinanan, MD, FACS, work closely with Jon Sutton, Members Go Bad: Practical ACS Governor and professor Manager of State Affairs, Aspects of Hard Problems, of surgery, University of ACS Division of Advocacy featuring ACS legal counsel Washington, Seattle, spoke on and Health Policy, to obtain Paula Goedert, Esq., Barnes & Managing the Complex Referral funding for a state lobby day. Thornburg, LLP; and Governors Patient. Frank D. Sacco, MD, 101: Building a Partnership, FACS, a general surgeon at hosted by Betty A. Sanders, MBA, Alaska Native Medical Center, ACS Chapter Services PMP, Senior Administrator, Anchorage, gave an Update announces new webinar series ACS Board of Governors. on the State of Alaska Trauma ACS Chapter Services is now To register and view a full System. A lively Town Hall offering a new free chapter list of webinars, go to the ACS discussion involving chapter webinar series for ACS members Chapter Services webinar page members and guests focused and chapter administrators/ at www.facs.org/member-services/ on future chapter goals. The staff. The webinars focus on best chapters/webinars. For questions chapter council, including practices and important issues regarding registration or officers and councilors-at- in ACS chapter management. accessing webinar recordings, large, met to further solidify This series is aimed at anyone contact Vivian Ross, Chapter and outline the goals discussed involved in ACS chapter Services Program Coordinator at the Town Hall session. management. The 45-minute at [email protected]. ♦ Over the past 18 months, webinars are presented live, a small yet active core group with time for questions at the of Fellows in Alaska has been end of each session. These brief instrumental in reviving interest but informative sessions are in the chapter. Significant being recorded and are accessible motivating factors for bringing online after the webinars.

JUN 2015 BULLETIN American College of Surgeons Save Up to 20% on Group Level Term Life Insurance

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*Rates displayed include the 20% premium discount currently in effect for 2015. Applicants can Underwritten by New York Life Insurance Company, New York, NY 10010, qualify for super preferred non-smoker, preferred non-smoker, non-smoker, preferred smoker under Group Policy Form GMR, Complete terms, conditions, definitions, and smoker. Upon approval of your application you will be notified of the rate classification for exclusions, limitations and renewability are outlined in the Certificate of each approved applicant. All rates and discounts can be found on ACS-Insurance.com. Insurance provided to each insured for each coverage.

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2015 Health Policy Scholars announced

Dr. Chu Dr. Powell Dr. Lam Dr. Chandrasekhar

| 71

Dr. Winchell Dr. Chen Dr. Jones Dr. Shim

A total of 17 surgeons will surgical specialty society. For Sandi Lam, MD, FACS, Baylor participate in the Leadership details about the scholarship College of Medicine/Texas Program in Health Policy and program and past participants, Children’s Hospital, Houston Management in June at the Heller see www.facs.org/member-services/ School for Social Policy and scholarships/health-policy. This • ACS/American Academy of Management, Brandeis University, year’s awardees are as follows: Otolaryngology–Head and Neck Waltham, MA, in June. Surgery Health Policy Scholar: Each year, the American • ACS Health Policy Scholar Sujana S. Chandrasekhar, MD, College of Surgeons (ACS) for General Surgery: Quyen FACS, New York Otology, NY; New partners with 16 surgical specialty D. Chu, MD, FACS, Louisiana York Head and Neck Institute, NY groups to help design the course State University Health and award scholarships to Sciences Center, Shreveport • ACS/American Association for surgeons who are ACS Fellows the Surgery of Trauma Health and members in good standing • ACS Health Policy Scholar for Policy Scholar: Robert J. Winchell, of these organizations. The General Surgery: Anathea C. MD, FACS, University of Texas scholarships pay for participation Powell, MD, Phoenix Indian Health Sciences Center, Houston in the week-long, intensive course. Medical Center, AZ Each scholar is then expected • ACS/American Pediatric Surgery to provide a year’s service in a • ACS/American Association Association Health Policy Scholar: health policy-related capacity to of Neurological Surgeons Mike K. Chen, MD, FACS, University the College and the cosponsoring Health Policy Scholar: of Alabama, Birmingham

JUN 2015 BULLETIN American College of Surgeons SCHOLARSHIPS

Each year, the ACS partners with 16 surgical specialty groups to help design the course and award scholarships to surgeons who are ACS Fellows and members in good standing of these organizations.

Dr. Potenti Dr. Lee Dr. Ferzandi Dr. Smith

72 |

Dr. Brownstein Dr. Seymour Dr. Reid Lombardo Dr. Conklin Dr. Lipsitz

• ACS/American Surgical MBA, MPH, FACS, Beth Israel Neal E. Seymour, MD, FACS, Association Health Policy Deaconess Medical Center Tufts University School of Scholar: Daniel B. Jones, MD, Medicine, Springfield, MA MS, FACS, Beth Israel Deaconess • ACS/American Urogynecologic Medical Center, Boston, MA Society Health Policy Scholar: • ACS/Society for Surgery of Tanaz R. Ferzandi, MD, Tuf ts the Alimentary Tract Health • ACS/American Society of Breast Medical Center, Boston, MA Policy Scholar: KMarie Reid Surgeons Health Policy Scholar: Lombardo, MD, MS, FACS, Veronica Shim, MD, FACS, Kaiser • ACS/American Urological Mayo Clinic, Rochester, MN Permanente, Berkeley, CA Association Health Policy Scholar: Norm D. Smith, MD, • ACS/Society of Thoracic • ACS/American Society University of Chicago, IL Surgeons Health Policy Scholar: of Colon and Rectal Jeremy Conklin, DO, MPH, MBA, Surgeons Health Policy • ACS/Eastern Association for Albany Medical Center, NY Scholar: Fabio Potenti, the Surgery of Trauma Health MD, MBA, FACS, Cleveland Policy Scholar: Michelle R. • ACS/Society for Vascular Clinic Florida, Weston Brownstein, MD, University of Surgery Health Policy Scholar: North Carolina, Chapel Hill Evan C. Lipsitz, MD, FACS, • ACS/American Society of Montefiore Medical Center, Plastic Surgeons Health Policy • ACS/New England Society of Albert Einstein College of Scholar: Bernard T. Lee, MD, Surgery Health Policy Scholar: Medicine, Bronx, NY ♦

V100 No 6 BULLETIN American College of Surgeons SCHOLARSHIPS

ACS awards five Faculty Research Fellowships

The American College of Surgeons TX. Research project: Allogeneic (ACS) has awarded five Faculty Antibody Therapy for Non- Research Fellowships for 2015. Small Cell Lung Cancer These two-year fellowships are offered to surgeons entering • C. James Carrico, MD, FACS, careers in surgery or a surgical Faculty Research Fellow: specialty and carry awards of Steven J. Schwulst, MD, FACS, $40,000 per year from July 1, assistant professor of surgery, 2015, through June 30, 2017. Northwestern University, Three of the Faculty Research Chicago, IL. Research project: Fellowships are named in honor The Role of Infiltrating Myeloid of past ACS leaders and sponsored Cells in Traumatic Brain Injury- Dr. Burt by the Scholarship Endowment Induced Immune Suppression | 73 Fund of the College. The Franklin H. Martin, MD, FACS, Faculty • Thomas R. Russell, MD, FACS, Research Fellowship of the Faculty Research Fellow: American College of Surgeons Kathleen B. To, MD, FACS, assistant honors the founder of the College. professor of surgery, University of The C. James Carrico, MD, FACS, Michigan, Ann Arbor. Research Faculty Research Fellowship project: Emergency General for the Study of Trauma and Surgery—Catalyst for Change: Critical Care honors the late Outcomes, Models of Care and Dr. Carrico. The new Thomas Performance Improvement R. Russell, MD, FACS, Faculty Research Fellowship is provided Additional undesignated Dr. Schwulst by the Thomas R. Russell Fund, Faculty Research Fellowships and supports research aimed at for 2015–2017 were awarded improving surgical outcomes. The to the following individuals: award honors the late Dr. Russell, who served as ACS Executive • Stephen H. McKellar, MD, FACS, Director from 2000 to 2010. assistant professor of surgery, The recipients of these University of Utah, Salt Lake fellowships are as follows: City. Research project: Genomic and Metabolomic Analysis of • Franklin H. Martin, MD, FACS, Energy Metabolism in Right Faculty Research Fellow: Bryan Heart Failure and Recovery M. Burt, MD, FACS, assistant professor of surgery, Baylor • Bedabrata Sarkar, MD, PhD, Dr. To College of Medicine, Houston, assistant professor of surgery,

JUN 2015 BULLETIN American College of Surgeons SCHOLARSHIPS

Dr. McKellar Dr. Sarkar

Boston University School of next application deadline for the Endowment Fund are welcome. Medicine, MA. Research project: 2016 Faculty Research Fellowships Fellows who are interested in Mitochondrial DNA Regulates will be November 2, 2015. making tax-deductible gifts to Cytokine mRNA Stability in Sepsis These awards are funded fund these vital programs via the through the ACS Scholarship Scholarship Endowment Fund or Endowment Fund, which was the Thomas R. Russell Fund are Applications established to provide income to encouraged to contact the ACS The description and requirements fund scholarships and fellowships Foundation at 312-202-5338. ♦ for this program are posted at awarded by the ACS Board of www.facs.org/member-services/ Regents. Direct contributions scholarships/research/acsfaculty. The to support the Scholarship

| 74 American College of Surgeons O cial Jewelry & Accessories #S5 #S6 #S1 designed, craed and produced exclusively by Jim Henry, Inc. #S2 Tie Tac/Lapel Pin Ring Rollerball Pen - Chrome #S1 Gold-Filled $60 #S14 Solid 14K Gold $2250 #S25 Cross Townsend #S2 Solid 14K Gold $350 #S14.1 Solid 10K Gold $1675 Medalist with 23/K (Indicate nger size) Gold Plated Emblem $135 Cuff Links #S3 Gold-Filled $200 Tie Bar Money Clip (Not Shown) #S15 #S4 Solid 14K Gold $1150 #S15 Gold-Filled Emblem $75 #S26 With Gold-Filled emblem $75 #S3 Key (shown actual size Necktie #S4 of 3/4 ) #S16A Dark Blue $35 Desk Set (Not Shown) #S5 Gold-Filled $85 #S16B Light Blue $35 #S27 Solid Walnut with Cross #S6 Solid 14K Gold $700 #S17 Maroon $35 Gold-Filled Pen & Pencil/Gold- Extra long add $5.00 Filled emblem; name and year Miniature Key elected a Fellow engraved on

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Designed expressly for the American College of • Please use model # and item description Jim Henry, Inc. Surgeons, these emblematic items are crafted to when ordering 435 irty-Seventh Avenue perfection in the Jim Henry tradition of excellence. • Include payment with order St. Charles, Illinois 60174 • VISA, American Express, & MasterCard accepted phone 630 584 6500

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V100 No 6 BULLETIN American College of Surgeons SCHOLARSHIPS

ACS awards six Resident Research Scholarships

Dr. Patel Dr. Olson Dr. Woodard Dr. Wolf Dr. Grisotti Dr. Marshall

The American College of Heparin-Binding-Like Growth surgery. Research project: Surgeons (ACS) has awarded six Factor: A Novel Therapy for Inhibition of Tumor Growth Resident Research Scholarships Necrotizing Enterocolitis by Healing Wounds for 2015–2017. The scholarships are offered to encourage • Gavitt A. Woodard, MD, PGY-4, residents to pursue careers in University of California, San Applications | 75 academic surgery and carry Francisco. Projected specialty: The description and requirements awards of $30,000 for each Thoracic surgery. Research for this scholarship are posted of two years, beginning July project: Sonic Hedgehog and at www.facs.org/member-services/ 1, 2015. The recipients of the Gli Pathway and Erlotinib scholarships/resident/acsresident. 2015–2017 Resident Research Resistance in Lung Cancer The application deadline for Scholarships are as follows: the 2016 Resident Research • Lindsey Wolf, MD, PGY-3, Brigham Scholarships is September 1, 2015. • Madhukar S. Patel, MD, & Women’s Hospital, Boston. The Scholarship Endowment postgraduate year (PGY)-3, Projected specialty: Surgery, acute Fund of the College sponsors at Massachusetts General care surgery. Research project: these scholarships. Hospital, for research to be Improving Access to Surgical Care The Scholarship Endowment performed at Beth Israel in Vulnerable Populations: A Pilot Fund was established to provide Deaconess Medical Center, Proposal Using Mixed Methods income to fund scholarships Boston. Projected specialty: and fellowships awarded by Surgery. Research project: • Gabriella Grisotti, MD, PGY-3, the ACS Board of Regents. Preventing Device Associated Yale University, New Haven, Direct contributions to support Infections Using Slippery Liquid- CT. Projected specialty: the Scholarship Endowment Infused Porous Surfaces Pediatric surgery. Research Fund are welcome. Fellows project: Determining the who are interested in making • Jacob K. Olson, MD, PGY-3, Loma Role of Lymphotoxin-a in tax-deductible gifts to fund Linda University Medical Center, the Lymphangiogenesis these vital programs are CA, for research to be performed of Wound Healing encouraged to contact the ACS at Nationwide Children’s Hospital, Foundation at 312-202-5338. ♦ Columbus, OH. Projected • Clement Marshall, MD, PGY-2, specialty: Pediatric surgery. Stanford University, CA. Research project: Probiotics and Projected specialty: Transplant

JUN 2015 BULLETIN American College of Surgeons MEETINGS CALENDAR

Calendar of events*

*Dates and locations subject to change. For more information on College events, visit www.facs.org/events or http://web2.facs.org/ChapterMeetings.cfm

Illinois Chapter Georgia Society of the ACS JUNE June 18–20 August 29–30 Peoria, IL Atlanta, GA Austria-Hungary Chapter Contact: Luann White, Contact: Kathryn Browning, June 3–5 [email protected], [email protected], www.georgiaacs.org Linz, Austria www.ilchapteracs.org Contact: Albert Tuchmann, [email protected] SEPTEMBER Alabama & JULY Jacksonville Chapter Mississippi Chapters September 1 June 4–6 North Carolina Jacksonville, FL Point Clear, AL & South Carolina Chapters Contact: Patti Chapman, Contact: Lisa Beard, July 17–19 [email protected] [email protected], Pinehurst, NC www.alabamaacs.org and Contact: Jennifer Starkey, Kansas Chapter www.mschap-acs.com [email protected], September 11–12 www.ncfacs.org and www.scfacs.org Overland Park, KS 76 | Brooklyn-Long Island Chapter Contact: Denise Lantz, June 9 2015 ACS NSQIP [email protected], Garden City, NY National Conference www.kansaschapteracs.org Contact: Teresa Barzyz, July 25–28 [email protected], www.bliacs.org Chicago, IL New Mexico Chapter Contact: ACS NSQIP staff, September 18–19 Lebanon Chapter [email protected], Albuquerque, NM June 11–13 www.acsnsqipconference.org Contact: Gloria Chavez, Beirut, Lebanon [email protected] Contact: Muhammad Younis, Tennessee Chapter [email protected], July 31–August 2 www.facs-lebanon.org Knoxville, TN Contact: Wanda McKnight, FUTURE CLINICAL Northeast Mexico Chapter [email protected], CONGRESSES June 11–13 www.tnacs.org Nuevo León, Mexico 2015 Contact: Raul Lozano-Quiroga, October 4–8 [email protected] Chicago, IL AUGUST Washington & 2016 Oregon Chapters Colombia Chapter October 16–20 June 11–14 August 11–14 Washington, DC Cle Elum, WA Bogota, Colombia Contact: Harvey Gail, Contact: Sonia Babativa, 2017 [email protected], [email protected] October 22–26 www.wachapteracs.org and San Diego, CA www.oregonchapteracs.org

V100 No 6 BULLETIN American College of Surgeons