News & Media

STS Develops Resource Utilization Tool for Cardiac Surgery The COVID-19 pandemic has significantly constrained hospital resources, making informed resource allocation decisions more important than ever. To assist its members and other health care providers in triaging adult cardiac surgery cases, STS has developed an interactive resource utilization prediction tool.  The online STS Resource Utilization Tool for Cardiac Surgery is free to use and open to everyone. The power behind the tool is 440,000 de-identified patient records from the STS Adult Cardiac Surgery Database from 2018 and 2019. Displaying outcome metrics such as time in the operating room, time on the ventilator after surgery, ICU and hospital lengths of stay, and expected number of blood product units likely to be needed, the tool allows you to estimate the resources your hospital will need for your patients. >Access the tool at sts.org/resourcetool. For more information, contact the STS Research Center. Society Prepares New Strategic Plan The STS Board of Directors and other surgeon and staff leaders recently participated in a strategic planning retreat. The March session in Chicago was one of several that will help chart the mission, vision, and strategy for the Society for the next 3 to 5 years. STS President Joseph A. Dearani, MD, welcomed participants. During the 1.5-day meeting, the group considered how the Society can best serve members going forward. The three new STS Directors-at-Large (from left, Gregory P. Fontana, MD, Jennifer C. Romano, MD, MS, and James S. Tweddell, MD) enjoyed the STS-branded knit caps distributed at the retreat. Gain Insights into Your Performance with Individual Outcomes Report The first round of surgeon-specific outcomes reports from the STS Adult Cardiac Surgery Database (ACSD) were released in January to approximately 400 participants. The reports included individual outcomes on coronary artery bypass grafting (CABG), aortic valve replacement (AVR), AVR+CABG, isolated mitral valve repair/replacement (MVRR), and MVRR+CABG. If you are an ACSD participant and would like to receive your personalized report in the next release later this year for data from January 2017 to December 2019, complete the election form at sts.org/surgeonspecific. >If you have questions about this initiative, please contact surgeonspecific@sts.org. Roundtables Offer Perspectives on Low-Risk TAVR, Tobacco Use, ISCHEMIA Trial, and More The Society’s annual roundtable series brings experts together for lively discussions on a variety of hot topics. This year’s conversations cover issues that impact cardiothoracic surgeons, members of the health care team, and patients, including: Artificial Intelligence and Machine Learning in Cardiothoracic Surgery Which Low-Risk Patients Should Receive TAVR? The Changing Landscape of Tobacco Use What Is the Best Way to Treat Heart Disease? Strategies for Surgeons to Prevent Burnout The roundtables are available as videos on the STS YouTube channel and as episodes on the STS Surgical Hot Topics podcast. >Watch videos of the roundtables at sts.org/videos; podcast episodes are accessible at sts.org/podcast or via your favorite podcast app. Stakeholders Discuss Critical Issues for TVT Registry The STS/ACC TVT Registry Stakeholder Advisory Group (SAG) convened on February 24 for an important meeting in Fort Washington, Maryland. The SAG consists of representatives from STS, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, industry, health systems, patient groups, US government agencies, and others. The attendees discussed current research projects based on TVT Registry data, progress on a Japanese TVT Registry, and development of a composite risk model. They also learned how health systems, industry, the Centers for Medicare & Medicaid Services, and the Food and Drug Administration are utilizing TVT Registry data. Michael J. Mack, MD, Joseph E. Bavaria, MD, Nimesh D. Desai, MD, PhD, and Tsuyoshi Kaneko, MD, were the surgeons representing STS during the meeting. Annals Readers Favor Content on CABG Recovery, Outcomes Data, Lung Cancer The most-downloaded articles on The Annals of Thoracic Surgery website in 2019 focused on a wide variety of topics, including exercise therapy after coronary artery bypass graft surgery, adult cardiac surgery data in the STS National Database, and non-small cell lung cancer. Both recent papers and older articles were popular, with one even dating back to 1966—the second year the journal was published. >A subscription to The Annals is a benefit of STS membership. Log in to read any of the below articles at annalsthoracicsurgery.org. Most-Downloaded Articles in 2019 Title Number of Downloads in 2019 Date of Publication Exercise Therapy after Coronary Artery Bypass Graft Surgery: A Randomized Comparison of a High and Low Frequency Exercise Therapy Program 9,639 May 2004 The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality 9,077 Jan. 2018 Standard Uptake Value Predicts Survival in Non-Small Cell Lung Cancer 8,313 Sept. 2009 The Rate of Pleural Fluid Drainage as a Criterion for the Timing of Chest Tube Removal: Theoretical and Practical Considerations 7,640 Oct. 2013 Publication of Unethical Research Studies: The Importance of Informed Consent 5,470 Feb. 2003 Localized Hodgkin’s Disease Presenting as a Sternal Tumor and Treated by Total Sternectomy 5,287 Jan. 1966 Surgical Treatment of the Dilated Ascending Aorta: When and How? 5,159 June 1999 The Use of High-Dose Hydroxocobalamin for Vasoplegic Syndrome 5,023 May 2014 Long-Term Survival in Patients Receiving a Continuous-Flow Left Ventricular Assist Device 4,926 Mar. 2018 Adjust for Multiple Comparisons? It’s Not That Simple 4,738 May 2016  

STS News, Spring 2020 — The Society is working closely with federal legislators, regulatory agencies, and grassroots advocates on a number of issues that impact cardiothoracic surgeons and their patients. These efforts include ensuring access to extracorporeal membrane oxygenation (ECMO) during the coronavirus pandemic, reducing tobacco use, and reversing cuts to Medicare reimbursement for the specialty. ECMO and COVID-19 STS proactively weighed in with the Administration’s coronavirus task force, various federal agencies, and members of Congress to highlight the importance of ECMO programs to the US pandemic response. Representatives from STS and the Extracorporeal Life Support Organization have been working to elevate concerns about patient access to ECMO, geographic distribution of centers, supply chain demands, and the need to quickly and accurately share information across all sites. In addition, the Society is advocating for legislation and administrative action that protects the health and safety of front line physicians, eliminates Medicare reimbursement cuts scheduled for next year, and provides financial relief for physician practices that lose revenue as a result of canceling or delaying elective cases, among other issues. STS will continue fighting to ensure that cardiothoracic surgeons on the front lines have the resources needed to treat patients during this global crisis. Anti-Tobacco Efforts A key STS advocacy priority was achieved in December with the passage of the fiscal year 2020 appropriations bill. The legislation included a provision raising the age for purchasing tobacco from 18 to 21, which will help protect kids and young adults from the harmful effects of smoking.  To build on this success, STS recently endorsed several bills aimed at reducing tobacco use, including the Protecting American Lungs and Reversing the Youth Tobacco Epidemic Act of 2020, which passed the House of Representatives on February 28. The legislation would prohibit any kind of flavoring (including menthol) in tobacco products, impose a tax on nicotine, and ensure that the Food and Drug Administration promptly implements graphic health warnings on cigarette packaging and advertising materials. At press time, the bill was under consideration by the Senate Committee on Finance. Additional legislative and regulatory actions supported by STS would ban e-cigarettes in schools and child care facilities that receive federal funding, charge a fee to manufacturers and importers of electronic nicotine delivery systems, and set stricter standards for premarket tobacco product applications. For more information on the Society’s commitment to combating tobacco use, a new policy paper is available at sts.org/tobaccopaper. The Board of Directors approved the paper—which serves as a guide for related advocacy efforts—for inclusion in the STS Health Policy Compendium in January. Cuts to Medicare Reimbursement The Society also is continuing to work closely with a group of surgical specialty societies to fight back against substantial cuts to Medicare reimbursement for cardiothoracic surgeons. Cuts of up to 7% for both cardiac and thoracic surgery are scheduled to be implemented in January 2021 and could have a significant impact on patient care. Additional drops in reimbursement are likely to be proposed this summer. The Surgical Coalition is planning a comprehensive strategy consisting of legislative and regulatory advocacy, a public relations campaign, research and data collection on the impact of the cuts, and legal action. More information is available at sts.org/globals. Key Contact of the Year Says ‘Medical Advocacy is a Team Sport’ The Society’s Key Contact of the Year Award recognizes those STS members who have gone above and beyond to advocate for the specialty. 2019 recipient Seth Wolf, a medical student at the University of Vermont (UVM) Larner College of Medicine in Burlington, shared his thoughts on the importance of grassroots advocacy, his experience working with legislators, and why he believes his fellow STS members must become involved in advocating for the specialty. Q: Why are you involved in STS advocacy? Why is it so important? A: Before attending Morehouse College in Atlanta, I lived in Stockholm, Sweden. Going from socialized medicine to inner-city Atlanta and now the sparsely populated, relatively rural community of Vermont has allowed me to experience an array of vastly different political and medical systems. My diverse encounters with health care is what piqued my interest in advocacy. As medical students, we represent the future workforce of physicians, which comes with the responsibility of fighting for the rights of tomorrow’s patients. It is with privilege and enthusiasm that I choose to carry this torch. Q: What was your experience at the most recent STS Legislative Fly-In? A: The 2019 Legislative Fly-In truly was a memorable experience. It was an amazing opportunity to gain insight into what is required for advocacy on a national scale. Networking and learning from individuals such as Drs. John Calhoon, Dawn Hui, Stephen Lahey, Robert Higgins, and many others who dedicated their valuable time was an exceptional experience. Q: How have you engaged with your lawmakers at home? A: In the past year, I arranged and led local meetings in Vermont with the offices of Senator Patrick Leahy and Congressman Peter Welch. These meetings were effective, in part, due to achieving buy-in from UVM cardiothoracic surgery faculty such as Drs. Bruce Leavitt and Fuyuki Hirashima, who accompanied me to meetings. These efforts resulted in co-sponsorship of bills including the Resident Physician Shortage Reduction Act. Q: What would you say to your fellow STS members to encourage them to become involved? A: Medical advocacy is a team sport, and maximum results require maximum effort. Everyone has a role to play, whether you are a medical student, resident, or attending. With an ever-evolving specialty and a fluctuating political scene, medical advocacy is imperative for continued growth and the ability to provide outstanding patient care. Having the opportunity to become involved with advocacy early in my career has ignited my passion, and I am determined to turn this into a lifelong commitment of advocating for the field of cardiothoracic surgery and the patients we serve.

STS News, Spring 2020 — Acquiring a unique combination of skills and finding a niche are becoming increasingly important in the rigorous and competitive environment of cardiothoracic surgery, where success often is defined by expertise. With specialist skills—commonly called “the new currency”—surgeons experience greater career satisfaction and, most importantly, are able to better care for patients. Leah M. Backhus, MD, MPH, an associate professor of cardiothoracic surgery at Stanford University in California, saw an opportunity to expand her skillset in pectus repair, given her growing interest in chest wall reconstruction and the fact that no one at her institution currently performs the Nuss procedure. After securing the support of her division chief, who pledged to help Dr. Backhus implement a pectus repair program, she applied for the Levi Watkins Innovation and Leadership Development Scholarship from The Thoracic Surgery Foundation (TSF), the Society’s charitable arm.  “My goal in pursuing this scholarship was to gain experience in a variety of repair techniques by visiting a high-volume center performing minimally invasive adult pectus surgery and complex reconstructions,” she said. “As the final goal is to establish a program at my home institution, it was important to also gain experience with patient selection and program infrastructure.” The TSF Watkins scholarship provides up to $5,000 for cardiothoracic surgeons who are within 10 years of their first faculty appointment and supports travel to a center of excellence for the purposes of acquiring clinical, translational, or leadership training.  Scholarship recipient Leah M. Backhus, MD, MPH (left), with mentor Dawn Jaroszewski, MD, MBA The award is named after Levi Watkins, MD, an accomplished cardiothoracic surgeon at The Johns Hopkins Hospital in Baltimore, who was part of the team that implanted the first automated internal cardiac defibrillator in a human being. He also was the first resident of color in the Johns Hopkins residency program and the first underrepresented minority to join the cardiac surgery faculty at Johns Hopkins. TSF awarded the Watkins scholarship to Dr. Backhus in 2019. In November, she traveled to the Mayo Clinic in Phoenix, Arizona, where she studied pectus repair with Dawn Jaroszewski, MD, MBA, a national leader in surgery for pectus carinatum, excavatum, and mixed defects in adults. During her 4 days at Mayo, Dr. Backhus observed several primary Nuss procedures on patients with a varying severity of pectus deformities. “Cases included both severe and milder pectus deformities, use of titanium bars in patients with heavy chest walls, and mixed and asymmetric defects,” she said. “I also was able to observe bar removal procedures, which require specialized prep and technical considerations for safe removal.” Building a pectus repair program requires more than just learning surgical technique, however. Patient selection, workup, and an emphasis on multidisciplinary care are critical components to establishing a new program. To increase the program’s chance of success and maximize the learning experience, Stanford provided funding for two of Dr. Backhus’s nursing colleagues to travel with her. "The scholarship is an investment in yourself and your future." Leah M. Backhus, MD, MPH “Taking members of the Stanford thoracic team with me to Arizona was, by far, the most important decision ever,” she said. “It allowed me to concentrate almost exclusively on the technical aspects of the surgery and direct patient care, while our outpatient nurse practitioner delved into the details of patient flow from referral to postoperative care. Our thoracic OR RN concentrated on room setup and equipment, and he even was able to obtain preference cards for me to adapt at home.” While Dr. Backhus acknowledged that it can be challenging for early career surgeons to make time for these types of trips, she encouraged her colleagues to apply for a TSF scholarship and find their niche. “Traveling to a center of excellence gets you away from your normal environment—with all of its distractions—and allows you to immerse yourself,” she said. “The scholarship is an investment in yourself and your future.” >Learn more about what TSF does and how you can donate at thoracicsurgeryfoundation.org. TSF Awards More than $1 Million in New Grants Earlier this year, TSF issued 29 new grants totaling $1,047,500 in support of research and education programs in cardiothoracic surgery. These grants will help advance treatment options for patients with heart and lung diseases and offer much-needed assistance to underserved patients in developing countries and regions such as Armenia, Honduras, India, Kenya, Nepal, Nigeria, Pakistan, South Africa, and sub-Saharan Africa. Additional awards and scholarships will be distributed later this year. For a full listing of grant recipients, visit sts.org/2020TSFawards.  

STS News, Spring 2020 — Participants in the Adult Cardiac Surgery Database (ACSD) and General Thoracic Surgery Database (GTSD) now have access to the new, interactive dashboards and other features that are part of the phase 1 STS National Database rollout. “It feels very satisfying to have begun releasing this next generation platform,” said Felix G. Fernandez, MD, MSc, chair of the Workforce on National Databases. “Our patients will benefit because our data managers can get accurate data into the system more readily, and the data are presented in real-time, meaningful formats for surgeon participants, allowing them to better use the data for quality improvement and clinical care.” The highly secure, cloud-based dashboards currently provide access to unadjusted clinical outcomes, case volumes, demographics, patient comorbidities, and treatment details. In addition, real-time data quality reports include interactive links to help troubleshoot problems in submitted data files, and missing variable reports identify field-specific issues that would affect the completeness of a site’s data and subsequent analysis. The phase 1 rollout of the next generation STS National Database is now under way, and further enhancements and features will become available in the coming months. The phase 1 release for the ACSD and GTSD followed weeks of intensive beta testing by a dedicated group of data managers, surgeons, STS staff, and representatives from IQVIA, the Society’s new data warehouse. The platform will continue to be modified based on user suggestions and feedback. In the coming weeks, the transformed Congenital Heart Surgery Database (CHSD) will be available. Deadlines for the spring harvest for the CHSD will be delayed so that participants have ample time to submit their data. Support Is Available STS is offering a number of resources to help with the transition to the new Database platform. On the STS National Database Webinars page (sts.org/databasewebinars), users will find a schedule of upcoming webinars with information on how to participate, as well as links to videos and documentation from previous calls. In addition, how-to videos, instructions, and FAQs are available on the Database Transition Resources page (sts.org/databasetransition). The Society encourages all users to submit additional feedback online at sts.org/form/national-database-feedback. More Features to Come The next phases of the Database launch will include access to risk-adjusted outcomes and like group comparisons. A direct, web-based data entry option also is planned. “This will allow data cleanup to occur at the time of data submission, which will further reduce burden. Programs will have the option to continue entering data through their current vendor or use the web-based option,” Dr. Fernandez said. ACSD participants will see additional time-saving improvements to data collection with the version 4.20 specification upgrade, which will reduce the number of data fields by approximately 30%. Several changes have been made, including removing fields that were not necessary for quality measurement or were not often completed, using different formatting techniques such as multiple choice, and adjusting parent-child relationships. Data collection forms for version 4.20 are available at sts.org/ACSDdatacollection, and the training manual is scheduled to be posted in mid-May. STS also is making progress on major data enhancement projects. Socioeconomic data, which include information on income classification, education level, household crowding, deprivation index, and other details, have been linked with records in the ACSD, GTSD, and CHSD using state-of-the-art geocoding methodology. These additional variables will help researchers understand the impact of social determinants on outcomes in cardiothoracic surgery. Work also continues on acquiring longitudinal reoperation and survival data to augment data in these Database components. Note: STS recommends that all sites collecting data for the STS National Database begin gathering COVID-19 information for patients who underwent surgical procedures on or after January 1, 2020. More information is available at sts.org/COVID-19database. >The latest information on the next generation Database can be found at sts.org/database.

Dr. Dearani prepared his first column just as the COVID-19 pandemic started gripping the US. See page 1 for his message about how STS is responding to the crisis. Joseph A. Dearani, MD STS News, Spring 2020 — Let me start my first column as STS President by thanking you—our members—for electing me to this position. I also want to thank Dr. Bob Higgins and congratulate him for a most successful year that culminated with one of the most engaging and highly attended annual meetings in recent history. Serving as our Society’s President is the highest honor that you could achieve in the profession; I am honored by this opportunity to make a difference. In this role, I have a chance to work with colleagues at STS, as well as cardiothoracic surgery leaders throughout the world, to address challenges, take advantage of opportunities, and make the profession better for tomorrow’s practicing surgeon and the patients who need our help. Working for You One of the things that makes STS so unique and so great is that it is a member-centric, patient-centric Society. I cannot overemphasize this point enough. There are many great things that STS does for members and our patients. During my term as President, I want to make sure that we share more about all of the important things we are doing. Among them is our annual STS Legislative Fly-In in Washington, DC. At press time, we had just canceled the Fly-In and other in-person courses due to the coronavirus pandemic. I plan on keeping members informed about how STS is helping during this crisis via a series of videos and emails. We are facing a lot of unknowns right now, but as cardiothoracic surgeons, we know how to take charge and get the job done. I will do my best to help you through this crisis—and I am confident that we will be stronger as a result. Focusing on the Entire Specialty Although my primary professional focus is congenital heart surgery, my commitment is to the whole specialty—adult cardiac, general thoracic, and congenital. I will do my best to address all of the challenges in each of these areas. The two leading causes of death in this country are heart disease and lung cancer. The most common birth defect is a congenital cardiac anomaly. As cardiothoracic surgeons, we are ideally positioned to ask questions and solve problems that will have the greatest impact in terms of the number of people affected. Joseph A. Dearani, MD (left), with Immediate Past President Robert S.D. Higgins, MD, MSHA, was elected STS President for 2020-2021 during the Annual Membership (Business) Meeting in New Orleans this January. One way we are able to solve problems is through the STS National Database.  With the recent phase 1 launch of the Database (see page 11), we took a bold step forward to address changing practice needs at a time when the public and the profession expect near-perfect outcomes. We have a demanding specialty with high expectations, and the transformed Database offers you real-time access to your data in a highly secure, interactive environment that will help accelerate benchmarking, provide earlier recognition of potential weaknesses, and better adjust quality improvement initiatives.  As we roll out the next phases of the Database, we will continue to refine and innovate, making it easier and faster to access actionable clinical data and make real-time adjustments in treatment.  Artificial Intelligence/Machine Learning Cardiothoracic surgery is a specialty that’s constantly innovating and evolving. It’s a specialty that has a unique interface with technology. When you examine the potential role or place of artificial intelligence, machine learning, collaboration, and connectedness across other specialties and registries, it’s really exciting to think about how it will be better for our patients and the specialty.  STS has a perfect opportunity to be the model for others as we move from evidence-based medicine to intelligence-based medicine.  The STS National Database is ideally suited to apply machine learning opportunities because of its 30-year track record of trust, 8 million procedure records, and large number of validated data points. The transformed Database platform gives us not only the opportunity to look back and see how we’ve done, but also the opportunity to look forward, see where we are going, and apply data from the National Death Index to examine long-term outcomes.  Although my primary professional focus is congenital heart surgery, my commitment is to the whole specialty. Looking Forward Over the next year as you get to know me better, you’ll observe that I listen more than I talk. I believe strongly in transparency and accessibility, and I want to know your professional pain points so that I can help make a difference.  I also strongly believe in diversity. We are lucky that more women are interested in cardiothoracic surgery, and our specialty is better because of that. Dr. Higgins worked hard during his presidential year to include more women and underrepresented groups in the governance structure. He also launched the STS Leadership Summit to help advance the careers of the younger generation of surgeons. Our 2020 summit hit a home run, and we will keep building on that legacy.    In the coming months, we will continue strategic planning meetings (see page 9) to identify key focal points and create a new Society roadmap for the next 3 to 5 years. We are grateful to the many of you who took the time to complete the 2019 STS Practice Survey and 2018 Member-Needs Assessment. We are carefully reviewing the results of these surveys and will incorporate your feedback as we prepare the new STS Strategic Plan.  As we move forward, I see a bright future for the Society and for cardiothoracic surgery. Our specialty combines important qualities of intellect, critical thinking skills, judgment, technical abilities, and perseverance—it’s never over until it’s over. No other specialty really captures all of these ingredients. That’s what I love about cardiothoracic surgery, and that’s why I am committed to STS and making a difference.

STS News, Spring 2020 — Several important Bylaws changes were approved and STS officers and directors were elected or reelected during the Annual Membership (Business) Meeting in New Orleans, Louisiana. The meeting was held in conjunction with the STS 56th Annual Meeting. One Bylaws change was to the makeup of the Board of Directors. The Society’s membership voted to increase the number of directors-at-large on the Board from six to eight. This change will allow for greater diversity and a wider variety of perspectives on the Board, as well as provide more opportunities for promising leaders to obtain Board experience. Front row, from left: James S. Tweddell, MD, Joseph F. Sabik III, MD, John H. Calhoon, MD, Joseph A. Dearani, MD, Robert S.D. Higgins, MD, MSHA, Sean C. Grondin, MD, MPH, FRCSC, and Thomas E. MacGillivray, MD. Back row, from left: Jennifer C. Romano, MD, MS, Gregory P. Fontana, MD, Marc Ruel, MD, MPH, Ara A. Vaporciyan, MD, Vinod H. Thourani, MD, Domenico Pagano, MD, FRCS(C-Th), FETSC, Douglas J. Mathisen, MD, Kevin D. Accola, MD, and Joseph C. Cleveland Jr., MD. Not pictured: Leah M. Backhus, MD, MPH, Andrew B. Goldstone, MD, PhD, Roger Newton, PhD, MS, G. Alexander Patterson, MD, FRCS(C), and Alan D. Sihoe, MD, MA, FRCSEd. Leading the Board and the Society for 2020-2021 is Joseph A. Dearani, MD, from Rochester, Minnesota, who was elected STS President. Sean C. Grondin, MD, MPH, FRCSC, from Calgary, Canada, was elected First Vice President, and John H. Calhoon, MD, from San Antonio, Texas, was elected Second Vice President. The following also were elected or reelected: Secretary: Joseph F. Sabik III, MD, Cleveland, Ohio Treasurer: Thomas E. MacGillivray, MD, Houston, Texas  International Director: Domenico Pagano, MD, FRCS(C-Th), FETSC, Birmingham, United Kingdom Canadian Director: Marc Ruel, MD, MPH, Ottawa, Canada Public Director: Roger Newton, PhD, MS, Maple City, Michigan Directors-at-Large: Joseph C. Cleveland Jr., MD, Aurora, Colorado, Gregory P. Fontana, MD, Thousand Oaks, California, Jennifer C. Romano, MD, MS, Ann Arbor, Michigan, and James S. Tweddell, MD, Cincinnati, Ohio Editor: G. Alexander Patterson, MD, FRCS(C), St. Louis, Missouri New Membership Approval Process Also approved at the membership meeting was a Bylaws change to the admission process for Active and International Members. Previously, applicants for Active and International Membership were voted upon by the full Board three times per year at in-person meetings. Now, the Executive Committee will vote to admit new members throughout the year. This means that applicants can be approved and begin receiving member benefits sooner. >Learn more about the Society’s governance structure at sts.org/governance.

Many health care providers are experiencing immense strain due to the COVID-19 pandemic. This article on burnout, prepared prior to the coronavirus spread reaching a critical stage in the US, includes coping tips and strategies that also will be useful for those dealing with isolation, stress, depression, frustration, and other symptoms that are being reported in this COVID environment. STS News, Spring 2020 — Tackling the growing problem of burnout among cardiothoracic surgeons will require efforts by both health care organizations and individuals to reduce stigma and develop resilience in the face of a challenging workplace environment, according to experts at the recent STS Annual Meeting in New Orleans.  “Burnout is a syndrome characterized by depersonalization, emotional exhaustion, and a decreased sense of personal satisfaction that can be associated with work-related stress,” said Thomas K. Varghese Jr., MD, MS, head of the Section of General Thoracic Surgery, executive medical director, and chief value officer at the Huntsman Cancer Institute at the University of Utah in Salt Lake City.  Results from the 2019 STS Practice Survey, which will be released in the coming months, revealed that more than half of surgeon members in the United States reported experiencing symptoms of burnout. “As cardiothoracic surgeons, we have competitive drives, and most people would describe us as having type A personalities,” said Oliver S. Chow, MD, an assistant professor of clinical cardiothoracic surgery at Weill Cornell Medicine in New York City. “Having that image and expectation upon us might actually predispose us to burnout.” Burnout Symptoms Appear Early and Often The surgery profession is known for its demanding training environment, and symptoms of burnout can arise early in a surgeon’s career. A 2019 study in The New England Journal of Medicine looked at the incidence of burnout among approximately 7,400 surgical residents. The data drew from a survey administered alongside the American Board of Surgery in-training exam. The results showed that 38.5% of surgical trainees reported experiencing symptoms of burnout at least weekly. The findings may only be showing a fraction of the real issue, said Michal Hubka, MD, head of thoracic surgery at Virginia Mason Medical Center in Seattle. “When I discussed these results with my residents, they actually thought that this was an underestimate,” he said. "Surgeons are at great risk for developing burnout symptoms because of long work hours, delayed career gratification, and what is admittedly not the best work-life balance." Thomas K. Varghese Jr., MD, MS To obtain a better sense of the burnout problem within cardiothoracic surgery training in the US, researchers surveyed members of the Thoracic Surgery Residents Association in March 2019. Nearly 60% of respondents said they had feelings of burnout a few times a month or more frequently. In addition, 44.4% reported feeling down, depressed, or hopeless in the previous month. And 25.9% said that if given the choice, they would not choose to complete a cardiothoracic surgery residency again. “These findings are important since the overall wellbeing of our trainees will impact our cardiothoracic surgical community, as well as the patients we’re working to serve together,” Dr. Chow said. Compounding the problem is that it’s not only surgeons and trainees who may be feeling burned out. Nurse practitioners, physician assistants, and other team members are at risk as well, according to Susan D. Moffatt-Bruce, MD, PhD, MBA, chief executive officer of the Royal College of Physicians and Surgeons of Canada in Ottawa. “Our efforts to improve our wellness index and our environment need to be multidisciplinary and really engage our team members,” she said. Examining the Root Causes and Consequences Several factors may predispose cardiothoracic surgeons, trainees, and other members of the health care team to burn out. “Surgeons are at great risk for developing burnout symptoms because of long work hours, delayed career gratification, and what is admittedly not the best work-life balance,” Dr. Varghese said. A roundtable discussion filmed at the STS Annual Meeting in January provided insights into the problem of burnout in the specialty and advice to tackle this issue. The ever-changing health care environment—with increased scrutiny of clinical outcomes, reimbursement for quality versus quantity, more medically complex patients, and the need for quick adoption of new techniques and technologies—also can cause strain. “Our job descriptions have changed since we started,” Dr. Hubka said. “The operations I perform today are very different than the operations that I was trained to do.” These stressors not only can impact a surgeon’s sense of professional satisfaction, but also can lead to patient safety issues. A study published in the Annals of Surgery looked at the correlation between burnout and medical errors made by surgeons. The results showed that each one-point increase in feelings of depersonalization was associated with an 11% increase in the likelihood that a surgeon reported making an error in the past 3 months, while each one-point increase in emotional exhaustion correlated with a 5% increase. Solution Involves Multipronged Approach Experts suggested taking steps to address burnout at both the organizational and personal levels. Making significant changes to the workplace culture will require buy-in from health care administrators, Dr. Moffatt-Bruce noted. “We need to harness the power of leadership. It’s about setting cultural norms and expectations that value physician wellness.” In her previous roles as executive director of the University Hospital and chief patient safety and quality officer at The Ohio State University (OSU) Wexner Medical Center in Columbus, Dr. Moffatt-Bruce helped develop and lead programs geared toward enhancing employee wellness and reducing burnout. OSU’s “Mindfulness in Motion” weekly program includes reflective writing, guided meditation, stretching, and discussion in small groups. Implementation of this program in the hospital’s surgical intensive care unit led to improved employee resilience and better patient outcomes after 2 months. Now, OSU’s residents also are participating in the program, which is led by Maryanna Klatt, PhD, a professor of clinical family medicine at the University. “It's unbelievable how well-received this has been,” Dr. Moffatt-Bruce said. Workplaces also must take steps to reduce the stigma of asking for help or admitting to feeling overwhelmed, Dr. Chow added. “Burnout has not traditionally been a popular topic in our field,” he said. “I think a main contributor to this is that we view ourselves as individuals who should be very good at handling stress. We are supposed to be calm under pressure in high-stakes situations, used to hard work, and possess great stamina and resilience. A surgeon’s workload is very much expected to be rigorous. So when we find ourselves or our fellow surgeons struggling with stress, we are prone to hide it or dismiss it.” "Networks matter. Friends matter. Take the time to engage with them." Susan D. Moffatt-Bruce, MD, PhD, MBA Given these taxing responsibilities, addressing risk factors for burnout early on—while still in residency—may help prepare surgeons to succeed in their careers. “As we train our fellows and residents, we need to teach them not only surgery, but also the soft skills that they will need to integrate into organizations which oftentimes are very different than the organization in which they’ve trained,” Dr. Hubka said. Surgeons and trainees can make an effort to improve their personal resilience by prioritizing their basic needs—exercising, eating well, and getting adequate sleep—and building strong networks of colleagues, friends, and family members to whom they can turn when situations are challenging. “Networks matter,” Dr. Moffatt-Bruce advised. “Friends matter. Take the time to engage with them.” Ultimately, what’s important is that the specialty tackle this problem head-on and encourage those suffering from burnout to reach out for help, Dr. Varghese said. >Watch a roundtable discussion on burnout featuring Drs. Chow, Hubka, Moffatt-Bruce, and Varghese at sts.org/burnout. The conversation also is available as an episode on the Surgical Hot Topics podcast; subscribe at sts.org/podcast.  >An educational session on burnout also was held at the STS 56th Annual Meeting; you can listen to the lectures and view slides in Annual Meeting Online.