The diversity effect

Washington University Department of Surgery 1School | surgery.wustl.edu of Medicine Annual Report 2017 The diversity effect Core values shape a department The Department of Surgery is building a more diverse workforce — and a stronger, more vibrant future. A commitment to nine core values, personified by these surgeons and researchers, is making it possible. Read their stories inside. Vascular surgery Chief Luis Sanchez, MD, performs a vascular stent graft procedure. CONTENTS

Letter From the Chair 1

Introduction 2

Division of Cardiothoracic Surgery 4 Section of Cardiac Surgery 6 Section of General Thoracic Surgery 8 Section of Pediatric Cardiothoracic Surgery 10

ON THE COVER Division of General Surgery 12 Among those embracing the Section of Acute and Critical Care Surgery 14 department’s diversity and inclusion Section of Colon and Rectal Surgery 16 efforts are, left to right: endocrine and oncologic surgeon Rebecca Aft, MD, Section of Endocrine and Oncologic Surgery 18 PhD; public health sciences researcher Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery 20 Bettina Drake, PhD, MPH; St. Louis Children’s Hospital Surgeon-in-Chief Section of Minimally Invasive Surgery 22 Brad Warner, MD; plastic and Section of Transplant Surgery 24 reconstructive surgeon Ida Fox, MD; cardiothoracic surgeon Alec Patterson, Section of Vascular Surgery 26 MD; surgical/trauma intensivist and emergency medicine physician Tiffany Division of Pediatric Surgery 28 Osborn, MD, MPH; general surgery resident Leisha Elmore, MD; urologic Division of Plastic and Reconstructive Surgery 32 surgeon and Faculty Practice Plan Chief Medical Officer Sam Bhayani, Division of Public Health Sciences 36 MD; and hepatobiliary-pancreatic and gastrointestinal surgery Chief William Hawkins, MD. Division of Urologic Surgery 40

COVER PHOTO BY JAY FRAM Education 44

ALL PHOTOGRAPHS BY TIM PARKER UNLESS OTHERWISE NOTED Research 50

Clinical Operations 56

Washington University Medical Campus 60

St. Louis 62

Leadership 64

Faculty 66

Giving 70

Washington University encourages and gives full consideration to all applicants for admission, financial aid and employment. The university does not discriminate in access to, or treatment or employment in, its programs and activities on the basis of race, color, age, religion, sex, sexual orientation, gender identity or expression, national origin, veteran status, disability or genetic information. Inquiries about compliance should be addressed to the university’s Vice Chancellor for Human Resources, Washington University, Campus Box 1184, One Brookings Drive, St. Louis, MO 63130. The School of Medicine is committed to recruiting, enrolling and educating a diverse student body. MARK KATZMAN Letter from the Chair

e embarked on a journey of self-discovery and growth more than Wa decade ago, when we conducted a faculty survey that revealed the need to improve faculty mentoring and elements of our work culture. At the same time, we recognized the need for greater diversity within our department to reflect the growing numbers of women and underrepresented minorities entering the field of medicine. Since then, we have committed to creating a work environment in which everyone is valued and supported. We have made great strides in providing faculty leadership and mentorship opportunities, setting expectations for behavior, and also fully participating in an institution-wide diversity and inclusion training program. An organic outcome of this process has been to increase diversity and to become more inclusive in the operating room and other work settings. According to a report by the Association of American Medical Colleges, medical students were almost evenly divided between men and women in 2016. The number of underrepresented minorities continues to increase steadily. Our department actively recruits residents and faculty from diverse backgrounds. About 40 percent of last year’s class of general surgery residents were women, and the class overall was a diverse group. We have two women faculty with endowed chairs, and we recently promoted Associate Professors M.B. Majella Doyle, MD, MBA, and Mary Politi, PhD, to lead mentoring efforts and Professor Tiffany Osborn, MD, MPH, to guide leadership and behavioral excellence among faculty. There are many things we can’t control, but among those we can are the work environment, training approaches and behavioral influences. Being open to others’ observations in the operating room, promoting leadership training and establishing zero tolerance for bad behavior creates not only a more inclusive environment, but also a safer one for patients. We also aim for the fairest compensation possible, considering research success, clinical work and educational accomplishments. This report reflects how our changing departmental culture has affected the makeup of the people who choose to build their careers here, and how that growing diversity is in turn shaping our future. Our growing diversity is a welcome change and a strength — a trend we hope will only increase.

Timothy Eberlein, MD William K. Bixby Professor of Surgery Chair, Department of Surgery Washington University School of Medicine Director, Alvin J. Siteman Cancer Center

Department of Surgery Annual Report 2017 | 1 In the Division of Plastic and Reconstructive Surgery, each surgery begins with a team meeting, simulated below, to review the upcoming procedure and its necessary materials. The exercise is designed to foster egalitarian relationships, honest communication and, ultimately, patient safety, says Division Chief Susan Mackinnon, MD, far right.

2 | surgery.wustl.edu THE DIVERSITY EFFECT Core Values Shape a Department

CORE VALUES: The value of diversity is self-evident;when talented people bring varying perspectives Psychological safety to bear on complex problems, innovation Leadership training flourishes and richer solutions arise. It’s a powerful recipe for addressing today’s Broad promotion criteria toughest medical challenges. Recruiting diversity in all forms Mirroring a university-wide effort, the Addressing disparities Department of Surgery has made a major commitment to embracing several core Fostering leadership values that support a culture of diversity. Work-life balance As a result, the department is building an increasingly diverse faculty, a broader Mentorship research portfolio, and an environment Serving a diverse that fosters optimal patient care and population faculty satisfaction.

Despite progress, much work remains, through ongoing, intentional effort. The desired outcome: a department well prepared to solve the health care challenges of tomorrow.

Department of Surgery Annual Report 2017 | 3 4 | surgery.wustl.edu Division of Cardiothoracic Surgery

Cardiac Surgery • General Thoracic Surgery • Pediatric Cardiothoracic Surgery • Critical Care Service in the Cardiothoracic Intensive Care Unit CORE VALUE: Psychological safety

Alec Patterson, MD The division is a national referral center Across the department, formal efforts over the past decade have for complex cardiothoracic conditions and promoted psychological safety — the concept that members of has one of the world’s oldest, most respected a team should feel safe sharing ideas, concerns and mistakes. The residency programs. Its faculty advance notion is key to a healthy work environment and is essential for patient care through pioneering research. patient safety. As head of the department’s Leadership and Professionalism Committee since its inception in 2006, thoracic surgeon Alec Patterson, MD, patient care has led psychological safety clinical and related efforts and watched research them evolve. They began with 87 outpatient total an all-faculty peer review and studies visits procedures now include projects to foster teamwork and full participation 19,175 14,142 in the school’s four-part diversity and inclusion training. He recently research grants 4.8 started sharing leadership responsibilities with Tiffany million peer-reviewed Osborn, MD, MPH, but remains publications committed to improving patient $ 2016 93 safety, empowering every team member and helping everyone faculty appreciate diversity in the 25 operating room. Patterson also is a proponent of the #HeforShe All figures FY2016–17 unless otherwise noted movement promoting gender equality. “We should encourage men to foster women,” he says.

Department of Surgery Annual Report 2017 | 5 Surgeon Spencer Melby, MD, speaking here with nurse colleague Melita Ware, MSN, ANP-BC, has led an interdisciplinary project applying staff education and closer patient monitoring to reduce the time patients spend on ventilators.

6 | surgery.wustl.edu6 | surgery.wustl.edu Division of Cardiothoracic Surgery Highlights Cardiac Surgery Targeted efforts reduce time on ventilators

ashington University cardiac surgeons have significantly reduced Wthe amount of time patients are on ventilation after surgery, an important measure of surgical care quality. “Evidence suggests that the longer patients stay on ventilation, the higher their chances of getting a ventilator-associated pneumonia,” says cardiac surgeon Spencer Melby, MD. “The risk goes up about 10 percent CARDIAC SURGEONS PERFORMED more than every day patients are ventilated after surgery. Prolonged ventilation also 1,200 major cardiac procedures in 2016 — the most in the division’s history. They also keeps the patient sedated longer and slows the recovery process.” extended services into central Illinois and Melby and a multidisciplinary quality-improvement team have spent southern Missouri through collaborative the past two years working to reduce prolonged ventilation — defined by agreements with UnityPoint Health - the Society of Thoracic Surgeons as longer than 24 hours — in patients Methodist | Proctor hospitals in Peoria, Ill., and SoutheastHEALTH system in Cape undergoing coronary artery bypass graft (CABG) and aortic valve Girardeau, Mo. The section also collaborates replacement (AVR). As a result, CABG patients experiencing prolonged with Blessing Hospital in Quincy, Ill., and ventilation decreased from 15 percent in 2014 to 12.8 percent in 2016, and Good Samaritan Hospital in Mount Vernon, Ill. High-risk patients gain greater access to in AVR patients, the rate decreased from 11.7 percent to 8.7 percent. The advanced open-heart surgery and clinical average hours spent on ventilation also decreased — from 42.1 hours to trials, and the institutions’ surgeons benefit 33.7 hours in CABG patients and from 41.2 to 16.7 hours in AVR patients. from on-site training, Washington University educational seminars, consultation services Melby, cardiac surgeon Keki Balsara, MD, anesthesiologist Charl De and quality-assurance input. Wet, MD, and cardiothoracic surgery intensive care unit (CT ICU) clinical nurse manager Elaine Thomas-Horton, RN, accomplished the reductions largely through education of physicians, nurses and nurse practitioners HERSH MANIAR, MD, was the senior author of studies suggesting that preoperative about the importance of removing patients from ventilation as soon pulmonary function tests should be a part of as possible. Staff in the eICU, a remote monitoring facility, also assist the workup for surgical or transcatheter aortic by reminding the CT ICU team when 12 and 18 hours have gone by — valve replacement (TAVR) and on evaluating the learning curves for surgeons using alternative logical intervals at which to reassess the need for ventilation. methods to gain vascular access for TAVR. The Washington University cardiac surgeons and anesthesiologists are Journal of Thoracic and Cardiovascular Surgery ahead of the curve on taking patients off ventilators in the operating room and Annals of Thoracic Surgery published the papers. Maniar is co-principal investigator of the before moving them to the CT ICU. At Barnes-Jewish Hospital, about PARTNER (Placement of AoRTic traNscathetER) III 30 percent of CABG and AVR patients are extubated, or removed from clinical trial, which studies the use of minimally ventilation, in the operating room, compared with about 3 percent of invasive surgical techniques to place aortic valve devices vs. open-heart aortic valve replacement cardiac surgery patients nationally. in low-risk patients. “To extubate in the operating room, you have to be comfortable your patient is doing well and that the surgery went well,” says Melby. Melby and colleagues are now working with surgeons at Christian “IN THE WORDS OF THE PRESIDENTS,” a book by cardiac surgery Chief Marc Moon, Hospital and Missouri Baptist Hospital to improve surgical outcomes. MD, presents interviews of all 29 living past presidents of the American Association for Thoracic Surgery (AATS). Five past presidents were Washington University faculty, including Alec Patterson, MD, who was president in 2009-2010.

Department of Surgery Annual Report 2017 | 7 Through basic science research on the immune system, Daniel Kreisel, MD, PhD, left, and Andrew Gelman, PhD, are pursuing methods to advance transplant treatment.

8 | surgery.wustl.edu8 | surgery.wustl.edu Division of Cardiothoracic Surgery Highlights General Thoracic Surgery Transplant program gets top outcomes rating

n 2016, as it celebrated two major milestones, the Washington University Iand Barnes-Jewish Lung Transplant Program was recognized for generating among the nation’s best lung transplant outcomes. The program received the highest rating from the Scientific Registry of Transplant Recipients, an evaluation based on the percentage of patients surviving with a functioning transplanted lung one year after transplant. Only four PERFORMING ROBOTIC THORACIC SURGERIES out of 77 centers received this rating. The program also became one of the and training cardiothoracic surgery fellows in the technique is a priority of section surgeons few U.S. centers to perform 1,500 total adult lung transplants, and for the Varun Puri, MD, MSCI, and Benjamin Kozower, year, surgeons performed 83 — a hospital record. MD, MPH, pictured above. In addition, former Cardiothoracic surgeon Keki Balsara, MD, presented the center’s long- fellow Alex Bribriesco, MD, and current fellow term outcomes at the American Association for Thoracic Surgery 2017 Ruben Nava, MD, have received fellowships from the American Association for Thoracic Surgery Annual Meeting, comparing survival rates among patients who received and the company Intuitive Surgical to undergo transplants before and after the national system changed in 2005 to allocate online training in robotics and to use inanimate lungs based on disease severity rather than wait time. The five-year survival models and cadavers to gain hands-on skills. The fellowship also requires attending surgeons rate increased from 56.8 percent to 68.3 percent, the latter being among the to expose fellows to a set amount of robotic highest survival rates reported to date. cases in a fixed amount of time after training. Daniel Kreisel, MD, PhD, surgical director of the Lung Transplant

Program, attributes the group’s success to several factors. “We have a VARUN PURI, MD, MSCI, has been named strong multidisciplinary approach and a very good supporting staff. associate surgical director of the Washington Improvements in immunosuppression, perioperative care and treating University and Barnes-Jewish Lung Transplant Program. Puri has an active lung transplant chronic rejection also benefit patients,” he says. practice and an interest in clinical-outcomes In addition, the program has a long-standing policy of performing research. As associate director, he will work only double-lung transplants, which yield better outcomes than single- with pulmonologists to establish a single lung transplants. clinical database of lung transplant cases to drive quality assurance and quality- Kreisel and researcher Andrew Gelman, PhD, also advance lung improvement projects. Currently, multiple transplant treatment through the National Institutes of Health (NIH)- databases hold lung transplant information. funded Thoracic Immunobiology Laboratory, based at Washington

University. Gelman’s lab discovered that an enzyme therapy currently used STRONG BASIC SCIENCE and clinical-outcomes to avoid tissue damage at the time of transplant may inhibit the ability research are among the section’s attributes. of immunosuppressants to promote survival; his lab is testing potential Puri, Bryan Meyers, MD, MPH, and Benjamin Kozower, MD, MPH, have contributed to major remedies. Kreisel’s research has identified a new immunological pathway findings in treatment outcomes for early stage that causes lung rejection. And postdoctoral research fellow Hsi-Min lung and esophageal cancer and surveillance Hsiao, PhD, has described cellular mechanisms that contribute to primary after lung cancer surgery. Having three general graft dysfunction — a syndrome of tissue damage that is a major cause of surgery residents — Tara Semenkovich, MD, MPHS, Jessica Hudson, MD, MPHS, and early death and long-term complications. Melanie Subramanian, MD — who focus their “Our collaborative work has yielded experimental tools to help research this year on clinical outcomes in understand what causes lung transplant rejection, information that can thoracic surgery is another testament to the section’s strength in this area. be used to identify new approaches to treat it,” says Gelman.

Department of Surgery Annual Report 2017 | 9 Washington University surgeons at St. Louis Children’s Hospital AARON ARBANELL run the world’s most experienced lung transplant program, having performed more than 400 lung and heart-lung transplant procedures. Peter Manning, MD, left, and Pirooz Eghtesady, MD, PhD, right, are among those involved.

10 |10 surgery.wustl.edu | surgery.wustl.edu Division of Cardiothoracic Surgery Highlights Pediatric Cardiothoracic Surgery Rare heart-lung transplant saves teen

Chicago teenager with severe heart and lung disease was down to

A his last hope: finding an institution willing to perform a life-saving BOSTONROBERT heart-lung transplant. That hope was fulfilled at St. Louis Children’s Hospital, and he is now working his way back to the physical activities he loves. Spencer Kolman, 15, received the rare transplant at the end of a four- VIDEO/PICTURE SCRAPBOOKS capture the year diagnostic journey. It began when he fell short of breath and collapsed surgical journeys of 30 to 40 St. Louis Children’s Hospital cardiothoracic surgery patients and while playing hockey in January 2013. Doctors diagnosed him with their families each year. Called “Your Heart’s asthma and then pneumonia before finding the real culprit: pulmonary Story” and produced by Media Production fibrosis, or scarring in the lungs. It was the result of chemotherapy that Specialist Rachel Simon-Lee, pictured above, had successfully addressed a cancer Spencer experienced as a toddler. the videos capture the patient’s and family’s experiences at the hospital through family Living in his bedroom on oxygen last year, his lungs and heart photos, an edited video of the surgery and became sicker. A Boston hospital determined he needed a lung transplant, voice-over narration. Simon-Lee won a Salute but judged that his health was too poor to undergo the procedure. Spencer to Excellence in Health Care award from the St. Louis American Foundation for her work. and his family then went to St. Louis Children’s Hospital and received She videotapes all pediatric cardiothoracic better news. Pirooz Eghtesady, MD, PhD, chief of pediatric cardiothoracic operations at St. Louis Children’s; the footage surgery, and pulmonologist Stuart Sweet, MD, PhD, W. McKim O. not only enhances her scrapbooks but also serves as a valuable resource for the surgical Marriott Professor of Pediatrics, said he actually needed a heart-lung team and trainees. transplant, and Eghtesady was comfortable going ahead with the surgery. Heart-lung transplants are rare for many reasons, says Eghtesady, the Emerson Chair in Pediatric Cardiothoracic Surgery. Suitable organs are AN APP FOR FOLLOW-UP CARE is being evaluated by section surgeons. The app, called in short supply, complication rates are high, and few patients need both Epharmix, periodically texts a child’s family after organs. “There is not tremendous enthusiasm for the procedure because discharge, asking for information such as weight, of bleeding complications and, unfortunately, generally poor outcomes.” temperature and level of oxygen saturation — which parents check via a provided monitor. Spencer’s physical condition was deteriorating when he was admitted Staff members flag and address any responses to the St. Louis Children’s intensive care unit. Thankfully, relief came in that raise concerns. A company founded by about three weeks: The donor organs were on their way. Washington University medical students developed the app. Peter Manning, MD, In a five-hour operation, Eghtesady removed Spencer’s heart and lungs plans to pursue nationwide testing through and took the donor heart and lungs — which were attached to each other the National Pediatric Cardiology Quality — and made connections to the airway, aorta, superior vena cava and Improvement Collaborative. inferior vena cava. Today, Spencer is doing well. He thanked his donor family in a letter, ANALYZING SAFETY EVENTS in weekly telling them he hoped to earn his Eagle Scout award and once again play meetings, the St. Louis Children’s and the trumpet and maybe even hockey. Washington University Heart Center’s Outcomes Committee identifies those events that have potential to cause future harm and addresses them through issue-specific workgroups. Hospital-wide issues are referred to hospital leaders. The committee’s efforts may contribute to St. Louis Children’s low mortality rate of 1.32 percent among pediatric heart and lung patients, compared with the national average of 3.1 percent, according to data from the Society of Thoracic Surgeons National Database.

Department of Surgery Annual Report 2017 | 11 12 | surgery.wustl.edu Division of General Surgery

Acute and Critical Care Surgery • Colon and Rectal Surgery • Endocrine CORE VALUE: and Oncologic Surgery • Hepatobiliary-Pancreatic and Gastrointestinal Leadership Surgery • Minimally Invasive Surgery • Transplant Surgery • Vascular Surgery training

Tiffany Osborn, MD, MPH The division provides comprehensive Leadership training is a cornerstone of the department’s subspecialty services, and its robust research commitment to fostering an inclusive, supportive environment. efforts continually contribute major advances. Surgical/trauma intensivist and emergency medicine physician Rigorous training programs prepare the next Tiffany Osborn, MD, MPH, has benefitted from this commitment generation of leaders. and now supports development of her faculty peers as co-director of the department’s Leadership and Professionalism Committee. Osborn was an early leader in patient care the evolving combined field of clinical emergency medicine/critical research care (EM/CC) and is the nation’s 241 outpatient total first female EM/CC full professor. studies visits procedures She has completed institutional academic leadership training 66,788 36,046 and women-specific programs through the university’s Women research grants 7.9 Faculty Leadership Institute and Olin Business School. Osborn million peer-reviewed believes today’s cultural divisions publications demand strong leadership among $ 2016 166 physicians. “Learning medical principles is ultimately done faculty alone; applying them requires 64 a team. Inclusivity, service and collaboration are essential All figures FY2016–17 unless otherwise noted physician tools, especially today.”

Department of Surgery Annual Report 2017 | 13 Grant Bochicchio, MD, MPH, left, shown with research coordinator Steve Jarman, RN, BSN, has collaborated with a corporate partner to develop a continuous blood glucose monitor to improve care for critically ill patients.

14 |14 surgery.wustl.edu | surgery.wustl.edu Division of General Surgery Highlights Acute and Critical Care Surgery Continuous glucose monitor aides ICU care

igh blood sugar occurs frequently in critically ill patients, resulting

H from metabolic and hormonal changes that accompany the body’s BOSTONROBERT response to injury and stress. It is also associated with poor clinical outcomes, including infections and other complications, increased hospital length of stay, and death. To date, measuring high blood sugar in the intensive care unit (ICU) A STUDY OF NEARLY 50,000 sepsis patients has been a moving target; it takes time to draw blood and get lab results, confirmed the importance of rapid diagnosis and treatment for this life-threatening and the patient’s blood glucose level may change in the interim. condition. Sepsis, the body’s toxic response Because of that imprecision and the risk of triggering low blood to infection, is the leading cause of death sugar, many ICUs have moved away from aggressive blood-sugar control, in hospitals. Tiffany Osborn, MD, MPH, says Grant Bochicchio, MD, MPH, section chief and the Harry Edison pictured above, co-authored the study, which analyzed patients from 149 hospitals in New Professor of Surgery. To provide a viable solution, his lab has worked York state treated between April 2014 and intensively over the past decade with U.S-based OptiScan Biomedical June 2016. Published in the New England Corporation to create a bedside continuous glucose monitor. He led a Journal of Medicine, it found that for each hour treatment is delayed, a patient’s risk recent multicenter trial that found the device to be safe and accurate, of death jumps 4 percent. Osborne also has and the company has applied for FDA approval. worked to establish sepsis treatment protocols, “Currently, because it takes time to get lab results, you’re treating the educational campaigns and policy initiatives to reduce incidence. She and John Mazuski, patient based on their blood glucose levels from hours ago rather than MD, PhD, were among many authors of new what it is right now,” says Bochicchio. “Using mid infrared spectroscopy, international guidelines, called Surviving the new bedside device draws and measures the patient’s blood every Sepsis Guidelines 2016, jointly published by 15 minutes and provides an immediate reading. It improves patient care the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. and decreases nurses’ workload.” Bochicchio says similar point-of-care monitors have been used for years in ICUs. But they do not provide continuous readings and JOHN MAZUSKI, MD, PHD, completed his term as president of the Surgical Infection Society have been shown to be inaccurate in critically ill patients because of this by hosting the organization’s 37th annual population’s anemia and heavy medication. In the current study, the meeting in St. Louis in May 2017. Members new device outperformed these point-of-care monitors on every 1- to of the Acute and Critical Care Surgery Section gave eight presentations, and Isaiah Turnbull, 3-hour glucose measurement. MD, PhD, and Christopher Horn, MD, each Bochicchio reported the trial’s findings in the Journal of Trauma won awards. (See summary of Mazuski’s and Acute Care Surgery in June 2017. Other participating centers were presidency on page 65.) Tufts University in Boston, Memorial Hermann Hospital in Houston and Starwood Cardiac Group in Portland, Ore. THE SECTION EXPANDED its surgical services Bochicchio is working with OptiScan to test the monitor’s use in at Christian Hospital in north St. Louis County measuring lactate and eventually other substances. Controlling lactate by adding surgeons Nishant Raj, MD, and Muhammad Yasin, MD, formerly employed by levels is a major goal of preventing septic shock, a life-threatening the non-profit health care organization BJC condition that occurs when blood pressure drops dangerously low HealthCare. They join Stephen Eaton, MD, and after infection. Bradley Freeman, MD, to offer a wide range of general and colorectal surgeries to an

underserved area. Grant Bochicchio, MD, MPH, consulted with OptiScan Biomedical Corporation on FDA submission of the bedside continuous glucose monitor.

Department of Surgery Annual Report 2017 | 15 Left to right, radiation oncologist Parag Parikh, MD, medical oncologist Andrea Wang-Gillam, MD, and colorectal surgery Chief Matthew Mutch, MD, have developed a more effective rectal cancer treatment protocol.

16 |16 surgery.wustl.edu | surgery.wustl.edu Division of General Surgery Highlights Colon and Rectal Surgery Shorter regimen BOSTONROBERT improves outcomes

ashington University physicians treating rectal cancer have Wadopted a new treatment regimen that they have shown reduces or eradicates tumors at a significantly higher rate than conventional therapy. “The prognosis for rectal cancer tends to be worse than for some other cancers we treat because of the anatomic location of the rectum within the pelvis,” says Matthew Mutch, MD, section chief and the Solon and A NEW TREATMENT PROTOCOL for colorectal Bettie Gershman Chair for Colon and Rectal Surgery. “The risk of local surgery care reduced surgical site infections, hospital length of stay and readmissions over recurrence is 4 to 10 percent, and distant recurrence occurs in 25 to 40 a three-year period. The colorectal Enhanced percent of cases.” Recovery After Surgery (ERAS) protocol won To improve outcomes, Mutch has teamed up with fellow colorectal a Barnes-Jewish Hospital award for quality surgeons, as well as radiation oncologists and medical oncologists, to improvement. Results were reported at the annual American College of Surgeons National develop a regimen that is nine weeks shorter than the traditional approach Surgical Quality Improvement Program® (ACS and gets chemotherapy into the patient much sooner. NSQIP®) meeting in July 2016. The protocol — Traditionally, the order of treatment has been radiation (five weeks), led by surgeon Matthew Silviera, MD, clinical nurse manager Angelia McBride, RN, and nurse surgery and then chemotherapy — a 46-week process, with chemotherapy practitioner Bonnie Johnston, BSN, RN, pictured beginning roughly at week 23. The new protocol changes the order, on page 58 — is part of an ongoing effort to starting with short-course radiation (five days), followed by chemotherapy test and implement evidence-based patient care pathways. Among their findings: (16 weeks) and then surgery. The regimen takes 37 weeks, with chemotherapy starting at week four. • Johnston found that educating colorectal surgery patients about proper pre- and The multidisciplinary team reported positive results in the post-surgical self care reduced the surgical- International Journal of Radiation Oncology, Biology and Physics: site infection rate to 5 percent, half the rate After radiation and chemotherapy, severity of cancer decreased in for all patients. 71 percent of patients, and 25 percent showed a complete absence of • Johnston and surgeon Steven Hunt, MD, tumor — results significantly better than those seen with the traditional concluded that, among patients who received an ostomy, follow-up calls 48 hours protocol. “We hope to see a reduction in the rate of distant recurrence after discharge did not affect the rate of as well,” says Mutch. readmission, even though this intervention Colorectal surgeons also are standardizing preoperative imaging, has been effective in other patient groups at high risk for readmission; a follow-up cancer staging procedures and multidisciplinary conference planning office visit with an ostomy nurse proved for rectal cancer patients. Resident William Chapman Jr., MD, will more effective. study clinical outcomes, costs and patient-reported outcomes.

Mutch says rectal cancer patients are eligible for a non-surgical A COMPREHENSIVE PATIENT INFORMATION approach to care when radiation and chemotherapy eradicate their tumor. guide promoting continuity of care is In hopes of making this a viable option for more patients, he is working now in use at Barnes-Jewish Hospital and Barnes-Jewish West County Hospital. Hospital with Washington University biomedical engineers to develop better clinic staff developed the guide and use it to imaging methods to sharpen the evaluation of the presence or absence prepare patients for surgery, discharge and of cancer after radiation and chemotherapy. recovery at home. In addition, staff developed surgery-specific guides for patients, families and caregivers, outlining expected outcomes following surgery.

Department of Surgery Annual Report 2017 | 17 Resident Jennifer Yu, MD, MPHS, right, and faculty surgeon Julie Margenthaler, MD, left, have assessed guidelines that significantly reduce reoperation rates for breast cancer.

18 |18 surgery.wustl.edu | surgery.wustl.edu Division of General Surgery Highlights Endocrine and Oncologic Surgery New guideline reduces repeat lumpectomies

new guideline for determining whether enough tissue has been A removed during breast cancer lumpectomy procedures significantly reduces the number of reoperations and lowers costs, according to a study by Washington University breast cancer surgeons.* In a lumpectomy, surgeons remove the tumor plus a margin of surrounding healthy tissue. Pathologists cover the outside of the excised COURTESY OF REBECCA AFT, MD, PhD lump in ink, slice it, and examine the slices under a microscope to REBECCA AFT, MD, PHD, and colleagues determine the size of the margin. If the margin is too small, the patient reported on using a microfiltration technique to undergoes a second operation to remove more tissue. analyze disseminated tumor cells (DTCs), shown Until recently, there has been disagreement about how wide that above, in the bone marrow of breast cancer patients, where their presence indicates a high margin needed to be. Then in 2014, the Society of Surgical Oncology risk of cancer recurrence. The microfiltration (SSO) and American Society of Radiation Oncology (ASTRO) issued a technique provided a more sensitive and consensus guideline known as the “no ink on tumor” standard. Under accurate way to detect DTCs in bone marrow, an ability that should improve detection of early this guideline, if there is no ink on the tumor, a second operation is recurrence. The technique also identified two unnecessary; wider margins do not lower the risk of recurrence. genes that are potential therapeutic targets. “We adopted the standard quickly,” says breast surgeon Julie PLOS ONE published the study in January 2017. Margenthaler, MD. “In addition to the potential for cost savings, it represents a big improvement in quality of care. Second surgeries A PERSONALIZED VACCINE for pancreas cause anxiety, lost time from work and delays in starting chemotherapy cancer, developed by William Gillanders, MD, and Robert Schreiber, PhD, professor in the and radiation.” Department of Pathology and Immunology, To measure cost savings, Margenthaler and general surgery resident will be the focus of a clinical trial approved Jennifer Yu, MD, MPHS, reviewed 1,506 cases conducted between 2010 by the National Institutes of Health (NIH). and 2013, pre-guideline, at Barnes-Jewish Hospital. They found that, had The researchers developed the vaccine under a Pancreatic Cancer Specialized Programs the new guideline been in place, it would have avoided 87 reoperations of Research Excellence (SPORE) grant at at a total cost of roughly $195,000 — reducing the rate of reoperations by Washington University. 5.6 percent.

“We will never get the reoperative rate down to zero, because we PHOTOACOUSTIC IMAGING uses light don’t have anything in the operating room to measure margins,” says and sound to produce images useful in Margenthaler. “Despite everything you do, some tumors will still have distinguishing cancer from normal tissue. The technology may enable surgeons to positive margins. But under the new guideline, we have reduced our rate gauge the success of lumpectomies while the of reoperation from about 20 to 30 percent to about 10 percent, which operation is still underway, rather than relying provides a significant reduction in cost and anxiety over past practices.” on pathology results that come in after the fact. Former Washington University biomedical engineer Lihong Wang, PhD, now at Caltech, * Yu J, Elmore LC, Cyr AE, Aft RL, Gillanders WE, Margenthaler JA. Cost Analysis of a Surgical Consensus developed the technology and is investigating Guideline in Breast-Conserving Surgery. J Am Coll Surg. 2017 Aug;225(2):294–301 its use in the operating room; Aft recently co- authored a paper in Science Advances reporting that photoacoustic imaging provides images similar in quality to the histological images currently used to determine whether all cancer has been removed — an early proof-of-concept of the technology’s clinical value.

Department of Surgery Annual Report 2017 | 19 New faculty member Chet Hammill, MD, MCR, is pioneering the use of laparoscopic and robotic techniques to perform major liver and pancreas surgeries.

20 |20 surgery.wustl.edu | surgery.wustl.edu Division of General Surgery Highlights Hepatobiliary-Pancreatic and Gastrointestinal Surgery Surgeons forge the last laparoscopic frontier

inimally invasive surgery has become the standard of care for most M general surgical procedures. Now Washington University surgeons are leading the effort to introduce these techniques to general surgery’s last laparoscopic frontier: major liver and pancreas surgeries. “Minimally invasive liver and pancreas surgeries are not very widespread because these are such major operations,” says Chet Hammill, MD, MCR, who joined the faculty in March 2017. “But they’re gaining traction.” A GENETICALLY ENGINEERED, immunodeficient mouse model under As the former director of hepatobiliary and pancreatic (HPB) surgery development by Ryan Fields, MD, and a for the Legacy Health System in Portland, Ore., Hammill has extensive multidisciplinary team could enable cancer experience with laparoscopic liver and pancreas surgeries, including distal specialists to provide more effective care. pancreatectomy, a procedure for treating cancer in which the surgeon Researchers inject part of a patient’s tumor and bone marrow into the model, then test removes the tail of the pancreas. He is eager to share his expertise by how the tumor responds to various therapies. not only performing these surgeries but also training his fellow HPB-GI If validated, the model could help cancer surgeons at Barnes-Jewish Hospital to use the same advanced techniques. specialists choose treatments tailored to each patient. Fields, pictured above with research “There are good data that show you get the same health outcomes technician Ye Bi, is testing the model in with a minimally invasive distal pancreatectomy as you do performing melanoma patients, but it could be applied the open procedure,” says Hammill. “When done laparoscopically, you get to all cancers. The research is supported by a National Institutes of Health (NIH) R01 grant; the benefits of less pain and blood loss, shorter hospital stay and quicker co-investigators include Robert Schreiber, return to function. These patients typically go home one or two days after PhD, professor of pathology and immunology, surgery compared to four or five days with an open procedure.” researchers at the Elizabeth H. and James S. McDonnell III Genome Institute at Washington The section’s surgeons are in the early stages of developing a minimally University, and collaborators at Yale University invasive approach for the Whipple procedure, performed to treat pancreas and The Jackson Laboratory. cancer. In this major operation, the surgeon removes the head of the pancreas, gallbladder, part of the stomach, part of the small intestine and A SPORE GRANT (Specialized Programs of the bile duct. For the open procedure, mortality at high-volume centers is Research Excellence) received in June 2016 is 3 percent. But Whipple patients have a 40 percent surgical complication allowing researchers to take their first steps rate, and their rate of survival from the cancer is low. in developing drugs and immunotherapies to treat pancreatic ductal adenocarcinoma As a result, improving quality of life for Whipple patients is a high (PDAC). Clinical trials will test a combination priority for the section’s surgeons. Recently, they implemented a new of drugs that inhibit the survival pathway patient care protocol that emphasizes patient education, an earlier return of certain cancers, as well as a personalized pancreas cancer vaccine. William Hawkins, to activity and normal diet, and improved pain management. MD, HPB-GI surgery section chief, is principal Surgeons perform about 100 Whipple surgeries a year at Barnes- investigator of the $10.4 million grant funded Jewish Hospital. by the National Cancer Institute.

FORMER CHIEF RESIDENT Dominic Sanford, MD, MPHS, who will join the HPB-GI surgery faculty in 2018, coordinated a clinical trial comparing video-based patient instruction before hospital admission and standard instruction during hospital stay in pancreas cancer patients. The trial uses readmission rates and patient-reported outcomes to measure success.

Department of Surgery Annual Report 2017 | 21 Jeffrey Blatnik, MD, left, and Michael Awad, MD, PhD, right, are among a small but growing number of surgeons around the country pioneering the use of incisionless procedures to address swallowing disorders and other conditions.

22 |22 surgery.wustl.edu | surgery.wustl.edu Division of General Surgery Highlights Minimally Invasive Surgery Incisionless surgery gains ground

essica Philips, a 28-year-old retail store manager from St. Peters, Mo., Jsuffered for 10 years with swallowing problems that grew progressively worse, until she had trouble consuming any food at all. In March 2017, Jessica was diagnosed with achalasia, a rare swallowing disorder in which the esophagus is unable to move food into the stomach. The next month — before she could get treatment for the condition JEFFREY BLATNIK, MD, pictured above, — Philips was admitted to Barnes-Jewish Hospital with dehydration. right, has been a champion for the Americas Hernia Society Quality Collaborative (AHSQC) There, she underwent a per oral endoscopic myotomy (POEM), a surgical among Washington University surgeons who procedure for achalasia performed via endoscope through the mouth. perform hernia procedures. Formed in 2013, Philips’ surgeons, Jeffrey Blatnik, MD, and Michael Awad, MD, PhD, the AHSQC aims to improve the value in hernia report that patients typically feel no pain from the POEM procedure, care delivered to patients. The collaborative collects patient-centered data on ventral, in which surgeons relax the muscle that connects the esophagus to incisional and inguinal hernia cases, offers the stomach. ongoing performance feedback to clinicians, “I can eat a regular diet and am sleeping now, the best in years,” and promotes quality improvement. During his postgraduate years at Case Western Reserve says Philips. Medical Center, Blatnik helped develop metrics POEM is a relatively new, less-invasive alternative to the long-standing for AHSQC. conventional choice, the Heller myotomy, in which surgeons access the esophagus through abdominal incisions; originally performed as an SURGEONS OVERPRESCRIBE OPIOID open surgery, the laparoscopic Heller surgery has been the procedure of PAINKILLERS following surgery, according choice since the 1990s. Japanese surgeon Hirano Inoue, MD, performed to research by Section Chief L. Michael Brunt, the first POEM in 2009, and since then the popularity of the procedure MD, and colleagues. Patients undergoing minimally invasive surgery consume only a has grown. It has a similar success rate as Heller myotomy, with about small portion of their dispensed opioid pills 95 percent of patients having a significant, long-term improvement in and still report decreased pain severity during swallowing. Still, it is a highly technical procedure, and a limited number the first two postoperative weeks. The results are being submitted for publication. Brunt of U.S. centers offer it. also co-authored a commentary with Awad performed Barnes-Jewish Hospital’s first POEM with an Evan Kharasch, MD, PhD, in the journal interventional endoscopist from the Division of Gastroenterology in 2013. Anesthesiology recommending that surgeons consider reducing the number of take-home He and Blatnik now perform the procedure together. opioid pills prescribed after surgery. “Two- and three-year follow-up in U.S. case studies and longer- term Japanese studies show equivalent outcomes to laparoscopic Heller SHAINA ECKHOUSE, MD, is working with myotomy,” says Blatnik. “For certain populations, POEM is more effective transplant selection committees to offer weight- because you can cut the muscle over a greater length of the esophagus.” loss surgery to obese patients awaiting kidney POEM may be just a start for incisionless surgery in the Section of and liver transplants. Kidney transplant patients Minimally Invasive Surgery. Awad is looking at a similar treatment for with a body mass index of 40 or greater must lose weight before they can undergo their gastroparesis, a disorder that slows or stops the movement of food from operation. Weight-loss surgery helps them the stomach to the small intestine. qualify for, and minimize the risks of, transplant surgery. Obese liver transplant patients may also qualify for bariatric surgery; patients with cirrhosis, related complications and portal hypertension undergo a liver transplant and weight-loss procedure simultaneously.

Department of Surgery Annual Report 2017 | 23 Jason Wellen, MD, MBA, right, and his surgical team harvest a kidney from a live donor. Wellen and colleagues want to make living kidney donation easier and more common.

24 |24 surgery.wustl.edu | surgery.wustl.edu Division of General Surgery Highlights Transplant Surgery Kidney transplant focus shifts to living donors

evin Hamilton, 59, underwent a kidney transplant at Barnes-Jewish K Hospital in March 2016 through a national paired kidney exchange after tests determined that his wife, Barbara, 58, was an incompatible donor. In this “kidney swap,” Kevin and Barbara exchanged kidneys with another donor/recipient pair: Kevin received a kidney from a donor in South Carolina, and Barbara’s went to a recipient in Oregon. WASHINGTON UNIVERSITY’S TRANSPLANT Kevin, who had chronic kidney disease, was two months away from FELLOWSHIP is the first transplant program in the country to offer early specialization needing dialysis and likely would have waited three to five years for a (ESP). General Surgery Chief Resident Vijay kidney transplant from a deceased donor. With his new kidney, Kevin is Subramanian, MD, trained for 6 months on now doing well and is out swinging a golf club again. Barbara also is faring the transplant service as a PGY-4 resident and well and is glad she was able to help her husband. will add six months of transplant training this year, then complete the fellowship in one Success stories such as this are playing out more and more often at year instead of two. Washington University Barnes-Jewish, as the transplant program employs multiple ways to find was among the earliest in the country to offer living donors. dual certification in general surgery and either vascular or cardiothoracic surgery. A 10-year “We have really changed our culture to focus on living donation,” says study in the Journal of the American College Kidney Transplant Director Jason Wellen, MD, MBA. Their efforts include of Surgeons of ESP training at Washington encouraging patients to find their own living donor. “If you don’t have a University and five other institutions concludes that the approach is successful and appropriate living donor, help us find someone to be your champion. Find an outgoing for any surgical subspecialty. Above, Surendra church member or sibling. Let them ask for you.” Shenoy, MD, PhD, leads trainees on rounds. The effort is worthwhile, says William Chapman, MD, section chief and the Eugene M. Bricker Professor of Surgery. Kidneys from living ADOLESCENT TRANSPLANT PATIENTS have donors are generally better quality, and circumventing the long wait for the highest rate of noncompliance in following a deceased donor may allow patients to avoid dialysis, which carries its care guidelines, studies show. Doctors and care own risks. coordinators see them monthly as children and adolescents, but as adults, they will have If blood work determines that a potential living donor is incompatible, fewer appointments and must take greater the recipient has several options: a transplant from an ABO-incompatible responsibility. Liver transplant director M.B. donor, in which the recipient receives medical treatment before and after Majella Doyle, MD, MBA, and kidney transplant director Jason Wellen, MD, MBA, have worked transplant to lower the risk of organ rejection; a paired exchange through with quality managers at St. Louis Children’s a Barnes-Jewish database; or a national paired exchange. Hospital and Barnes-Jewish Hospital to The kidney transplant program also has stepped up efforts to make improve the transition of abdominal transplant patients from adolescent to adult care. Helpful the kidney donor process more donor friendly. Barbara recalls the steps include having the adult care coordinator experience as “wonderful.” The program has since expanded the number participate in pediatric planning meetings of clinic days per week, gathered input from donors about their donation and performing a neuro-psychiatric exam experiences, and developed an early recovery after surgery protocol that before transition. improves pain management. IN ADDITION TO TRANSPLANTS, liver transplant surgeons perform a wide range of liver surgeries. Newly recruited surgeon Adeel Khan, MD, MPH, performs minimally invasive surgery and will train other transplant surgeons in the technique, which could be used to harvest the organ in live-donor liver transplants, among other procedures.

Department of Surgery Annual Report 2017 | 25 Vascular surgeon Patrick Geraghty, MD, and resident Meghan Kelly, MD, examine patient Beth Roper.

26 |26 surgery.wustl.edu | surgery.wustl.edu Division of General Surgery Highlights Vascular Surgery Major clinical trials target arterial disease

ascular surgeon Patrick Geraghty, MD, specializes in treating patients Vwho have peripheral arterial disease (PAD) — blockage of the vessels that carry blood from the heart to the legs. But his reach extends well beyond his clinical practice in the St. Louis region; he also is a national leader in developing new PAD treatments. “Tobacco use and diabetes are the two most significant drivers of PAD, JEFFREY JIM, MD, MPHS, above, center, which carries the risks of heart attack, stroke and the need for amputation,” trains other vascular specialists from around the country to perform transcarotid artery says Geraghty, who treats patients at Barnes-Jewish Hospital. “PAD is most revascularization (TCAR), a minimally invasive commonly seen in the elderly, but heavy smokers and diabetic patients procedure to open blocked carotid arteries in may require intervention by their late 30s or 40s.” patients whose poor health or advanced age The Centers for Disease Control and Prevention (CDC) estimates that makes the traditional open surgery too risky. The two carotid arteries in the neck supply 8.5 million people in the United States have PAD. As the population ages blood to the brain and can become blocked and diabetes becomes epidemic, these numbers are steadily increasing. with plaque; if left untreated, blockages Geraghty began his practice in the early 2000s, when almost all stent can stop blood flow, and plaque debris can dislodge to the brain, causing a potentially devices used in the superficial femoral artery — the most common artery disabling stroke. In the procedure, surgeons affected by PAD — were designed to treat other conditions. Working deliver a stent directly into the carotid artery with manufacturers, Geraghty helped design clinical trials to test new from a small incision in the neck — a safer and shorter route than delivering via the devices created specifically for PAD. The VIBRANT trial, which he groin. Washington University was one of 25 co-led, identified features that contributed to the devices’ limitations. institutions around the world to test TCAR, The resulting redesigned version continues to be a mainstay of lower- which is now FDA-approved. extremity interventions. Geraghty also worked with the Society for Vascular Surgery (SVS) A CLINICAL TRIAL at Washington University Critical Limb Ischemia Workgroup to advise the Food and Drug School of Medicine and two other U.S. centers Administration (FDA) regarding clinical trial design. The workgroup is evaluating a branched endovascular graft for treating aneurysms and aortic dissections introduced objective performance goals that now allow companies to in the ascending aorta and aortic arch. Other test some devices against historical data instead of using a control group, stent devices — which also have been tested reducing cost and potentially speeding the introduction of new treatments. at Washington University — can be used in the aortic arch but have limited applicability. Geraghty’s current focus is on disease of the small arteries below the knee, where PAD most severely affects diabetic patients. Among other research efforts, he helped design the nation’s first clinical trial of drug- THE FIVE-YEAR RESIDENCY program in vascular surgery graduated its first resident, coated angioplasty balloons for treatment of the distal arteries of the leg, John Ohman, MD, who has joined the faculty. and is the global co-principal investigator for that trial. The residency provides a shorter, more focused Geraghty describes running out of treatment options for patients as alternative to completing both a general a “brutal” experience. surgery residency and vascular surgery fellowship. Graduating fellow Senthil Jayarajan, “Every amputation is a stimulus for wanting to do better. That has led MD, MS, also joined the faculty and will offer me to devote much of my career to providing physicians with data they expertise in analyzing quality and other health- can use to select the best treatment for their patients.” care data.

Department of Surgery Annual Report 2017 | 27 28 | surgery.wustl.edu Division of Pediatric Surgery

CORE VALUE: Broad promotion criteria

Brad Warner, MD The division offers robust treatment To attract and retain faculty of diverse backgrounds and talents, in trauma and congenital conditions, the department embraces promotion criteria that reward conducts basic science and clinical contributions in any of its three missions: education, patient care investigations to address short-gut and research. In the Division of Pediatric Surgery, faculty syndrome and other conditions, and activities run the gamut. In the clinic, interests range from attracts top fellowship candidates. trauma prevention to fetal surgery; research involves basic science, clinical and comparative effectiveness studies; teaching efforts include surgical and lab clinical patient care training of fellows and residents. research As division chief, Brad Warner, MD, 30 outpatient total encourages faculty in all pursuits. studies visits procedures Surgeon Jacqueline Saito, MD, MSCI, has had the freedom to pursue training and leadership 5,948 3,376 positions in patient safety and quality improvement (PS/QI). She research grants 1.4 works as an outcomes physician million peer-reviewed in the BJC HealthCare Center for publications Clinical Excellence and gives back 2016 to the division through PS/QI $ 16 projects. Warner also jumps in to faculty support newly recruited surgeon 6 Jesse Vrecenak, MD, as she performs large fetal intervention cases. “You have to support your All figures FY2016–17 unless otherwise noted team,” says Warner.

Department of Surgery Annual Report 2017 | 29 Patients such as Cole Chrisco, successfully treated for a life-threatening esophageal abnormality, will benefit from a research consortium through which investigators share data on rare childhood conditions. COURTESY OF THE CHRISCO FAMILY

30 |30 surgery.wustl.edu | surgery.wustl.edu Division of Pediatric Surgery Highlights

Institutions join forces to treat rare conditions

t just four years of age, Cole Chrisco has faced more health challenges A than most people face in a lifetime. Immediately after his birth at a suburban St. Louis hospital, Cole was diagnosed with a rare, life- threatening abnormality of the esophagus and transferred to St. Louis Children’s Hospital. There, surgeon Jacqueline Saito, MD, MSCI, performed a life-saving operation within his first 24 hours. SAVING THE LIVES OF CHILDREN with short The condition she corrected was esophageal atresia/tracheoesophageal bowel syndrome (SBS) is one aim of the research lab of Division Chief Brad Warner, MD. SBS, fistula (EA/TEF), in which the upper and lower esophagus do not meet, characterized by a lack of functional small and the lower esophagus connects to the windpipe instead of the upper intestine, is fatal in 30 to 40 percent of cases, esophagus. In the four years since that initial surgery, Cole also has been with 60 percent of those fatalities thought to treated for a heart condition, narrowing of the esophagus, an allergic/ result from liver disease — a major complication of SBS. Until recently, experts attributed this immune condition called eosinophilic esophagitis, and other serious fatal complication to the intravenous feeding medical issues. His recovery has been strong. children with SBS receive. But Warner’s lab “He’s doing very well,” says Elizabeth Chrisco, Cole’s mother. found that surgical intestine removal alone is a significant cause of liver disease in these In treating patients such as Cole who have EA/TEF or other patients and that oral antibiotics prevent liver rare conditions, Saito draws not only from her surgical training and injury. Their findings, published in the journal experience, but also from her participation in the Midwest Pediatric Surgery, open the door for using not only oral antibiotics but prebiotics, probiotics or fecal Surgical Consortium (MWPSC),* a group of 11 Midwestern academic transplantation to help avert liver disease. medical centers focused on improving care of rare conditions through Warner is pictured above with medical student research. Saito and St. Louis Children’s are charter members. Shirli Tay, left, and general surgery resident In December 2016, the consortium published a retrospective Lauren Barron, MD. study of 396 EA/TEF cases treated at member hospitals — the largest report of the condition to date. The study identified potential A TOP-TIER FELLOWSHIP program is the opportunities for improved care related to the use of nasogastric result of several steps taken over the past decade in the division, including obtaining tubes during surgical treatment. American College of Surgeons (ACS) trauma “This is a study that a single center would have difficulty performing verification, lining up top speakers for the Jessie in a meaningful way,” says Saito. “The consortium will compare four Ternberg Visiting Professorship and preparing lab residents to present research findings at treatment approaches and monitor the outcomes in a future quality- national meetings. In 2017, the pediatric surgery improvement study.” fellowship had 100 applicants for a single The MWPSC also is conducting clinical studies on management of position. collapsed lung, congenital cystic lung malformations and gastroschisis, a condition in which the bowel pushes through a hole in the abdominal wall. JESSE VRECENAK, MD, joined the faculty In addition, it has funding from the Patient-Centered Outcomes after completing a pediatric surgery fellowship Research Institute to study the costs and outcomes of a non-surgical at Children’s Hospital of Philadelphia. She has established a basic science laboratory treatment of acute appendicitis. The approach could represent an investigating hematopoietic stem cell improved and more cost-efficient way to treat some patients. transplantation, a treatment that could prevent blood diseases such as sickle cell *Other MWPSC centers are Children’s Hospital of Wisconsin, Children’s Mercy Kansas City, Cincinnati anemia, thalassemia or spherocytosis. Children’s Hospital Medical Center, Indiana University, Nationwide Children’s Hospital, Northwestern Vrecenak also will be the surgical director University, University of Chicago, University of Louisville, University of Michigan and University of Wisconsin - Madison. for the fetal care program.

Department of Surgery Annual Report 2017 | 31 32 | surgery.wustl.edu Division of Plastic and Reconstructive Surgery

CORE VALUE: Recruiting diversity in all forms

Ida Fox, MD The division is dedicated to improving The department fosters excellence in part by recruiting diversity in patient care through basic and clinical all forms. The Division of Plastic and Reconstructive Surgery is a research. It is known worldwide for prime example, with its diversity of gender, age, ethnicity and peripheral nerve transfers and other research interests, from bench to bedside. Drawing from the advanced treatments and offers leading mentorship of Division Chief Susan Mackinnon, MD, plastic residency and fellowship training. and reconstructive surgeon Ida Fox, MD, has become a national leader in nerve transfers to restore arm and hand function in patients with spinal cord injuries; clinical patient care she has actively shared her skills research with colleagues nationwide. She 56 outpatient total recently began collaborating with studies visits procedures researchers at Stanford University on a multicenter study of nerve and tendon transfers. Fox, who 11,993 32,421 was the only female resident in her plastic surgery residency, research grants 1.7 says she feels at ease in a division million where everyone is unique. “I can peer-reviewed focus on my family, colleagues, publications 2016 residents and students — and $ 48 clinical care.” Now a mentor herself, she tells residents her 13 faculty high standards are meant to help them achieve their best.

All figures FY2016–17 unless otherwise noted

Department of Surgery Annual Report 2017 | 33 Surgeon Amy Moore, MD, and biomedical engineer Matthew Wood, PhD, are developing new approaches to avoid the nerve pain that is a common complication of amputation.

34 |34 surgery.wustl.edu | surgery.wustl.edu Division of Plastic and Reconstructive Surgery Highlights

Technique addresses amputee nerve pain

ince 2001, U.S. soldiers have undergone more than 2,200 major S upper- and lower-limb amputations because of war injuries. But their problems don’t end with the fitting of a prosthesis and care of the residual limb. Pain typically persists. The pain comes from neuromas — balls of regenerated nerve cells that form on the end of a cut nerve. Neuromas are a frequent complication SURGEONS WORLDWIDE learn new techniques of the most common amputation technique, called traction neurectomy, in peripheral nerve surgery from Washington University surgeons through the division’s online which involves cutting the nerve and relocating the remaining nerve education tools and in-person visits to St. Louis. ending to an area more protected by muscle and soft tissue. If the nerve Ecuadoran hand surgeon Marco Yanez, MD, ending regenerates in a disorganized way, it forms a neuroma. visited in April 2017, and division surgeon John “These service members get their amputations in the battlefield or at a Felder, MD, traveled to Ecuador in fall 2017 to perform surgeries with him and conduct training. foreign military hospital,” says Amy Moore, MD, a Washington University Yanez wants to learn more about brachial plexus plastic and reconstructive surgeon at Barnes-Jewish Hospital who both and nerve-transfer surgeries to help patients in treats and studies neuromas. “They can develop painful neuromas and his country with debilitating limb injuries. He and others can also reference a new educational then require a corrective surgery before they can wear a prosthesis.” website called PASSIO (passioeducation.com), She and her colleagues found a potential solution while studying developed by Division Chief Susan Mackinnon, a different but related topic: the process of using chemically processed MD, and interactive surgical education specialist Andrew Yee. The website builds on an earlier nerve tissue to bridge gaps in injured nerves. In the lab, they noticed that website (nervesurgery.wustl.edu) that instructed processed grafts seemed to accelerate and then slow the nerve growth military surgeons in treating limb injuries. Felder, that, in this situation, is desirable for re-establishing nerve function. Yanez and Yee (left to right) are pictured above. They hypothesized that these processed grafts, attached to nerve endings in amputations, might help control the nerve regeneration that leads FOREGOING HIERARCHY, new practices in to neuromas. the division’s operating rooms foster the open In 2016, she received a grant from the Department of Defense to communication and personal accountability that is essential for patient safety. Before surgery, study the possibility. team members introduce themselves by first Division Chief Susan Mackinnon, MD, the Sydney M. Jr. and Robert name and role. The surgeon reminds the team H. Shoenberg Chair in Plastic and Reconstructive Surgery, developed that the patient is the most important person in the room, and all team members refer to the necessary surgical technique. She and Moore have used it in about each other by first name. On a whiteboard, a 40 people, with initial success. medical student or intern writes patient data; Moore is collaborating with researchers at Walter Reed National the senior resident writes the surgical steps; and the surgeon lists needed equipment so the Military Medical Center and the Uniformed Services University of the nursing team is aware of special requirements Health Sciences, both in Bethesda, Md., to test the technique in animal and has them ready to go. models through microscopic study and by monitoring the blood for substances that indicate pain. The long-term goal is a clinical trial. A DECISION-SUPPORT TOOL under If successful, their work could benefit more than 2 million U.S. development by public health sciences citizens living with limb loss and those with neuromas caused by other researcher Mary Politi, PhD, and plastic surgeon nerve conditions. Terence Myckatyn, MD, is designed to enable physicians and patients to make sound decisions about breast reconstruction based on clinical evidence and patient preferences.

Department of Surgery Annual Report 2017 | 35 36 | surgery.wustl.edu Division of Public Health Sciences

CORE VALUE: Addressing disparities

Bettina Drake, PhD, MPH The division conducts multidisciplinary Addressing health care disparities through research and community research, education and outreach efforts to engagement is a core value of the School of Medicine, the prevent cancer and other major diseases, Department of Surgery and its Division of Public Health Sciences. promote population health and improve The work of epidemiologist Bettina Drake, PhD, MPH, exemplifies the quality of and access to health care. these values. She co-leads the Prostate Cancer Community Partnership, which promotes prostate cancer screening among African-American men. She also develops epidemiologic studies in this high-risk group to identify clinical modifiable factors that can be research faculty addressed through intervention 70 19 or educational tools. The nature of studies the division’s research is a strong Master of Population draw for faculty who are members of underrepresented minorities, Health Sciences Program both within the division and across the school. “It’s not just research grants 4.0 faculty, but staff that’s diverse,” million 16 24 says Drake. “That provides a graduates currently welcoming environment for 2017 enrolled faculty candidates, post-docs and $ peer-reviewed applicants to our master’s program who are underrepresented publications 2016 patients minorities.” The division’s expertise 170 also has attracted collaborators 3,531 in 3 interventional school-wide. trials 2016–17

All figures FY2016–17 unless otherwise noted

Department of Surgery Annual Report 2017 | 37 Postdoctoral research scholar Marquita Lewis, PhD, left, and faculty member Aimee James, PhD, MPH, are studying how low-income Missourians cope with the inability to pay for health care.

38 |38 surgery.wustl.edu | surgery.wustl.edu Division of Public Health Sciences Highlights

Study explores impact of inability to pay

n a 2014 study, conducted after implementation of the Affordable Care IAct (ACA), the Henry J. Kaiser Family Foundation reported that low- income Missourians still struggled to afford medical costs. A third of those enrolled in MO HealthNet, the state Medicaid program, were not confident they could afford usual or major medical costs. Among uninsured Missourians, more than three quarters could not afford usual medical costs, and nine in 10 reported they were unable to pay major medical costs. MORE THAN HALF OF CANCERS could be Public health sciences researcher Aimee James, PhD, MPH, says the prevented by simply applying knowledge that inability of low-income people to pay medical costs and the resulting lack we already have, according to a study reported of adherence to medical treatment plans is a long-standing problem that in the New England Journal of Medicine and conducted by Division Chief Graham Colditz, has remained relatively constant in Missouri, a state that did not expand MD, DrPH, and Karen Emmons, PhD, of the Medicaid under the ACA. She hopes her work funded by a new grant will Harvard T.H. Chan School of Public Health. help the uninsured and underinsured — along with their providers — Tobacco use, inactivity and obesity are all modifiable risk factors. Smoking cessation find solutions. at age 50 reduces lung cancer deaths by “We still have patients who make too much for Medicaid and too 62 percent; human papillomavirus (HPV) little for the ACA subsidies,” says James. “With the insured, there are still vaccination protects against cervical, penile, co-pays and medications. We decided to try to address these issues.” anal and oral cancer; screening patients with a genetic risk for colorectal cancer reduces Under a grant from the National Institute on Minority Health and mortality up to 70 percent. Colditz and Health Disparities, James and her coworkers are recruiting patients with Emmons also were advisers for the national one or more chronic health conditions at federally supported health Cancer Moonshot initiative. Colditz is shown above with his division colleague Siobhan centers and from the community at large. The researchers will survey Sutcliffe, PhD, ScM, MHS. study participants about financial strain and the strategies patients use to follow their doctors’ instructions. Are they taking one medication but MARY POLITI, PHD, continues to update her not another? Are they going to the food pantry instead of the grocery website showmehealthplans.org, which has store to save money? Are they skipping their medicines altogether? for the last two years provided health insurance The next steps will be making health providers more aware of their education and a tool to compare costs among patients’ dilemmas and developing an intervention program that helps insurance plans available in Missouri under the Affordable Care Act. She also has received bring patients and providers together to discuss options. An end goal will an American Cancer Society grant to build a be a resource guide and strategic intervention to close the gaps. similar tool for cancer patients. “I would love to test the findings in a larger trial,” says James. “Is there time for physicians and patients to have longer conversations about THE UNITED NETWORK FOR ORGAN SHARING less expensive prescriptions and other alternatives? We would like to (UNOS) has developed a new policy that seeks make that happen.” to provide more equitable medical guidelines in deciding kidney allocation for patients receiving a liver and kidney at the same time vs. patients who receive only a kidney. During the policy review period, health economist Su-Hsin Chang, PhD, used historical data and past trends to create a simulation model that projected the life expectancy and quality- adjusted life years for both sets of patients under the proposed policy. The data enabled UNOS to evaluate the policy’s impact.

Department of Surgery Annual Report 2017 | 39 40 | surgery.wustl.edu Division of Urologic Surgery

CORE VALUE: Fostering leadership

Sam Bhayani, MD Division faculty treat all urologic cancers Urologic surgeon Sam Bhayani, MD, is a product of concerted and conditions and provide outstanding departmental efforts to build successful leaders and provide residency and fellowship training. Faculty leadership opportunities. After completing his medical degree research efforts have contributed major and surgery residency training at Washington University, advances in the early detection and he was a busy clinician and internationally known researcher treatment of prostate cancer. for many years, then recognized he wanted to do more. With the support of Department Chair Timothy Eberlein, MD, and Business Affairs Executive Director clinical patient care Jamie Sauerburger, he took research on leadership roles at Barnes- 59 outpatient total Jewish West County Hospital, studies visits procedures including serving as chief medical officer (CMO). Now he is CMO of Washington University Physicians, 25,022 19,049 among the nation’s largest academic clinical practices. In research grants 2.7 this major administrative role, million peer-reviewed he advises 1,361 physicians in publications patient safety, patient satisfaction 2016 and other issues. Bhayani, the $ 71 Holekamp Family Endowed Chair faculty in Urology, says the department 15 gave him the foundation to achieve as a leader, including his work to improve access to All figures FY2016–17 unless otherwise noted health care in St. Louis.

Department of Surgery Annual Report 2017 | 41 Through a National Institutes of Health (NIH) grant, urologist Alana Desai, MD, and colleagues are working with investigators at four other institutions to improve stone disease management and prevention.

42 |42 surgery.wustl.edu | surgery.wustl.edu Division of Urologic Surgery Highlights

Studies address stone disease pain

rologist Alana Desai, MD, hears patients with urinary stone U disease describe the accompanying pain as the worst they have ever experienced; women report that it is more painful than childbirth. Yet funding and research studies on how to alleviate this pain and prevent recurrence have been limited. The National Institute of Diabetes and Digestive and Kidney A NEW BIOPSY PROCEDURE detects prostate Diseases (NIDDK) broke new ground when it formed a funded network cancer more precisely and reduces the need for additional biopsies. Washington University of investigators at Washington University and four other institutions urologists are the only specialists in the central to establish the Urinary Stone Disease Research Network to focus on Midwest to offer the procedure, which improves management and recurrence of stone disease. The NIDDK grant will upon standard ultrasound guidance. Called fund observational studies on hydration practices and the use of ureteral magnetic resonance imaging (MRI)/ultrasound fusion, it begins with a radiologist capturing stents. The agency also will set up a biorepository to collect specimens. MRI images of the prostate, generating a 3-D Desai and fellow Washington University urologist H. Henry Lai, MD, reconstruction of the organ, and mapping co-principal investigators, both treat patients with urinary stone disease. anatomic landmarks and suspicious regions. That 3-D map is then merged with the “Our goal in the hydration trial is to study hydration effect on urologist’s real-time ultrasound imaging during recurrence of stone disease in adults and children,” says Desai. “We know the biopsy, so that he or she can place biopsy that increasing fluid intake reduces the risk of recurrent stones. We will needles more precisely. Division Chief Gerald Andriole, MD, also is working on software look at ways to maintain that over the long term with a multi-component that allows urologists to alter biopsy needle behavioral intervention program.” placement to further reduce infection risk. Desai will lead the trial in patients from Barnes-Jewish Hospital and St. Louis Children’s Hospital, comparing a control group given standard QUALITY IMPROVEMENT and process care with a treatment group that receives incentives to take additional enhancement are the aims of the division’s fluid each day and guidance from a behavioral therapist if they do not monthly morbidity and mortality (M&M) meet their goals. conference. The group, which examines breakdowns in patient care and seeks ways Some patients also suffer severe pain and discomfort from stents to avoid them, recently expanded its focus placed in the ureter after endoscopic stone surgery. Urgency or frequent beyond cases involving death or complications. urination may accompany this pain. Lai will conduct a study to identify Other divisions are following suit. factors that predict which patients will experience these issues, information that could influence treatment decisions and patient counseling. DANE JOHNSON, MD, joins the faculty after Washington University and the other centers will contribute blood, a fellowship in male infertility and andrology at the Medical College of Wisconsin in urine and microbial samples to a central NIDDK biorepository, which Milwaukee. He will specialize in men’s health is the first in the country for stone disease. and male infertility in collaboration with Other centers in the NIDDK study are Duke University, the Washington University in vitro fertilization University of Pennsylvania, the University of Texas Southwestern and specialists, creating the only multidisciplinary program in the region for infertile couples. the University of Washington.

GREG MURPHY, MD, joins the faculty after a reconstructive urology fellowship at the University of California-San Francisco. He specializes in urethral stricture and congenital abnormalities in adults.

Department of Surgery Annual Report 2017 | 43 44 | surgery.wustl.edu Education

CORE VALUE: Work-life balance

Leisha Elmore, MD Residents and fellows benefit from exposure Institutional support for work-life balance fosters work satisfaction to a large and diverse patient population among faculty, allowing them to contribute on flexible terms. at nationally ranked hospitals. Trainees General surgery resident Leisha Elmore, MD, has extended this enjoy strong mentorship from faculty who departmental core value to the trainee level through her award- are leaders in their fields. winning research on gender differences in burnout among U.S. general surgery residents. Her research abstract, reporting results from her national survey of residents, garnered an award at the 2016 Academic Surgical in U.S. Congress. A key finding: the rate 101 surgery residency of burnout for women went up residents th ranking 4 Doximity, Inc., 2017 when they had a partner or a partner and children, while the rate of burnout decreased for men 39 under the same circumstances. Resident Career Path Women and men also exhibited fellows different signs of burnout. Elmore reports residents help each other Life After Residency through nanny sharing and other Who advances to fellowship? means; they also draw from senior residents, alumni and faculty for both career and life advice. Wellness initiatives to enhance of general97% surgery residents resident quality of life also are under way. 78% in 22% in academic private of 88%all surgery residents practice practice

2012–2016 2010–2015

Department of Surgery Annual Report 2017 | 45 Associate General Surgery Residency Program Director Jason Wellen, MD, MBA, second from left, discusses a case with residents Kelly Koch, MD, Bola Aladegbami, MD, and Shuddhadeb Ray, MD, left to right. ROBERT BOSTONROBERT

46 |46 surgery.wustl.edu | surgery.wustl.edu Education Highlights

Residency stresses safety, quality improvement

he General Surgery Residency has stayed a step ahead of regulatory T requirements for reducing duty hours and trends in skills training, simulation and curriculum development. Efforts to create a culture of patient safety and quality improvement (PS/QI) follow a similar trajectory: The residency was poised to meet recent Accreditation Council for Graduate Medical Education (ACGME) guidelines as the accreditation GENERAL SURGERY RESIDENTS received body rolled them out. recognition for their contributions to patient safety and quality-improvement (PS/QI) “The ACGME General Surgery Milestones require that residents projects. Kerri Ohman, MD, presented data have experience in PS/QI, and the higher-level milestones require them from a colorectal early recovery after surgery to be actively involved in projects to improve patient care,” says Residency protocol at the American College of Surgeons Program Director Paul Wise, MD. National Surgical Quality Improvement Program® (ACS NSQIP®) Annual Meeting Multiple layers have emerged as Wise, Associate General Surgery in July 2016. The department honored Residency Program Director Jason Wellen, MD, MBA, and department Shuddhadeb Ray, MD, for a poster on minimizing faculty continue to build a residency culture in which PS/QI is a complications of laparoscopic gallbladder removal. Barnes-Jewish Hospital recognition central focus: went to Jessica Hudson, MD, MSc, for work on • The residency has a curriculum that includes lectures on principles office-based spirometry, and to Jennifer Yu, MD, of PS/QI every year. Another four lectures on topics such as MPHS, Wen Hui Tan, MD, and Jared McAllister, MD, for their research on postoperative opioid problem-based quality improvement and the elements of a patient- prescribing practices. Above, urology resident safety culture occur over a span of two years. Both residents and John Brockman, MD, right, presents results faculty attend the presentations. to surgeons Jeffrey Jim, MD, MPHS, left, and • Morbidity and mortality (M&M) conferences, held weekly among William Chapman, MD. faculty and trainees to discuss patient-care mistakes, no longer focus solely on poor outcomes, but also on near misses, which present A GUN-VIOLENCE PREVENTION and ethics an opportunity for quality improvement. Residents create fishbone session for the department, led by trauma surgeon Laurie Punch, MD, associate residency or Ishikawa diagrams to visualize contributing factors and identify program director, included breakout sessions in root causes. which residents discussed actual cases. Douglas • All residents and fellows in the Department of Surgery are required Schuerer, MD, director of trauma for Barnes- Jewish Hospital, and other members of the acute to participate in PS/QI projects during their training. In addition, and critical care surgery section also participated. they are encouraged to present their projects at the department’s Punch and Schuerer are active in community annual PS/QI poster session. efforts to curb gun violence in the city of St. Louis. • As part of the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) Quality in Training AN ONLINE WELLNESS RESOURCE for residents, initiative, Wellen shares outcomes data with residents regarding developed by minimally invasive surgeon their own surgical cases. The program prepares residents for Arghavan Salles, MD, PhD, offers counseling services, crisis lines, information on coping with evaluating their performance as independent surgeons. adverse events, resources regarding family “We have become much more intentional with our focus on PS/QI life and fitness, and other tools. Salles became and making sure it becomes routine,” says Wise. “Residents must have an active in wellness issues as a resident at Stanford University after the suicide of a residency understanding of how they can ensure better outcomes for their patients.” graduate spurred efforts to improve residents’ well-being. Salles has also published papers on resident wellness, and Time magazine featured her work in an article titled “Doctors on Life Support” about physician stress and burnout.

Department of Surgery Annual Report 2017 | 47 Education

Residencies

General Surgery Residency Research surgical dermatology, orthopedic trauma The department has strong basic science and anesthesia. Training takes place at The Washington University General Surgery research, but residents are not limited to Barnes-Jewish Hospital, Barnes-Jewish Residency was among the first surgical laboratory work in their research years. West County Hospital, Christian Hospital training programs in the country to begin They can engage in clinical or translational and St. Louis Children’s Hospital. reshaping a century-old model of teaching research or earn advanced degrees in public residents how to perform surgery. Residents Program director: Marissa Tenenbaum, MD health or business administration. were traditionally taught under the “See One, Do One, Teach One” method: observe International Rotation a surgery, replicate it with limited guidance, The residency’s newest addition is a Urology Residency and, later, teach it. Almost 20 years ago, rotation at Mzuzu Central Hospital in the Washington University residency Malawi, Africa, a resource-limited hospital The Urology Residency has a long and introduced a skills and simulation lab that that serves the needs of nearly 2.5 million distinguished history in preparing allowed trainees to learn some technical citizens. Residents care for a wide range graduates for careers in urologic surgery, skills at their own pace. More recently, its of adult and pediatric surgical patients, dating to 1910. Today, urology residents educators have been at the forefront of performing more than 100 cases during this are exposed to a volume and diversity of these activities: two-month rotation. surgical cases that is among the highest for urologic residency programs. The program • Early specialization programs Resident Involvement places major emphasis on technological Residents have many opportunities at an • Flexibility in Surgical Training with more innovation. Residents complete four annual retreat to offer input on managing focused training in the resident’s surgical years, as well as an additional intern year, the educational curriculum and improving specialty of choice performing rotations at Barnes-Jewish the program. A social outing at the retreat is Hospital, St. Louis Children’s Hospital, • Training models incorporating more among several annual activities that bring the VA St. Louis Health Care System and evaluation and feedback residents together. Barnes-Jewish West County Hospital. • Involvement in national surgical Program director: Erica Traxel, MD curriculum development Plastic Surgery Residency Program Leadership Professor of Surgery Paul Wise, MD, is Vilray Blair, MD — one of the founders of Vascular Surgery Residency program director of the residency, which the plastic surgery specialty — initially The Vascular Surgery Residency is a five- began in 1919 and remains one of the top developed the training program at year program for medical school graduates surgical residency programs in the United Washington University School of Medicine who decide to focus exclusively on vascular States. Five associate program directors in the early 20th century. The residency is surgery, endovascular surgery and the support Wise by offering expertise in a six-year integrated program, including management of patients with vascular specific areas of surgical education and 4 ½ years of plastic surgery training in disease. The program has full accreditation engaging residents on a daily basis. The breast, craniofacial, pediatrics, head/neck and graduated its first resident in 2017. department faculty — many of whom trauma, hand, microsurgery, cosmetic The section also offers a vascular surgery have been or are leaders of national and peripheral nerve surgery. Residents fellowship for postgraduate trainees who organizations — also enthusiastically also complete rotations in all the general decide to specialize in vascular surgery embrace their roles as teachers and surgery experiences required by the during their general surgery residency. mentors. American Board of Plastic Surgery and subspecialty rotations in oculoplastics, Program director: Jeffrey Jim, MD, MPHS

48 | surgery.wustl.edu Fellowships

Advanced Gastrointestinal/Minimally Invasive Surgery Fellowship Program director: L. Michael Brunt, MD Breast Disease Fellowship Program director: Julie Margenthaler, MD Cardiothoracic Surgery Fellowship Program director: Marc Moon, MD Colorectal Surgery Fellowship Program director: Steven Hunt, MD Hand, Nerve and Microsurgery Fellowship Program director: Amy Moore, MD Hepatobiliary-Pancreatic Surgery Fellowship Program director: William Hawkins, MD Minimally Invasive Urology Fellowship Clinical fellowship director: R. Sherburne Figenshau, MD Research fellowship director: Ramakrishna Venkatesh, MD Pediatric Urology Fellowship Program director: Douglas Coplen, MD Surgical Critical Care Fellowship Program director: Douglas Schuerer, MD Transplant Surgery Fellowship Program director: M.B. Majella Doyle, MD, MBA Vascular Surgery Fellowship Program director: Jeffrey Jim, MD, MPHS

Department of Surgery Annual Report 2017 | 49 50 | surgery.wustl.edu Research

CORE VALUE: Mentorship

William Hawkins, MD The department’s research enterprise To foster a healthy environment for attracting and retaining is among the largest of its peers in the young talent, the department expects all faculty to be strong U.S. It encompasses the full spectrum of mentors. To support that effort, the department provides translational and public health science resources to develop these skills. Hepatobiliary-Pancreatic and and draws from the school’s critical mass Gastrointestinal Surgery Chief William Hawkins, MD, is an of leading faculty and facilities. exemplary mentor, working with junior faculty, fellows and lab residents. As head of a pancreatic cancer SPORE grant that provides Focused Areas of early funding to young faculty, he even has the opportunity to active Research Excellence support investigators outside of 136 grants Cancer biology Washington University. In that Cancer epidemiology and capacity, he seeks all forms of public health diversity, including individuals Cancer immunology whose interests extend beyond clinical Cardiovascular physiology traditional cancer research. Two trial Education of his mentees are Linda Jin, contract 2.9 Lung transplantation immunology MD, a lab resident who won a income million Peripheral nerve injury national scholar research award, Prostate cancer and Ismael Dominguez, MD, a Sepsis and critical injury postdoctoral fellow who returned $ Vascular biology home to Mexico to advance in U.S. public policy and health care. “If NIH funding to perpetual motion actually exists, academic surgery Clinical Research Studies it’s found in mentorship,” Hawkins departments #2 2016, Blue Ridge Institute of says. “You get back as much or Medical Research Report* more than you put into it.” 543 All figures FY2016–17 unless otherwise noted *Includes Siteman Cancer Center support grant

Department of Surgery Annual Report 2017 | 51 As part of his graduate work toward a medical degree and a master’s degree in public health, Kshitij Desai, right, is studying peripheral arterial plaque of diabetic patients with his research mentor, vascular surgeon Mohamed Zayed, MD, PhD.

52 |52 surgery.wustl.edu | surgery.wustl.edu Research Highlights

Broad research efforts COURTESY OF THE SENATE APPROPRIATIONS COMMITTEE remain strong

he Department of Surgery is strongly committed to its research Tmission, which includes fostering basic, translational, clinical and public health research to improve human health. Despite a very competitive funding environment, the department continues to draw ample support, ranking second in National Institutes of Health (NIH) funding among surgery departments nationwide in 2016.* A U.S. SENATE SUBCOMMITTEE heard Department Chair Timothy Eberlein, MD, Basic and Translational Research explain at a March 8 hearing, shown above, why federal funding is critical to the search Researchers seeking to improve survival for pancreatic ductal for innovative therapies for cancer and other adenocarcinoma have developed two clinical trials as part of a Specialized diseases. Eberlein, also director of Siteman Programs of Research Excellence (SPORE) grant, a major translational Cancer Center, cited the application of genomic analysis to develop precision cancer treatments research award from the National Cancer Institute (NCI). The SPORE as an example of promising research. He also grant funds four drug-development and immunotherapy projects, a said NIH is vitally important to the careers biostatistics core, a tissue repository core and a career-development of young scientists. Other medical experts who testified at the hearing were Stacey program for junior researchers. Pancreas SPORE researchers span the Schultz-Cherry, PhD, of St. Jude Children’s department, medical school and other institutions. Basic science across Research Hospital; Thomas Grabowski, MD, disciplines also remains a strength. of the University of Washington; and Jennifer Sasser, PhD, of the University of Mississippi. Clinical Research

Surgeons who serve as principal investigators in surgical oncology EARLY CAREER NIH K08 AWARDS went to trials received new administrative support this year as the department’s plastic surgeon Alison Snyder-Warwick, MD, and vascular surgeon Mohamed Zayed, MD, Clinical Research and Data Management Group assumed coordination PhD. The awards highlight the breadth of the of many of the surgical oncology trials at the Alvin J. Siteman Cancer department’s basic science research and its Center at Barnes-Jewish Hospital and Washington University School of commitment to developing young surgeon- scientists through mentoring. Snyder-Warwick Medicine. The department’s Vice Chair for Research, William Gillanders, will investigate the role of terminal Schwann MD, is national principal investigator for a breast cancer study combining cells — located at the interface between motor chemotherapy and antibody therapy to activate anti-tumor immunity. nerves and muscle — in normal function William Chapman, MD, is principal investigator for a device trial and after motor nerve injury. Her studies may suggest new strategies to treat nerve injuries. evaluating normothermic machine perfusion technology to protect liver Zayed’s grant will fund ongoing translational organs before transplant. Mohamed Zayed, MD, PhD, maintains a vascular research that explores the biochemistry biobank that serves scientific investigations related to vascular diseases. of diabetic peripheral arterial disease and potential methods to inhibit this difficult-to- Public Health Research treat disease. He also received the American College of Surgeons/Society for Vascular Public health sciences researchers are leaders in cancer and disease Surgery Foundation Career Development grant, which matches K08 funds. prevention research, with Division Chief Graham Colditz, MD, DrPH, at the forefront of efforts to promote healthy lifestyles. Last year, he advised the national Cancer Moonshot initiative to accelerate cancer research. Investigators also study patient decision-making, health disparities, health communication, chronic disease prevention, cancer genetics, biostatistics and public health in underdeveloped countries.

*Blue Ridge Institute for Medical Research

Department of Surgery Annual Report 2017 | 53 Research

of recurrence of urinary stones, conduct research additional funding Research to understand and mitigate ureteral stent-related pain and symptoms, and provide data and collect Cardiothoracic Surgery Funding biological samples from the studies to create a resource for future researchers. New awards, FY2016-17 Andrew Gelman, PhD Section of General Thoracic Surgery Ryan Fields, MD $176,265 major funding Division of General Surgery, Section of Hepatobiliary-Pancreatic Quark (Industry)/The Evaluation of Quark siRNA in William Hawkins, MD and Gastrointestinal Surgery Mouse Lung Transplants 06/27/2017-06/23/2018 Division of General Surgery, $1,816,168 Section of Hepatobiliary-Pancreatic NIH R01/Towards True Precision Oncology: General Surgery and Gastrointestinal Surgery Validation of a Comprehensively Humanized, $10,362,953 Autologous Mouse Model (R01CA204115) Dirk Spitzer, PhD NIH SPORE/Washington University SPORE in 01/09/17-12/31/19 Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery Pancreatic Cancer (P50CA196510) Fields and a multidisciplinary research team are 07/28/16-06/30/21 developing a mouse model that could enable $686,236 The Specialized Programs of Research Excellence cancer specialists to test how an individual person’s Department of Defense/U.S. Army/New-Generation (SPORE) grant is a cornerstone of the National tumor responds to specific therapies. The lab is Precision Medicines: Biomarker-Targeted TR3 Cancer Institute’s efforts to promote collaborative, testing the model in melanoma patients, but Biologics Overcome Treatment Resistance in Ovarian interdisciplinary translational cancer research. This eventually it could be applied to all cancers. Cancer (W81XWH-17-1-0102) 04/01/17-03/31/20 SPORE grant involves both basic and clinical/applied Vetta Thompson, PhD scientists working together and supports projects William Gillanders, MD that will result in new and diverse approaches to Division of Public Health Sciences Section of Endocrine and Oncologic Surgery the prevention, early detection, diagnosis and $1,030,161 $400,000 treatment of pancreatic cancer. Patient-Centered Outcomes Research Institute Siteman Investment Program Pre-SPORE/Siteman (PCORI)/Developing and Validating Quantitative Alana Desai, MD, and Henry Lai, MD Cancer Center Breast Cancer SPORE (competitive Measures to Assess Community Engagement in second year) 01/01/17-12/31/17 Division of Urologic Surgery Research: Addressing the Measurement Challenge $3,399,499 (ME-1511-33027) 02/01/17-01/31/20 William Hawkins, MD NIH U01/1/1 Urinary Stone Disease Washington Thompson, co-PI, and researchers use community- Section of Hepatobiliary-Pancreatic University Research Network (U01DK110986) engaged research approaches and mixed methods and Gastrointestinal Surgery 07/01/06-06/30/18 (e.g. qualitative/quantitative) research techniques $150,537 to develop and validate comprehensive (long) and This grant establishes a multicenter, Pancreatic Cancer Action Network (PanCAN)/ condensed (shorter) survey instruments that assess multidisciplinary group of investigators known Targeting Tumor Infiltrating Myeloid Cells to the level of community engagement in research as the Urinary Stone Disease Research Network Enhance Immunotherapy (16-65-HAWK) studies from the stakeholder perspective. (USDRN). Washington University is one of these 07/01/16-06/30/18 centers, which will look at the impact of increased fluid intake and increased urine output on the rate Mohamed Zayed, MD, PhD Section of Vascular Surgery $150,000 Society for Vascular Surgery Foundation/Mentored Clinical Scientist Research Career Development Award 06/01/17-05/31/20

54 | surgery.wustl.edu Plastic and Reconstructive Surgery RESEARCH GRANTS Alison Snyder-Warwick, MD $717,332 Total: $22,569,798 NIH K08/Investigation of Terminal Schwann Cell Function in Homeostasis and Injury (K08NS096232) 04/01/17-03/31/21 By Source Katherine Santosa, MD Government $15,399,639 $121,980 Non-Government $7,170,159 NIH F32/Molecular Mechanisms of Terminal Schwann Cell Response After Nerve Injury (F32NS098561) 07/01/16-06/30/18

Plastic and Reconstructive Surgery/Public Health Sciences

Terence Myckatyn, MD (Plastic Surgery) and Mary Politi, PhD (Public Health Sciences) $400,000 Siteman Investment Program Multi-PI Pre-R01/ By Division Optimizing Decision Making About Breast General Surgery $7,958,016 Reconstruction After Mastectomy: A Patient- Centered Approach 01/01/17-12/31/18 Cardiothoracic Surgery $4,803,409 Public Health Sciences $3,993,580 Public Health Sciences Urologic Surgery $2,695,632 Plastic and $1,711,709 Erin Linnenbringer, PhD Reconstructive Surgery $543,275 Pediatric Surgery $1,407,453 NIH K07/Integration of Genomic and Social Science in Breast Cancer Disparities Research (K07CA212032) 09/15/06-08/31/20

CLINICAL TRIAL CONTRACT INCOME

Total: $2,912,939

General Surgery $1,531,607 Cardiothoracic Surgery $1,064,021 Urologic Surgery $254,431 Plastic and $58,380 Reconstructive Surgery Public Health Sciences $4,500

All figures: FY 2016-17

Department of Surgery Annual Report 2017 | 55 56 | surgery.wustl.edu Clinical Operations

CORE VALUE: Serving a diverse population

Rebecca Aft, MD, PhD Through a strong relationship with our two The department is making deliberate efforts to ensure that nationally ranked hospital partners, the the strong diversity of its patient population is represented in its department provides multidisciplinary care clinical trials — a necessity for ensuring that medical research in nearly every surgical subspecialty, with benefits everyone. Leading in this area is breast surgeon and cancer a focus on excellence and patient safety. researcher Rebecca Aft, MD, PhD, who enrolls many of her patients in clinical trials. Overall, about 16 percent of Siteman Cancer Center patients are underrepresented minorities, and this group makes practice patient care up 12 percent of therapeutic trial sites in enrollment. In some of Aft’s trials 128,926 105,034 — many focusing on targeted 13 Missouri outpatient total therapy for early-stage breast visits procedures cancer — minority participation is as high as 25 percent. She and adult: 113,755 adult: 95,135 Siteman colleagues work hard Ranked among pediatric: 15,171 pediatric: 9,899 to address the complex barriers the nation’s best to minority trial participation. Issues include lack of trust and Barnes-Jewish Hospital practical issues such as lack of & transportation. “We educate St. Louis Children’s Hospital 55 patients and work with all the U.S. News & World Report nurse resources we have to ensure that practitioners participating in trials is not a and burden for them,” says Aft. physician 120 surgeons assistants

All figures FY2016–17 unless otherwise noted

Department of Surgery Annual Report 2017 | 57 Better patient education is an important component of department-wide patient safety and quality-improvement protocols employed by staffers such as colorectal surgery nurse practitioner Bonnie Johnston, BSN, RN.

58 |58 surgery.wustl.edu | surgery.wustl.edu Clinical Operations Highlights

NUMBER OF VISITS & PROCEDURES Standardization Visits Procedures improves outcomes 250,000 200,000

lmost a decade ago, the Department of Surgery began moving 150,000 its surgical care into a value-based model, focused on improving A 100,000 patients’ health through evidence-based, cost-effective methods. This approach — almost certain to remain the trend in U.S. health care — 50,000 continues to yield benefits for the department’s surgical patients and 0 FY07 FY12 FY17 promises to improve care for years to come. Over the past year, the department has focused on standardizing care WORK RELATIVE VALUE UNITS pathways, developing patient safety and quality improvement projects in (Work RVUs) data-determined areas of deficiency, and reducing operating-room costs. 1,000,000 The colorectal surgery section and urology division have led the way in establishing standard enhanced recovery after surgery (ERAS) protocols 750,000 that prescribe exact steps for patients and caregivers — from preparation at home through the hospital stay and recovery periods. The results have 500,000 been a dramatic reduction of surgical site infections (SSIs) in patients 250,000 who have part of their colon removed and a decreased rate of deep-space infections for patients who have had all or part of their bladders removed. 0 “Transplant surgeons recently implemented an ERAS protocol for FY07 FY12 FY17 their living kidney donors, and hepatobiliary-pancreatic surgeons have begun using a protocol for patients undergoing pancreas cancer surgery,” IMPROVED METHODS AND STANDARDIZATION says Dee Dee Epstein, RN, BSN, patient safety nurse coordinator. “These in surgery scheduling could yield big benefits for the Department of Surgery, its patients and pathways aim to decrease pain and length of stay, improve recovery and other surgical areas. reduce readmission.” Transplant, cardiothoracic, and plastic and To further improve patient care, each division and section reviews reconstructive surgeons are piloting the metrics from internal and external quality-reporting systems: the project with the support of Jackie Martin, MD, Washington University event-reporting system, Barnes-Jewish Hospital vice president of perioperative services at Barnes-Jewish Hospital. Surgeons use an cost data, the Vizient reporting system for academic medical centers, and electronic scheduling form that requires the American College of Surgeons National Surgical Quality Improvement details about the patient and surgery: for Program® (ACS NSQIP®). These metrics have led to the SSI reductions and example, whether the patient is healthy or sick, obese, or has adhesions from previous to the procedural change of reporting radiology and lab results directly to surgeries, or whether any blood work or special the surgeon, instead of sending reports through specialists. equipment is needed for the surgery. A yearlong effort to reduce operating room costs helped the hospital The information goes to the entire operating- save millions of dollars over the past year. room team, including nurses, anesthesiologists, “We achieved agreement to use one type of stapler, implant and other central sterile supply staff and residents. disposable items after asking our surgeons to compare the many existing “In the past, nurses would have to read surgeons’ minds to know that a special piece of equipment alternatives,” says Gerald Andriole, MD, vice chair for patient safety and was needed for a specific patient,” says Gerald clinical effectiveness. “This was the low-hanging fruit; next year it will be a Andriole, MD, vice chair for patient safety. “The little more challenging.” new scheduling process enables the operating room to be much better prepared for surgery.” Martin plans to use the scheduling system as a best practice that other clinical care areas such as otolaryngology, neurosurgery, and obstetrics and gynecology could adopt.

Department of Surgery Annual Report 2017 | 59 A major campus renewal project consolidates and expands surgical services, cancer care and other programs, adds to private inpatient beds and incorporates outpatient clinics and diagnostics. COURTESY OF BJC HEALTHCARE

60 | surgery.wustl.edu Washington University Medical Campus

Washington University Medical Campus is among the largest academic medical centers in the world, with comprehensive strengths in nearly every area of clinical medicine and biomedical investigation. Its culture is collaborative and collegial.

ITS PRIMARY MEMBERS are Washington certification from the Joint Commission The Alvin J. Siteman Cancer Center at University School of Medicine and its on lung volume reduction surgery Barnes-Jewish Hospital and Washington affiliated hospital partners, Barnes-Jewish and ventricular assist devices and is an University School of Medicine is the only Hospital and St. Louis Children’s Hospital. American College of Surgeons-verified National Cancer Institute-designated The School of Medicine’s clinical practice Level I trauma center. Comprehensive Cancer Center in Missouri group, called Washington University and is ranked as one of the nation’s top St. Louis Children’s Hospital is the largest Physicians, is one of the largest academic cancer facilities by U.S. News & World children’s hospital in the region, with 280 clinical practices in the nation. Its 1,361 Report. It is among the top five nationally beds and an American College of Surgeons- specialty and primary care clinicians in patient volume. verified Level I pediatric trauma center. comprise the medical staffs at Barnes-Jewish It offers comprehensive services in every Multidisciplinary research in nearly every and St. Louis Children’s hospitals. pediatric medical and surgical specialty area of biomedicine is a hallmark of the Barnes-Jewish Hospital is the largest hospital and is recognized as one of America’s top school. U.S. News & World Report perennially in Missouri, with 1,365 beds. It has been children’s hospitals by U.S. News & World ranks the school’s graduate programs ranked on U.S. News & World Report’s Report, which in 2017 ranked the hospital among the nation’s best. Faculty and chief Honor Roll of America’s best hospitals in all 10 specialties surveyed. residents author the Washington Manual of for 25 consecutive years, holds advanced Medical Therapeutics, among the world’s most widely sold medical textbooks.

research grants physicians hospital and contracts (university-employed) 1,645 beds 548.5 1,361 million hospital 90,979 discharges including $375 million 1,082,665 Barnes-Jewish Hospital and from$ the NIH FY2015–16 outpatient visits St. Louis Children’s Hospital 2016 2016

Department of Surgery Annual Report 2017 | 61 © GETTY IMAGES/RUDY© GETTY BALASKO

62 | surgery.wustl.edu St. Louis

The “Gateway to the West” is a thriving metropolitan area of 2.8 million people that retains the friendly character of the Midwest. The fun and culture of a big city are readily available, but living in St. Louis is easy and affordable.

THE SCHOOL OF MEDICINE is located St. Louis offers a significantly lower cost of hot attractions in local clubs, and a large in the city’s eclectic Central West End housing than the nation’s major coastal cities. outdoor venue draws major concerts. Annual neighborhood, full of sidewalk cafes, In this family-friendly environment, residents festivals celebrate regional beer breweries coffeehouses, shops and affordable of all ages enjoy a substantial number of free and wineries, hot air balloons, Earth Day, housing. Forest Park, located adjacent to attractions year round. St. Louis is a sports- African arts, Japanese culture, international the medical center, is a haven for those minded city that enthusiastically supports films, Mardi Gras, wine, Scottish games and seeking cultural and outdoor activities. St. Louis Cardinals baseball and Blues Strassenfest, among other interests. At 1,300 acres, it is among the nation’s hockey and a number of semi-pro teams. Outdoor activities can be found within and biggest city parks — 500 acres larger than The Missouri Botanical Garden offers around the metropolitan area; bike trails line New York’s Central Park — and is home beautiful displays year round. The St. Louis both the Mississippi and Missouri rivers, and to art, history and science museums, an Symphony is among the country’s best, and the Ozark mountains and river valleys are outdoor musical theater and the Saint Louis several first-rate theater companies practice perfect for backpacking, camping, fishing and Zoo, as well as a variety of athletic facilities, their art here. The Fox Theatre presents canoeing. St. Louis’ central location makes picnic areas and a system of scenic lagoons Broadway shows, dance performances and exploring nearby cities easy and inexpensive. and waterways. concerts. Blues, jazz and rock bands are

Free museum district city for Missouri History Museum #1 city park & zoo USA Today Reader’s Choice 2016 millennials Saint Louis Art Museum #1 Business Insider 2017 Saint Louis Science Center

Saint Louis Zoo Major League Affordable #2 Baseball among attendance major cities Major League Baseball #6 Investor’s Business Daily 2017

Department of Surgery Annual Report 2017 | 63 Leadership

Faculty in the Department of Surgery Erin Linnenbringer, PhD Gayan De Silva, MD Washington University have been appointed to national and Instructor of Surgery Lab General Surgery Resident international organizations and have Jane Engelberg Memorial Fellowship Resident Research Grant Award, School of Medicine received numerous honors. Advisory Group, National Society of Vascular & Endovascular Surgery Society Genetic Counselors Sam Bhayani, MD Jose “Pepe” Diaz-Miron, MD Holekamp Family Endowed Chair Peter Manning, MD Chief General Surgery Resident, in Urology National and International Professor of Surgery and Paul Wise, MD Chief medical officer, Faculty Practice Plan Co-clinical lead, Surgical/ICU Learning General Surgery Residency Organizations Lab, National Pediatric Cardiology Quality Program Director Elisa Birnbaum, MD Improvement Collaborative Alpha Omega Alpha (AOA) National Professor of Surgery Rebecca Aft, MD, PhD Medical Honor Society Chief Residents Faculty Mentorship Award Julie Margenthaler, MD (General Surgery Residency award) Professor of Surgery Professor of Surgery Sean English, MD Member, NCI Cancer Biomarkers Secretary–Treasurer, American Society Assistant Professor of Surgery Alex Bribriesco, MD Study Section of Breast Surgeons 2017 Wylie Scholar Award, Vascular Cures Cardiothoracic Surgery Fellow Jeffrey Blatnik, MD Gregorio A. Sicard Fellow Teaching Award John Mazuski, MD, PhD Patrick Geraghty, MD 2017 (General Surgery Residency award) Assistant Professor of Surgery Professor of Surgery Professor of Surgery Member, Board of Governors, President, Surgical Infection Society, First author, one of five most highly cited Pamela Choi, MD Americas Hernia Society 2016-17 articles in Journal of Vascular Surgery, General Surgery Chief Resident Keith Brandt, MD 2014-15 Keith D. Amos Memorial Award Bryan Meyers, MD, MPH (General Surgery Residency award) William G. Hamm Professor of Surgery Patrick and Joy Williamson Professor Linda Jin, MD Executive director, American Board of of Surgery Lab General Surgery Resident Graham Colditz, MD, DrPH Plastic Surgery Chief, Section of Thoracic Surgery Resident Scholar Research Award, Society Neiss-Gain Professor of Surgery L. Michael Brunt, MD Chair, American Board of for University Surgeons Foundation Chief, Division of Public Health Sciences Pancreas SPORE Biostatistics Chief, Section of Minimally Thoracic Surgery Susan Mackinnon, MD Invasive Surgery Core Director Marc Moon, MD Shoenberg Professor of Plastic and Administrative Core Associate Director Member, Society of American John M. Shoenberg Professor of Surgery Reconstructive Surgery Gastrointestinal and Endoscopic Chief, Section of Cardiac Surgery Chief, Division of Plastic and Julie Colicchio, MSN, RN, NP-C Surgeons Board of Governors Secretary, American Association for Reconstructive Surgery Nurse Practitioner Member, Board of Directors, SAGES Thoracic Surgery American Association of Plastic Surgeons Advanced Care Practitioner Award Education and Research Foundation Distinguished Fellow Award (General Surgery Residency award) Member, Board Fellowship Council Alec Patterson, MD Bettina Drake, PhD, MPH Secretary, Central Surgical Association Joseph Bancroft Professor of Surgery Terence Myckatyn, MD Editor-in-chief, The Annals of Professor of Surgery Associate Professor of Surgery Graham Colditz, MD, DrPH Thoracic Surgery Plastic Surgery Foundation Bernard G. Pancreas SPORE Administrative Core Neiss-Gain Professor of Surgery Sarnat Excellence in Grant Writing Award Co-Investigator Chief, Division of Public Health Sciences Luis Sanchez, MD Eleanor Drew, MD Advisor, National Cancer Gregorio A. Sicard Distinguished Tiffany Osborn, MD, MPH Assistant Professor of Surgery Moonshot Initiative Professor of Vascular Surgery Professor of Surgery and Clinical Teacher of the Year Award Advisor, National Cancer Institute President, Cirujanos Vasculares Emergency Medicine Board of Scientific Advisors de Habla Hispana, 2015–2017 First female full professor in combined Jason Gauthier, MD and Chair, National Academies of Sciences Alison Snyder-Warwick, MD field of emergency medicine (EM) and Jennifer Yu, MD Workshop on Improving Health Research Assistant Professor of Surgery critical care (CC) General Surgery Residents for Small Populations Secretary, Sir Charles Bell Society First female physician boarded in both Resident of the Year Award EM and CC in United States Ralph Damiano Jr., MD Siobhan Sutcliffe, PhD, ScM, MHS Aimee James, PhD, MPH Evarts A. Graham Professor of Surgery Associate Professor of Surgery Kristen Seiler, MD Associate Professor of Surgery Chief, Division of Cardiothoracic Surgery Project leader, Multidisciplinary Approach Lab General Surgery Resident Chair, Behavioral Science Subcommittee, Editor-in-chief, Innovations in Cardiotho- to the Study of Chronic Pelvic Pain (MAPP) Resident Research Award, Association Siteman Cancer Center Protocol Review racic and Vascular Surgery Research Network for Academic Surgery and Monitoring Committee Timothy Eberlein, MD Thomas Tung, MD Gregorio Sicard, MD Susan Mackinnon, MD William K. Bixby Professor of Surgery Professor of Surgery Emeritus Professor of Surgery Shoenberg Professor of Plastic Chair, Department of Surgery Board of Directors, American Society René Leriche Prize 2017, International and Reconstructive Surgery Board of Regents, American of Plastic Surgeons Society of Surgery/Société Internationale Chief, Division of Plastic and College of Surgeons de Chirurgie Reconstructive Surgery, Chair, National Comprehensive Alison Snyder-Warwick, MD and Alec Patterson, MD Joseph Bancroft Professor of Surgery Cancer Network Board of Directors National and International Assistant Professor of Surgery Editor-in-chief, Journal of the American K08 Clinical Investigator Grant Award, 25 Year Distinguished Service Award, College of Surgeons Awards National Institute Washington University School of Medicine William Gillanders, MD for Neurological Diseases and Stroke Laurie Punch, MD Professor of Surgery Keith Brandt, MD (NINDS), NIH Assistant Professor of Surgery Vice Chair for Research William G. Hamm Professor of Surgery Plastic Surgery Foundation Bernard G. Evarts Graham Teaching Award Member, Programmed Death Ligand 1 2016 American Society of Plastic Sarnat Excellence in Grant Writing Award (General Surgery Residency award) Project Team, Cancer Therapy Surgeons President’s Award Mohamed Zayed, MD, PhD Clinical Teacher of the Year Award Evaluation Program Donald Buck II, MD Assistant Professor of Surgery Dominic Sanford, MD Chair, Department of Defense Breast Assistant Professor of Surgery K08 Clinical Investigator Grant Award, General Surgery Chief Resident Cancer Study Section Special commendation, “Review of Plastic National Institutes of Health (NIH)/ Eugene Bricker Teaching Award Member, National Cancer Institute Surgery,” 2016 Surgical Textbook Awards, National Heart, Lung, and Blood (General Surgery Residency award) Clinical Oncology Study Section British Medical Association Institute (NHLBI), Research Fellowship Mary Klingensmith, MD William Chapman, MD Award, American Surgical Association Mary Culver Distinguished Professor Eugene M. Bricker Professor of Surgery Foundation of Surgery Chief, Division of General Surgery and Vice Chair for Education Section of Transplant Surgery Chair, American Board of Surgery Francis Moore Excellence in Mentorship in the Field of Transplantation Award

64 | surgery.wustl.edu Noted Accomplishments

Barnes-Jewish Hospital, PHOTOS BY MIKE NICHOLS WILLIAM CHAPMAN, JOHN MAZUSKI, MD, St. Louis Children’s Hospital MD, chief of the Section PHD, professor of and BJC HealthCare of Transplant Surgery surgery and co-director and the Eugene M. of the Barnes-Jewish Maria B. Majella Doyle, MD, MBA Bricker Professor of Hospital Surgical Associate Professor of Surgery, Surgery, received the Intensive Care Unit, and Jason Wellen, MD, MBA Associate Professor of Surgery 2017 Francis Moore concluded an active Directors, Abdominal Organ Transplantation Excellence in Mentorship in the Field of presidency of the Surgical Infection Society Program, St. Louis Children’s Hospital Transplantation Award from the American (SIS) in May 2017. He was part of a task Bruce Hall, MD, PhD, MBA Society of Transplant Surgeons. The award force that wrote SIS Revised Guidelines Professor of Surgery acknowledges established surgeons for on the Management of Intra-Abdominal Chief quality officer, BJC HealthCare their stewardship of fellowship trainees Infection and was the SIS representative Steven Hunt, MD Associate Professor of Surgery and junior faculty. for the Surviving Sepsis Guidelines 2016, Surgical co-director, Center for Advanced published jointly by the Society of Critical Medicine – South County Care Medicine and European Society of John Kirby, MD Intensive Care. Associate Professor of Surgery MARY KLINGENSMITH, Medical director, Rehabilitation Services, Barnes-Jewish Hospital MD, vice chair of Daniel Kreisel, MD, PhD education and the Mary Professor of Surgery Culver Distinguished BRYAN MEYERS, MD, Surgical director, Lung Transplant Program, Professor of Surgery, MPH, chief of the Section and Scientific director, Washington University became chair of the of Thoracic Surgery and and Barnes-Jewish Transplant Center American Board of the Patrick and Joy Kamlesh Patel, MD Assistant Professor of Surgery Surgery (ABS) board of directors in June 2017. Williamson Professor of Medical director of craniofacial surgery, The ABS certifies surgeons who have met Surgery, became chair of St. Louis Children’s Hospital defined educational, training and knowledge the American Board of Physician lead for rapid performance standards and oversees their continuous Thoracic Surgery (ABTS) in September 2017. improvement, St. Louis Children’s Hospital certification. As ABS chair, Klingensmith will The ABTS oversees certification of thoracic Jacqueline Saito, MD, MSCI Assistant Professor of Surgery lead efforts to revamp the certification surgery training program graduates and Outcomes physician, Center for Clinical process and will initiate a strategic planning ongoing maintenance of certification for Excellence, BJC HealthCare process. Klingensmith is the third woman ever certified thoracic surgeons. Meyers already has Matthew Silviera, MD to chair the ABS since its founding in 1937, led efforts to make the recertification exam Assistant Professor of Surgery and she is the fourth Washington University less punitive and more of a learning process. Co-leader of Colorectal Enhanced Recovery After Surgery Team, awarded Barnes-Jewish School of Medicine surgeon to lead the Hospital Team Award for Quality Improvement organization.

Outcomes research Surgical outcomes research is a major strength in the Department of Surgery. To build onto existing collaborations between surgeons and public health sciences faculty, the department established the Surgery and Public Health Research (SPHERE) Center. Members meet monthly for research discussions and mentorship, with an ultimate goal of spurring more competitive grants. Left to right, Public Health Sciences Chief Graham Colditz, MD, DrPH, thoracic surgeon Benjamin Kozower, MD, MPH, and public health sciences researcher Mary Politi, PhD, are co-leaders.

Department of Surgery Annual Report 2017 | 65 Faculty chair’s office institutional division of Section of General Critical Care Service leadership cardiothoracic Thoracic Surgery in the Cardiothoracic surgery Intensive Care Unit Michael S. Avidan, MBBCh, FCA, Chief Dr. Seymour and Rose T. Brown Professor of Anesthesiology and Surgery Timothy J. Eberlein, Maria B. Majella Doyle, Charl J. De Wet, MBChB MD, Chair MD, MBA Professor of Anesthesiol- Sam B. Bhayani, MD Bryan F. Meyers, MD, ogy and Surgery William K. Bixby Co-director, Faculty Career Holekamp Family MPH, Chief Professor of Surgery; Development/Mentoring Ralph J. Damiano Jr., Patrick and Joy Williamson Diego Casali, MD Endowed Chair in Urology; MD, Chief Director, Alvin J. Siteman Chief Medical Officer, Chair in Cardiothoracic Julianne Donnelly, MD Cancer Center Evarts Ambrose Graham Surgery Daniel A. Emmert, MD, Washington University Professor of Surgery Physicians PhD G. Alexander Patterson, Mohammad Helwani, Section of Cardiac MD MD, MSPH Joseph C. Bancroft Surgery Clare H. Ridley, MD Professor of Adnan Sadiq, MD Cardiothoracic Surgery Assistant Professors Andrew E. Gelman, PhD of Anesthesiology Jacqueline G. and William Tiffany M. Osborn, and Surgery E. Maritz Professor MD, MPH William C. Chapman, MD Director, Leadership Benjamin D. Kozower, division of Eugene M. Bricker and Professional Bruce Lee Hall, MD, MD, MPH Professor of Surgery; Development PhD, MBA Professor of Surgery general surgery Executive Vice Chair Chief Quality Officer, Daniel Kreisel, MD, PhD BJC HealthCare Marc R. Moon, MD, Professor of Surgery; Chief Director of Lung John M. Shoenberg Chair Transplantation in Cardiovascular Disease Alexander S. Krupnick, Ralph J. Damiano Jr., MD MD Chief, Division of Varun Puri, MD, MSCI Cardiothoracic Surgery; Associate Professors Evarts Ambrose Graham of Surgery Mary C. Politi, PhD Professor of Surgery William C. Chapman, Wenjun Li, MD MD, Chief Gerald L. Andriole, MD Co-director, Faculty Career Nabil A. Munfakh, MD Assistant Professor Eugene M. Bricker Robert Killian Royce, MD, Development/Mentoring Jacqueline M. Saito, Michael K. Pasque, MD of Surgery Professor of Surgery Distinguished Professor MD, MSCI Richard B. Schuessler, of Urologic Surgery; Outcomes Physician, Xingan Wang, MD, PhD PhD Instructor in Surgery Vice Chair for Patient Center for Clinical Professors of Surgery Section of Acute and Safety and Clinical Excellence, Critical Care Surgery Jeffrey M. Arbeit, MD William A. Gay Jr., MD Effectiveness Professor of Surgery BJC HealthCare Section of Pediatric Professor Emeritus Cardiothoracic Surgery Peter S. Goedegeburre, of Surgery PhD Michael Crittenden, MD Associate Professor Associate Professor of of Surgery Surgery; Chief of Cardio- thoracic Surgery, St. Louis VA Medical Center- John Cochran Division Brian P. Cupps, PhD Grant V. Bochicchio, MD, William E. Gillanders, MD Spencer J. Melby, MD MPH, Chief Vice Chair for Research Hersh S. Maniar, MD Pirooz Eghtesady, MD, Harry Edison Professor Associate Professors PhD, Chief of Surgery of Surgery Emerson Chair in Bradley D. Freeman, MD Pediatric Cardiothoracic Keki R. Balsara, MD John E. Mazuski, MD, PhD Surgery, St. Louis Akinobu Itoh, MD, PhD Tiffany M. Osborn, Puja Kachroo, MD Children’s Hospital MD, MPH Muhammad F. Masood, Peter B. Manning, MD Douglas J.E. Schuerer, MD MD Professor of Surgery Professors of Surgery Stefano Schena, MD, PhD Aaron Abarbanell, Obeid N. Ilahi, MD Assistant Professors MD, MS* Mary E. Klingensmith, MD John P. Kirby, MD of Surgery Orlando Petrucci, Mary Culver Distinguished Forest R. Sheppard, MD* Julia Kar, PhD MD, PhD Professor of Surgery; Associate Professors Instructor in Surgery Assistant Professors Vice Chair for Education of Surgery of Surgery Sara A. Buckman, Anoop Brar, PhD MD, PharmD Instructor in Surgery Julianne Donnelly, MD Eleanor Drew, MD Stephen R. Eaton, MD Zachary Englert, DO*

66 | surgery.wustl.edu Gerald R. Fortuna Jr., MD Rebecca L. Aft, MD, PhD Section of Transplant Patrick A. Dillon, MD division of public Adetunji T. Toriola, MD, Anja G. Fuchs, PhD William E. Gillanders, MD Surgery Christopher R. Erwin, PhD health sciences MPH, PhD Kareem D. Husain, MD Martin S. Keller, MD Anke C. Winter, MD, MSc Virginia M. Herrmann, William C. Chapman, Laurie J. Punch, MD MD MD, Chief Associate Professors Assistant Professors Nishant Raj, MD Julie A. Margenthaler, Eugene M. Bricker of Surgery of Surgery Jason A. Snyder, MD MD Professor of Surgery Jun Guo, PhD Kenneth R. Carson, MD Isaiah R. Turnbull, MD, Professors of Surgery Surendra Shenoy, Jacqueline M. Saito, Jean S. Wang, MD, PhD PhD Amy E. Cyr, MD MD, MSCI Assistant Professors Kelly J. Vallar, MD* MD, PhD Katherine Glover-Collins, Professor of Surgery Adam M. Vogel, MD of Surgery; Assistant Michael D. Weiss, DPM MD, PhD Jesse D. Vrecenak, MD* Professors of Medicine Muhammad Yasin, MD Maria B. Majella Doyle, Assistant Professors Assistant Professors Jean Hunleth, PhD, MPH* Assistant Professors of Surgery MD, MBA of Surgery of Surgery Jason R. Wellen, MD, MBA Graham A. Colditz, Erin L. Linnenbringer, Constance Wye Leng Lee, MD, DrPH, Chief PhD Chukwuma Apakama, Section of Hepatobiliary- Associate Professors of Surgery MD Neiss-Gain Professor Instructors in Surgery MD Pancreatic and Instructor of Surgery of Surgery; Associate Chun-Cheng (Richard) Gastrointestinal Surgery Adeel Khan, MD, MPH* Director, Prevention Chen, MD, PhD* Yiing Lin, MD, PhD and Control, Alvin J. division of Nadia M. Obeid, MD Brian W. Wong, PhD* division of Siteman Cancer Center; Instructors in Surgery Assistant Professors urologic surgery plastic and Deputy Director, of Surgery Institute for Public Health reconstructive Section of Colon Ross C. Brownson, PhD and Rectal Surgery Section of Vascular surgery Professor of Surgery; Surgery Professor, George Warren Brown School of Social Work William G. Hawkins, Sarah Gehlert, PhD MD, Chief Professor of Surgery; Neidorff Family and E. Desmond Lee Professor Gerald L. Andriole Jr., Robert C. Packman of Racial and Ethnic MD, Chief Professor of Surgery Diversity, George Robert Killian Royce, MD, Steven M. Strasberg, MD Warren Brown School Distinguished Professor Susan E. Mackinnon, Matthew G. Mutch, Pruett Family Professor of Social Work of Urologic Surgery MD, Chief Luis A. Sanchez, MD, Chief of Surgery; Carl Moyer Jefferson M. Gill, Sam B. Bhayani, MD Solon and Bettie MD, Chief Sydney M. Jr. and Departmental Teaching PhD, MBA Holekamp Family Gershman Chair for Gregorio A. Sicard Robert H. Shoenberg Coordinator Professor of Surgery; Endowed Chair in Urology Colon and Rectal Surgery Distinguished Professor Chair in Plastic and Ryan C. Fields, MD Director, Center for Ira J. Kodner, MD of Vascular Surgery Reconstructive Surgery Arnold D. Bullock, MD Chet Hammill, MD Applied Statistics; Alan A. and Edith L. Wolff Professor Emeritus Patrick J. Geraghty, MD Keith E. Brandt, MD Associate Professors Professor, Department Distinguished Professor of Surgery Brian G. Rubin, MD William G. Hamm Professor of Surgery of Political Science of Urology Robert W. Thompson, MD of Plastic Surgery Elisa H. Birnbaum, MD Dirk M. Spitzer, PhD Yan Yan, MD, PhD Paul E. Wise, MD Professors of Surgery Terence M. Myckatyn, MD R. Sherburne Figenshau, Assistant Professor Professor of Surgery MD Professors of Surgery Gregorio A. Sicard, MD Thomas H. Tung, MD of Surgery Joaquin Barnoya, MD Taylor Family and Emeritus Professor Professors of Surgery Steven R. Hunt, MD Bettina F. Drake, MPH, Ralph V. Clayman Chair of Surgery Associate Professor Section of Minimally Ida K. Fox, MD PhD in Minimally Invasive Kamlesh B. Patel, MD of Surgery Invasive Surgery Jeffrey Jim, MD, MPHS Feng Gao, MD, PhD, Urology; Professor Sean C. Glasgow, MD Associate Professor Marissa M. Tenenbaum, MPH, MS of Surgery Matthew L. Silviera, MD of Surgery MD Aimee S. James, Associate Professors Paul F. Austin, MD Assistant Professors Sean J. English, MD PhD, MPH of Surgery Ramakrishna Venkatesh, of Surgery Gerald R. Fortuna Jr., MD Yikyung Park, ScD MD Senthil Jayarajan, MD, Mary C. Politi, PhD Professors of Surgery MS* Siobhan Sutcliffe, PhD, Section of Endocrine Douglas E. Coplen, MD John W. Ohman, MD* ScM, MHS and Oncologic Surgery Robert L. Grubb III, MD Nanette R. Reed, MD Erika Waters, PhD, MPH H. Henry Lai, MD Mohamed A. Zayed, Associate Professors Seth A. Strope, MD, MPH MD, PhD of Surgery L. Michael Brunt, Associate Professors Assistant Professors MD, Chief Margaret Olsen, PhD, of Surgery Professor of Surgery of Surgery MPH Associate Professor Christopher T. Arett, MD Mary E. Klingensmith, MD Amy M. Moore, MD of Surgery; Associate Alana C. Desai, MD Mary Culver Distinguished division of Head of Hand and Professor of Medicine Dane Johnson, MD* Professor of Surgery Trauma Surgery Gregory P. Murphy, MD* pediatric surgery Yin Cao, ScD, MPH* Michael M. Awad, MD, Ralph J. Torrence, MD Donald W. Buck II, MD Su-Hsin Chang, PhD Jeffrey F. Moley, MD, PhD Erica J. Traxel, MD Gerald Jeung-Il Cho, MD* Kia L. Davis, ScD, MPH* Chief** J. Christopher Eagon, MD Gino J. Vricella, MD John M. Felder, MD Melody S. Goodman, Professor of Surgery Associate Professors Assistant Professors Grant M. Kleiber, MD MS, PhD Timothy J. Eberlein, MD of Surgery of Surgery William K. Bixby Professor Alison K. Snyder- Cynthia Herrick, MD Jeffrey A. Blatnik, MD Warwick, MD Cassandra Arroyo David A. Hardy, MD of Surgery; Chair, Shaina R. Eckhouse, MD Scott R. Manson, PhD Department of Surgery Matthew D. Wood, PhD Johnson, PhD, MS Arghavan Salles, MD, PhD Assistant Professors Ying Liu, MD, PhD Instructors in Surgery Assistant Professors of Surgery Rebecca Lobb, ScD, MPH of Surgery Brad W. Warner, MD, Chief Esther J. Lu, PhD Jessie L. Ternberg, MD, PhD Jingqin (Rosy) Luo, PhD Distinguished Professor * Joined faculty in of Pediatric Surgery; FY2017-18 Surgeon-in-Chief, St. Louis Children’s Hospital ** Deceased

PHOTOS BY TIM PARKER

Department of Surgery Annual Report 2017 | 67 New Faculty

Aaron Abarbanell, Kia Davis, ScD, MPH Jean Hunleth, PhD, MPH MD, MS Assistant Professor, Instructor, Assistant Professor, Division of Public Division of Public Section of Pediatric Health Sciences Health Sciences Cardiothoracic Surgery Training and experience: Training and experience: Training and experience: Doctor of science, Doctoral degree and Medical degree, Harvard T.H. Chan School master’s in public University of Michigan, of Public Health, Boston; health, Northwestern Ann Arbor; master of master of public health, University, Evanston, Ill.; science in clinical research, Indiana University; Saint Louis University School of Public Health, postdoctoral education, Division of Public Health general surgery residency and cardiac surgery St. Louis; postdoctoral fellow, Cancer Health Sciences, Washington University research fellowship, Indiana University; thoracic Disparities Training Program (T32), University of Research interests: Caregiving and treatment surgery residency, Emory University, Atlanta; North Carolina-Chapel Hill. seeking for infectious and chronic diseases in congenital heart surgery fellowship, Children’s Research interests: Applied social epidemiology; Africa (most specifically, Zambia) and the United Hospital of Los Angeles/University of Southern States. Special interest in children’s experiences California, Los Angeles; clinical instructor, reducing cancer health disparities by informing organizational and policy change; relationships of and responses to illness, medicine and pediatrics, University of Southern California, health programming Los Angeles; United States Navy Surface Warfare between socioeconomic status, stress and cancer Officer (operations, engineering and administration) risk factors in underserved communities Senthil Jayarajan, MD, MS Clinical interests: All facets of congenital heart surgery Zachary Englert, DO Assistant Professor, Section of Vascular Surgery Research interests: Clinical outcomes and registry Assistant Professor, database research in infants and young children Section of Acute Training and experience: undergoing cardiac surgery; partnership building and Critical Care Surgery Medical degree, Univer- and delivery of cardiothoracic surgical services to Training and experience: sity of Michigan Medical low- and middle-income countries Doctor of osteopathic School, Ann Arbor; medicine, Philadelphia master of science in clinical research and translational Yin Cao, ScD, MPH College of Osteopathic Medicine; internship and medicine, Temple University, Philadelphia, Pa.; Assistant Professor, residency, East Carolina University, Vidant Medical general surgery internship, postdoctoral research Division of Public Center; surgical critical care fellowship and acute fellowship and general surgery residency, Temple Health Sciences care surgery fellowship, Shock Trauma Center, University Hospital; vascular surgery fellowship, Training and experience: University of Maryland Medical Center Washington University Doctor of science, Clinical interests: Instructor for the Air Force Center Clinical interests: All aspects of vascular surgery Harvard T.H. Chan School for Sustainment of Trauma and Readiness Skills with a special focus on limb salvage and thoracic of Public Health, Boston; (C-STARS) program; management of complex outlet syndrome master of public health, wounds and necrotizing soft tissue infections Research interests: Cost-effective improvements Columbia University, New York of surgical outcomes Research interests: Cancer epidemiology, Chet Hammill, MD, MCR risk prediction, screening/early detection; Gerald Jeung-Il Cho, MD chemoprevention of major cancers, particularly Associate Professor, gastrointestinal malignancies Section of Hepatobiliary- Assistant Professor, Pancreatic and Division of Plastic and Gastrointestinal Surgery Reconstructive Surgery Chun-Cheng (Richard) Training and experience: Chen, MD Training and experience: Medical degree, University Medical degree, University Instructor, Section of Illinois, Urbana; master of Cincinnati; plastic and of Acute and Critical of science in aeronautical reconstructive surgery Care Surgery and astronautical engineering, University of Illinois, residency, University of Training and experience: Urbana; master of clinical research, Oregon Health California, San Francisco; hand surgery and micro- Medical and doctoral & Science University, Portland, Ore.; general surgery surgery fellowship, The Buncke Clinic, San Francisco; degree, Vanderbilt residency, University of Hawaii, Honolulu; hepato- craniofacial and pediatric plastic surgery fellowship, University School of biliary and pancreas surgery fellowship, Portland New York University Langone Medical Center, Medicine; master of engineering, Massachusetts Providence Medical Center, Portland, Ore. New York Institute of Technology, Cambridge; general surgery Clinical interests: Liver, pancreas and biliary diseases, Clinical interests: Facial trauma, post-traumatic residency and surgical critical care fellowship, minimally invasive and robotic surgery facial reconstruction, pediatric plastic surgery, Washington University Research interests: Image-guided surgery, ablation cleft lip and palate, craniofacial microsurgery, Clinical interests: General surgery, trauma and therapies, surgical technologies and innovation nose reconstruction, ear reconstruction, critical care orthognathic surgery Research interests: Surgical technology, informatics, automation

68 | surgery.wustl.edu Dane Johnson, MD John Ohman, MD Jesse Vrecenak, MD Assistant Professor, Assistant Professor, Section Assistant Professor, Division Division of Urologic Surgery of Vascular Surgery of Pediatric Surgery Training and experience: Training and experience: Training and experience: Medical degree, Medical degree, University Medical degree, University of Minnesota of Texas McGovern Medical University of Pennsylvania, Medical School, School, Houston; vascular Philadelphia; general Minneapolis; general surgery residency, surgery residency, surgery internship, Medical Washington University Hospital of the University College of Wisconsin; urology residency, Medical Clinical interests: General vascular surgery, complex of Pennsylvania; general surgery research fellowship, College of Wisconsin; male infertility and andrology open and endovascular aortic reconstructions for Children’s Hospital of Philadelphia; pediatric surgery fellowship, Medical College of Wisconsin aortic aneurysm and aortic dissection fellowship, Children’s Hospital of Philadelphia Clinical interests: Male infertility and andrology, Research interests: Rapid management and transfer Clinical interests: Fetal consultation and surgery, men’s health, erectile dysfunction and Peyronie’s of acute aortic syndromes through the pre-hospital including EXIT delivery and in utero interventions; disease, general urology; medical and surgical and hospital environments; management of primary surgical treatment of congenital diaphragmatic treatment of erectile dysfunction; microsurgical aortic and aortic graft infections hernia, congenital lung lesions (CPAM/BPS), intestinal techniques for vasectomy reversal, varicocele repair atresias, gastroschisis, omphalocele; minimally and testicular sperm retrieval invasive surgery, including hernia repair and surgical Nishant Raj, MD treatment of reflux; general pediatric surgery Adeel Khan, MD, MPH Assistant Professor, Research interests: Fetal biology and immunology; Section of Acute and in utero cellular therapies Assistant Professor, Section Critical Care Surgery of Transplant Surgery Training and experience: Training and experience: Medical degree, Brian Wong, PhD Medical degree, The Aga Ross University School of Assistant Professor, Khan University, Pakistan; Medicine, Portsmouth, Section of Transplant master of public health, Dominica; general surgery Surgery University of North Carolina residency, Cleveland Clinic Foundation, Cleveland Training and experience: at Chapel Hill School of Pub- Doctoral degree, cardio- lic Health; general surgery internship and residency, Clinical interests: General and minimally invasive surgery including laparoscopic and robotic surgery vascular pathology and Brown University School of Medicine, Providence, allograft vasculopathy, R.I.; clinical fellowship in hepatobiliary-pancreatic University of British surgery, Washington University; clinical fellowship Forest Sheppard, MD Columbia; postdoctoral fellowship in metabolic and in abdominal transplant surgery, Baylor University Associate Professor, epigenetic regulation of angiogenesis/lymphangio- Medical Center, Dallas; assistant clinical professor genesis, VIB/KU Leuven Center for Cancer Biology, of surgery, University of Wisconsin, Madison Section of Acute and Critical Care Surgery Leuven, Belgium Clinical interests: Adult and pediatric liver, kidney Research interests: Role of lymphatic vessels in and pancreas transplantation; living donor liver and Training and experience: Medical degree, University solid allograft rejection, with specific emphasis on kidney transplantation; laparoscopic and robotic understanding key metabolic and epigenetic regula- surgery of the liver, pancreas and bile ducts of Virginia School of Medi- cine, Charlottesville, Va.; tory pathways that regulate lymphatic function and general surgery residency immunomodulatory capabilities; role of lymphatics in Gregory Murphy, MD and trauma/surgical critical care fellowship, University transplant biology; development of novel therapeu- tics to improve graft outcome and prevent rejection Assistant Professor, Division of Colorado, Denver; trauma surgery research fellow- of Urologic Surgery ship, National Institutes of Health (NIH); U.S. Navy, four deployments, trauma/combat casualty care Muhammad Yasin, MD Training and experience: translational research Medical degree, University Assistant Professor, of Massachusetts Medical Clinical interests: Resuscitation, transfusion, trauma, Section of Acute and School, Worcester; general critical care, emergent general surgery Critical Care Surgery surgery internship and urol- Training and Experience: ogy residency, University of Kelly Vallar, MD Medical degree, Allama Connecticut, Farmington; trauma and reconstruction Iqbal Medical College, fellowship, University of California, San Francisco Assistant Professor of Punjab University, Lahore, Surgery, Section of Acute Pakistan; internal medicine Clinical interests: Trauma and reconstructive urology, and Critical Care Surgery male incontinence, urethral stricture disease, penile residency, District Headquarters Hospital, Faisalabad, and scrotal reconstruction, genitourinary trauma, Training and experience: Pakistan; general surgery observership, Good Samari- ureteral strictures and rectourethral fistula Medical degree, University tan Hospital, Cincinnati; general surgery residency, of Missouri-Kansas City; Our Lady of Mercy Hospital, Bronx, New York, general surgery residency, and Mount Carmel Health, Columbus, Ohio; Saint Louis University colon rectal surgery fellowship, Grant Medical School of Medicine; surgical critical care fellowship, Center, Columbus Washington University Clinical Interests: General and colorectal surgery Clinical interests: Laparoscopy, emergency general surgery, trauma, care for veterans

PHOTOS BY MIKE NICHOLS

Department of Surgery Annual Report 2017 | 69 Giving

The Department of Surgery gratefully acknowledges the generosity of the following donors.

Aesthetic Surgery Education and Dr. Taz Harmon Dr. Robert Royce Research Foundation Dr. Donald Huebener Dr. Harvey Sauer Ameren Corporation Charitable Trust International Society for Heart & Lung Dr. James Schiele American Association Plastic Surgery Transplantation Dr. Kathleen Schwarz American Foundation for Surgery of the Hand Janey & Stuart Symington Schwab Mr. & Mrs. Michio and Mitsuko Sekino Charitable Fund American Society Reconstructive Microsurgery Sexual Medicine Society of North America American Urological Association, Inc. Mr. & Mrs. Richard Kniep (SMSNA) Drs. Gerald and Dorothy Andriole Dr. & Mrs. Ira J. and Barbara Ann Society for Vascular Surgery Foundation Bottchen Kodner Association of Academic Surgery Foundation Stephens & Associates, Inc. Drs. Evan Raymond and Mimi Gee Kokoska Barrett Brown Foundation Mr. & Mrs. Craig and Barbara Stiegemeier Mr. & Mrs. Michael and Carolyn Kolman Mr. Gerson Bilow Dr. & Mrs. Paul and Suzanne Stockmann Dr. Paul Mace Dr. & Mrs. Keith Eric and Tina Brandt Susan G. Komen for the Cure Marc & Helen Rubenstein Philanthropic Fund Dr. Ross Brownson Ms. Cheryl Swallers March of Dimes Foundation Dr. David Caplin The Gateway for Cancer Research Matter Family Office Ms. Susan Casteel The Longer Life Foundation Midwest Stone Institute Mr. Lawrence Chase The Plastic Surgery Foundation Dr. & Mrs. Leon and Marian Godeke Miller Children’s Discovery Institute Dr. Matthew Thom Dr. Arthur Joseph Misischia Children’s Urological Foundation, Inc. Dr. Lewis Thomas Jr. Dr. Thalachallour Mohanakumar Dr. Ralph Clayman Vascular & Endovascular Surgery Society Mr. Takatoshi Nagai Dr. Patrick Cleary Dr. Renata Weber Dr. Seymour Nash Colon Cancer Alliance Inc. Dr. Michael Weiss Ms. Margery Neely Mr. Patrick Delhougne Worldwide Cancer Research Dr. George Oliver Dr. E. Gene Deune Pancreatic Cancer Action Network Dr. John Stanley Dillon Dr. Harper Pearse Mr. & Mrs. John and Yvette Drury Dubinsky To Make a Gift Ms. Kimberly Perry Dr. & Mrs. Robert Sherburne Figenshau The Department of Surgery welcomes your Ms. Janelle Phillips Mrs. Suzanne Chichester Fischer support. Ways to make a gift include annual Dr. Richard Prinz unrestricted giving such as membership in Foundation for Surgical Fellowships Dr. Joseph Anthony Reinkemeyer the Eliot Society, gifts for education of Foundation for Vascular Innovation residents and fellows, support for research and Rising Tide Foundation for Clinical Dr. George Friend endowment, and planned gifts and bequests. Cancer Research For additional information, please contact the Dr. Robert Fry Mr. Robert Rosenthal Office of Medical Alumni and Development at Dr. Daniel Gup (314) 935-9690.

Sam Bhayani, MD, was named the Andrew Gelman, PhD, has been Matthew Mutch, MD, colon and rectal Holekamp Family Endowed Chair named the Jacqueline G. and surgery chief, has been installed as in Urology. William E. Maritz Professor of Surgery, the Solon and Bettie Gershman Chair Pathology and Immunology. for Colon and Rectal Surgery.

70 | surgery.wustl.edu In memory: Jeffrey F. Moley

Jeffrey Fletcher Moley, MD, chief of “Jeff was a masterful surgeon,” said the Section of Endocrine and Oncologic Timothy Eberlein, MD, department Surgery, died Sunday, Oct. 15, 2017, chair. “He delicately performed surgery at his home in Kirkwood, Missouri. to remove the thyroid gland in young He was 64. children — some only a few months Moley, also an associate director old — who were destined to develop an at the Alvin J. Siteman Cancer inherited form of thyroid cancer. The Center at Barnes-Jewish Hospital margin of error in these procedures and Washington University School is almost none, and Jeff was simply of Medicine, died following a remarkable. He was uniformly admired sudden cardiac event. He had been nationally and internationally for his married for 30 years to Kelle Moley, surgical skills.” MD, the university’s James P. Crane Moley’s research also helped to Professor of Obstetrics and Gynecology. identify novel molecular targets in “Jeff was a world-class surgeon thyroid cancer and led clinical trials and a pioneering researcher,” said of systemic targeted therapy. Besides David Perlmutter, MD, executive treating patients at Barnes-Jewish vice chancellor for medical affairs and Hospital and St. Louis Children’s dean of the School of Medicine. “He Hospital, Moley worked for more than was admired by faculty here and across three decades for the VA St. Louis Yale faculty, he joined the Washington the globe and was a role model to Health Care System, recently as head University faculty in 1988. younger faculty and trainees.” of surgical services. Moley maintained a lifelong For more than two decades, At the hospitals, Moley trained interest in history and politics. He Moley studied and treated multiple residents and medical students. “They also enjoyed sports and music. A jazz endocrine neoplasia (MEN), rare loved him,” Eberlein said. “He was guitarist, mandolin player and vocalist, inherited syndromes that often cause gentle, kind and encouraging.” he led the Fletcher Moley Group, a thyroid cancer and other endocrine Born in New York City in 1953, local jazz and rhythm and blues band, diseases. Along with Samuel Wells Jr., Moley earned his bachelor’s degree and previously performed with Seldom MD, former chair of the Department from Harvard University in 1976 Home, a bluegrass band. of Surgery, Moley was part of a team and medical degree from Columbia In addition to his wife, Moley that identified the genetic mutations University in 1980. He completed his is survived by: three sons, Patrick, responsible for MEN syndromes and internship and residency, and was Charles and John; his mother, Janis advanced a preventive procedure chief resident in general surgery, at Walton Moley; a sister, Janis McCarthy; involving surgical thyroid removal. Yale New Haven Hospital and worked and a brother, Roger Moley. Moley also operated on patients with as a fellow at the National Cancer The Department of Surgery recurrent thyroid cancer and other Institute of the National Institutes will establish an endowed chair in endocrine diseases. of Health (NIH). After a year on the his memory. Department of Surgery

office of the chair division of cardiothoracic surgery Section of Minimally Invasive Surgery Timothy Eberlein, MD (314) 362-5247 (314) 454-8877 William K. Bixby Professor and Chair Section of Cardiac Surgery Section of Transplant Surgery Department of Surgery (314) 362-0993 (314) 362-7792 Jamie Sauerburger Section of General Thoracic Surgery Section of Vascular Surgery Executive Director, Business Affairs (314) 362-8598 (314) 362-7408 Phone: (314) 362-6770 Section of Pediatric Cardiothoracic Surgery surgery.wustl.edu (314) 454-6165 division of pediatric surgery (314) 454-6066 Washington University division of general surgery School of Medicine (314) 362-7792 division of plastic and CB 8109 Section of Acute and Critical Care Surgery reconstructive surgery 660 S. Euclid Ave. (314) 362-9347 (314) 362-4586 St. Louis, MO 63110 Section of Colon and Rectal Surgery Phone: (314) 362-8020 division of public health sciences Fax: (314) 454-1898 (314) 454-7183 Section of Endocrine and Oncologic Surgery (314) 454-7940 (314) 362-2280 division of urologic surgery View the annual report online Section of Hepatobiliary-Pancreatic and at surgery2017.wustl.edu Gastrointestinal Surgery (314) 362-8212 (314) 362-7046 GREG BARNETT #ILookLikeASurgeon In spring 2017, a New Yorker magazine cover illustration depicted a ring of female surgeons’ faces from the patient’s perspective. It sparked a worldwide social media conversation as female surgeons re-created the cover through photos of themselves. Their effort celebrated the presence of women in this traditionally male- dominated field. Washington University’s contribution featured some of the department’s female surgical faculty and residents. View the New Yorker cover at newyorker.com/ magazine/2017/04/03.

Partner Institutions The 1,300 specialty and primary care clinicians who make up Washington University Physicians comprise the medical staffs at Barnes-Jewish Hospital and St. Louis Children’s Hospital.

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