News & Media

STS News, Spring 2018 -- New STS officers and directors were elected during the Annual Membership (Business) Meeting on Monday, January 29, at the 54th Annual Meeting in Fort Lauderdale. The membership elected Keith S. Naunheim, MD as STS President for 2018-2019. Additionally, Robert S.D. Higgins, MD, MSHA was elected First Vice President, and Joseph A. Dearani, MD was elected Second Vice President.  The following also were elected or reelected by the STS voting membership at the Annual Meeting: Secretary: Joseph F. Sabik III, MD Treasurer: Thomas E. MacGillivray, MD Directors-at-Large:  Kevin D. Accola, MD Vinod H. Thourani, MD Ara A. Vaporciyan, MD

STS News, Spring 2018 -- For Mitchell J. Magee, MD, becoming involved in political advocacy was his way to influence patient care beyond the operating room and the health care setting. “While we all derive immense satisfaction from providing the best care to each individual patient, we are often confronted with limitations that we and our patients feel powerless to impact,” he said. “It has been personally and professionally satisfying to learn through STS advocacy that we are not powerless, and we can make a difference.” Dr. Magee, who is Surgical Director of Thoracic Oncology and the Minimally Invasive Therapy Institute for Lung and Esophagus at Medical City Dallas Hospital, recently received the Society’s Key Contact of the Year Award for his extraordinary efforts in advocating for the specialty. Mitchell J. Magee, MD received the Society’s Key Contact of the Year Award this past January (from left: Chair of the STS Council on Health Policy and Relationships Alan M. Speir, MD, Dr. Magee, and STS President Keith S. Naunheim, MD) He has attended many STS Legislative Fly-Ins in Washington, DC, and said his first Fly-In, in 2014, was the most enlightening. “The STS staff provided all of the tools that I needed, including a planned schedule of meetings with my representatives or their staffs, talking points for those meetings, and materials to leave behind. I also was grouped with other STS members, many of whom were Fly-In veterans. They showed me the ropes and made delivery of our messages more effective,” Dr. Magee said. He said that he was impressed with how diligently the representatives and their staffs listened. “It was apparent how much our opinions were respected and how genuinely interested the Congressional staff members were in understanding our concerns and how these issues impact us and our patients as their constituents,” Dr. Magee said. This initial positive experience in Washington led to annual meetings with his representatives, either in DC or their local offices in Dallas. These meetings have helped Dr. Magee foster personal relationships with his representatives and their key staff. Mitchell J. Magee, MD met with Rep. Pete Sessions (left) at an STS Legislative Fly-In in Washington, DC, last fall. One such relationship is with Rep. Pete Sessions (R-TX), Chairman of the House Rules Committee, who represents the Dallas area. Dr. Magee was invited to join the Congressman’s National Physicians’ Council for Healthcare Policy. “Rep. Sessions regularly seeks my input, which reflects that of the Society,” Dr. Magee said. “He knows that STS is a data-driven resource.” STS staff recently helped Dr. Magee create talking points about the benefits of accessing Medicare claims data for longitudinal research. Those talking points were then used during a Physicians’ Council meeting.  “By engaging policymakers to identify the issues impacting medicine and possible legislative solutions, Dr. Magee is helping physicians and patients across the country,” Rep. Sessions said. “His passion for advocacy is truly inspiring.” Although some cardiothoracic surgeons fully support advocacy efforts, Dr. Magee acknowledges that others may have a cynical view of the political process and use it as an excuse for not participating; he urged them to reconsider. “It has been personally and professionally satisfying to learn through STS advocacy that we are not powerless, and we can make a difference.” Mitchell J. Magee, MD “I certainly don’t agree with all of my representatives on every issue; with some of my representatives, I disagree on many issues,” Dr. Magee said. “Cardiothoracic surgeons share a desire to provide the best for our patients. Whether or not we agree with the process or like our representatives, we still must work to benefit our patients, the specialty, and the Society.”  To learn more about how you can become involved in STS advocacy efforts, visit sts.org/advocacy or contact the STS Government Relations office.

STS News, Spring 2018 -- More than 4,200 people, including more than 2,100 cardiothoracic surgeons and allied health care professionals, gathered in Fort Lauderdale January 27–31 for the STS 54th Annual Meeting. To view meeting photos, program content, and daily editions of the STS Meeting Bulletin, visit sts.org/annual-meeting-archive. Embracing Failures Serves as a Catalyst to Success Drawing from both the profession and the sport that he loves, Richard L. Prager, MD encouraged attendees of his Presidential Address at the STS 54th Annual Meeting to “see their realities” and “make seeing and knowledge continuous with each other.” “Professional innovation is our responsibility, and recognizing we are a creative specialty, I would offer that we—as surgeons—and our professional societies must be the leaders in accountability and transparency. To do so, we must embrace and advance performance measurement and analytics, performance feedback, and performance improvement,” he said. Dr. Prager’s work with quality improvement initiatives has been his professional calling, according to Keith S. Naunheim, MD, who introduced Dr. Prager. It was therefore fitting that the focus of Dr. Prager’s address was the vital role of performance measurement and feedback in achieving success. Richard L. Prager, MD highlighted the importance of performance measurement. Dr. Prager took attendees on a journey of quality improvement initiatives in cardiovascular surgery, highlighting the STS National Database and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, the latter of which he now directs. As one example of the Quality Collaborative’s power in improving outcomes, Dr. Prager described an initiative to increase the use of the internal mammary artery in coronary bypass surgery. Its success resulted from identifying rates of use at various sites, offering educational sessions, creating an exclusion form for operating surgeons who chose not to use the internal mammary artery, and providing feedback. Subsequent Quality Collaborative initiatives were successful in reducing ventilator time, decreasing unnecessary blood transfusions, and identifying when the critical or sentinel thought process or care process occurred leading to a patient’s death. “Cardiac and thoracic surgeons have a unique opportunity with the data we have from our registries in the United States and worldwide to explore our outcomes and comparative performances, and—with understanding and feedback, discussion, and resetting of approaches and goals—create improvements, knowledge, and benefit for patients and our national health care systems,” he said. "Accepting performance feedback and looking at our outcomes is as much about our character as our talent or ability as surgeons." Richard L. Prager, MD Dr. Prager then reinforced the integral role of performance analysis and feedback for success in the sport he loves: tennis. Through short video clips of interviews with players and coaches, attendees heard how performance measurement, performance feedback style and timing, and personal qualities lead to improvement and success. Dr. Prager captured the essence of the interviews by noting that cardiothoracic surgeons must embrace their failures, as that is the path to greatness, and should always think about getting better—not winning, but getting better—in order to be successful. “The commitment of [tennis] players is unwavering and the recognition that performance feedback is essential is understood by every player at every level. Perhaps we can learn from their commitment and approaches,” said Dr. Prager. “Accepting performance feedback and looking at our outcomes is as much about our character as our talent or ability as surgeons, and as our future tennis stars recognize, there always are ways to improve,” he added. “For all of us, while this may seem to be an aspirational narrative, the mastery of the approach, whether it is a hospital network, an individual hospital, or an individual surgeon, our professional innovation, our seeing, will create success.” Award Winners Honored The STS Annual Meeting offered the opportunity to recognize those who are making an impact on the organization and the specialty. The following were honored by the Society in Fort Lauderdale: Richard L. Prager, MD with Distinguished Service Award winners (from left) Cameron D. Wright, MD, Francis C. Nichols III, MD, and Marshall L. Jacobs, MD Distinguished Service Award Distinguished Service Awards recognize those who have made significant and far-reaching contributions to the Society. The 2018 recipients were Marshall L. Jacobs, MD, Francis C. Nichols III, MD, and Cameron D. Wright, MD. Earl Bakken Scientific Achievement Award The Earl Bakken Scientific Achievement Award was presented to Robert H. Bartlett, MD, who is best known for developing the lifesaving heart-lung technology known as extracorporeal membrane oxygenation. The Bakken Award honors individuals who have made outstanding scientific contributions that have enhanced the practice of cardiothoracic surgery and patients’ quality of life. President’s Award The President’s Award was presented to David D. Odell, MD, MMSc from Northwestern University for his paper, “Significant Variation in Compliance With Lung Cancer Quality Measures Exists Across US Hospitals.” Selected by the STS President, this award recognizes an outstanding scientific abstract by a lead author who is either a resident or a surgeon 5 years or less in practice. Poster Awards Adult Cardiac Surgery: Risk Model for In-Hospital Mortality in Aortic Surgery for Ascending Aortic Aneurysm in the United States Using the STS National Database (Makoto Mori, MD) Cardiothoracic Surgical Education: Preferences in Pathway to Becoming a Cardiothoracic Surgeon: A Survey of Current Cardiothoracic Surgery Residents (Trevor A. Davis) Congenital Heart Surgery: Aortic Extension to Relieve Pulmonary Artery Compression Following Norwood Palliation (Luke M. Wiggins, MD) Critical Care: Addressing Diaphragm Dysfunction in Cardiac Surgery Patients: Successful Therapeutic Use with Current Technology and Future Prophylactic Use of Temporary Diaphragm Pacing Utilizing Intramuscular Electrodes (Raymond P. Onders, MD) General Thoracic Surgery: Fabrication of a 3-Dimensional Bioprinted Tracheal Scaffold with Fibrous Cover and Cartilaginous Regeneration (David Zeltsman, MD) Quality: Patient-Reported Experience After Cardiac Surgery: Identifying Areas for Improvement (Meghana Helder, MD) Photo Gallery View photos from the Annual Meeting, including highlights such as Shark Tank, the Presidential Address by Richard L. Prager, MD, award winners, and popular hands-on STS University courses. Access STS 54th Annual Meeting Online STS Annual Meeting Online provides access to more than 100 hours of recorded sessions. Access to Annual Meeting Online was included with Annual Meeting registration. Non-attendees can purchase the online product at sts.org/AMonline. Annual Meeting by the Numbers 2,149 professional registrants 60 countries represented by registrants. Countries with the most registrants: United States, Japan, Canada, United Kingdom, and Brazil and Germany (tie) 130 exhibiting companies and organizations 226 pieces of bovine and porcine tissue purchased for STS University  

STS News, Spring 2018 -- Clinical trials in durable mechanical circulatory support (MCS), the use of these devices in children, and challenges to the paradigm of durable continuous-flow rotary pumps are just a few of the topics that will be explored at the 2018 STS Intermacs Meeting. With the addition of the STS Intermacs Database as the fourth component of the STS National Database (see Winter 2018 issue of STS News), the Society is continuing a tradition by planning a 1.5-day conference that will be held May 11-12 in Rosemont, Illinois, near O’Hare International Airport.  The meeting is designed not only for STS Intermacs Database participants, but also for anyone involved in the care of heart failure patients, including cardiothoracic surgeons, cardiologists, nurse specialists, and other members of the multidisciplinary health care team. “The meeting will be informative and enlightening,” said Robert L. Kormos, MD, Chair of the STS Intermacs Database Task Force. “We’ll provide snapshots of research performed with Intermacs data, discussion of controversial topics, debates, and presentations on new technology that’s still in development.” The program begins Friday afternoon, May 11, with experts reviewing quality of life measures, as well as discussing data input and data use for the STS Intermacs Database. Presentations will cover isolated durable right ventricular assist devices (VADs), de novo aortic insufficiency on left VAD support, continuous-flow VADs in pediatric patients, VAD implants for children with congenital heart disease, and biventricular assist devices in children. In addition, a focus will be placed on how to use Intermacs data for quality improvement and developing quality measures in one’s institution. The Friday session ends with poster abstract presentations and a wine and cheese reception. On Saturday, the meeting will begin with an outline of where the STS Intermacs Database is going in the future and details of new initiatives, such as data requests for research purposes. Other sessions will cover clinical trials in durable MCS, adverse events, MCS in the pediatric population, engineering better pumps and electronics, and new MCS devices. Register Now View the full agenda and register for the meeting at sts.org/intermacsmeeting.  

Robert A. Wynbrandt, Executive Director & General Counsel STS News, Spring 2018 -- Most readers of STS News will not independently remember this, but there was a time when physician advertising was banned in the United States. It was not so long ago when the American Medical Association, then boasting a membership that actually included a majority of US licensed physicians, maintained and enforced such a ban. However, in the wake of a 1975 US Supreme Court decision that declared Virginia’s ban on lawyer advertising unconstitutional, the Federal Trade Commission filed a complaint against the AMA for its analogous misdeeds in the medical profession. By 1980, my first year in legal practice, a federal appellate court had rejected the AMA’s challenge and upheld an FDA Order that it “cease and desist from promulgating, implementing and enforcing restraints on advertising ... by physicians ...” except when such advertising was false or deceptive. That ruling was finally upheld by the Supreme Court in 1982. As any casual reader of an airline inflight magazine can attest, the AMA’s former ban on physician advertising is now as antiquated as all those Disney VHS videotapes I bought when my kids were young. And not only is physician advertising alive and well, but information about physicians is abundant and readily available through the internet and all forms of social media.  In this world of plentiful information available to the public about physicians, as a function of both advertising and other promotional vehicles created by physicians, as well as numerous sources of information generated by third parties, cardiothoracic surgeons are wise to pay attention to their public images, e.g., by periodically “googling themselves” and learning about how they are depicted on the internet, which can be a source of false and misleading information. Some fortunate STS members may work at hospitals where this task is performed for them by marketing professionals. Such due diligence might strike some as a waste of time, if not narcissistic, but nothing can put a damper on one’s professional image—and potentially one’s career—like false or misleading information disseminated to the public. And while it’s true that some false or misleading information is virtually impossible to eliminate or correct in the virtual public square, just the knowledge of what your colleagues, administrators, and patients may be hearing and reading about you will at least arm you with information that you can affirmatively counteract in your dealings with them. Cardiothoracic surgeons are wise to pay attention to their public images. Medical specialties and their national societies also have to be mindful of their images. A negative image of a specialty impacts the interests of prospective trainees (i.e., the lifeblood of a profession), how its health policy positions are perceived by legislators and regulators, and most importantly how they are viewed by patients and prospective patients—the ultimate consumers of their services. Lest we forget, it was also not that long ago when the image of cardiothoracic surgery was not so rosy (see declining numbers of residency applications, William Hurt in “The Doctor,” etc.). In furtherance of its image, not to mention its organizational mission for which “the highest quality patient care” is the endgame, the Society recently began to address a number of broad social issues that have significance for the well-being of the specialty. STS action in three such arenas started with important member surveys: on diversity and inclusion, on opioid use in cardiothoracic surgical procedures (see page 2), and on gender bias and sexual harassment. While some of our members might deem such issues as counterintuitive—or even inappropriate—for focus by an organization such as ours, STS is not alone among national medical specialty societies in taking an active interest in these topics; a specialty society that is sensitive to cultural norms and alert to its own culture serves its public image, reflects well on its members, and is emblematic of the STS core value of professionalism. To that end, this column is both a thank you note to those who have participated in these surveys and a plea for the time and attention of all our readers for participation in our future surveys of this nature. You will be hearing much more on all of these fronts. One final comment about image that you’re likely to hear consistently from public relations professionals: the image that one seeks to cultivate must be authentic or it will lack credibility. Thus, astute readers of this space will note that the photographic image accompanying this column no longer reflects the 40-something-year-old me, but rather the 60-something-year-old me, thanks largely to the public shaming to which I was subjected by then-First Vice President Keith Naunheim prior to our 2018 Annual Meeting. This updated headshot is provided to enhance my own credibility (“if he’s misleading us about what he looks like, who knows if he’s otherwise misleading us?”) and as a commercial for a terrific innovation introduced by STS Director of Marketing and Communications Natalie Boden on the exhibition floor in Fort Lauderdale. If you did not take advantage of this free opportunity at our 2018 Annual Meeting, please be assured that we will repeat it next year in San Diego; I encourage you to stop by. In fact, you can consider your free headshot an STS return on your membership investment, to the benefit of your image.

STS News, Spring 2018 -- Your technical skills in the operating room are, of course, essential to developing a thriving cardiothoracic surgical career. But understanding how your procedures should be coded, navigating contract negotiations, and finding a good mentor also are important elements in ensuring your success. To assist cardiothoracic surgeons with all aspects of practice management, the Society offers a wealth of tools on its website, which you can find at sts.org/resources. Offerings in this section of the website include: Coding and Reimbursement Resources Submit specific coding questions to the Coding Help Desk. This tool is designed to assist STS members and their staffs with coding, billing, and reimbursement challenges. Risk Calculators Risk calculators provided by the Society can be valuable resources for patient consultations. The STS Short-Term Risk Calculator allows you to calculate a patient’s risk of mortality and morbidities following coronary artery bypass grafting (CABG) surgery, aortic valve replacement, mitral valve replacement, and more, based upon data from the STS National Database; the ASCERT Long-Term Survival Probability Calculator, based upon data from the STS Adult Cardiac Surgery Database and the Centers for Medicare & Medicaid Services, allows you to calculate survival probability following isolated CABG in patients aged 65 years and older. Clinical Practice Guidelines and Expert Consensus Statements Take advantage of these clinical decision-making aids. Sixteen cardiothoracic surgical topics are covered in the Society’s clinical practice guidelines, which are based on an exhaustive review of scientific evidence published in the medical literature. STS Expert Consensus Statements represent the collective opinions of expert panels on clinical topics; the most recent statement focuses on resuscitation of patients who arrest after cardiac surgery. Practice Management Columns Access an archive of Practice Management columns from past issues of STS News and read about topics such as the importance of collaborating with cardiologists, how to navigate an employment model environment, and bundled payments for CABG. Career Resources Get career advice, especially if you are in your first 7 years of practice: An extensive document provides answers to frequently asked questions on topics such as clinical interactions, program development, personal finances, contracting, and research. A new blog offers practical tips on all aspects of early career development. Topics include how to obtain research funding as a new investigator, balancing clinical, academic, and administrative responsibilities, and communicating with referring physicians; new posts are planned monthly. Find out how to connect with your fellow cardiothoracic surgeons on social media. You can access a feed of the @CTSurgCareers Twitter account, as well as learn about upcoming TweetChats. A just-released video roundtable features STS members Vinay Badhwar, MD, Shanda H. Blackmon, MD, MPH, Melanie A. Edwards, MD, and David D. Odell, MD, MMSc discussing the importance of mentorship, what the Society is doing to promote mentorship for early career surgeons, and defining the relationship between mentor and mentee. If you have suggestions on additional practice management resources that you’d like to see from STS, contact the Education Department.

Keith S. Naunheim, MD, President STS News, Spring 2018 -- There are many longstanding issues afflicting our cardiothoracic surgical specialty, including threats to reimbursement, liability issues, and burdensome regulation. The profession has addressed and continues to address these issues; however, just recently, a chronic but previously unrecognized danger to the specialty and our patients was identified—the national epidemic of opioid abuse. The opioid epidemic is a real phenomenon with devastating consequences in the US. The number of overall deaths from overdoses has more than doubled in the last decade, peaking at about 64,000 fatalities in 2016 and exceeding the deaths from traffic accidents or gun violence. Fully, two-thirds of those deaths were related to opioid overdose. The etiology of this problem is multifactorial and involves many health care players. Pharmaceutical companies intentionally downplayed the addiction risk of new pain medications while engaging in morally indefensible sales and distribution practices. In the 1990s, the American Pain Society, funded by the same pharmaceutical companies, touted pain as “the fifth vital sign,” insisting on visual pain scales with aggressive management that included narcotics. The Joint Commission published a pain management guideline in 2001 encouraging this pain management strategy, and in fact published a continuing education booklet (again funded by drug companies) citing studies suggesting “there is no evidence that addiction is a significant issue when persons are given opioids for pain control.” The Federation of State Medical Boards called for the punishment of doctors who inadequately treated patients’ pain, while simultaneously accepting pharmaceutical company money to produce drug prescribing guidelines. Hospitals implemented patient satisfaction scores specifically addressing inadequate pain management issues and threatened to downgrade physicians’ performance assessment for poor scores. Even the US legal system was involved, with physicians found financially liable for inadequate pain management practices (Bergman v. Chin). Despite these facts, it is the physician community that has been vilified by the media for wanton and irresponsible prescribing practices. While it is true that there are unscrupulous doctors at “pill mills” who are guilty of unethical practices, it is also true that a portion of the blame could be assigned to responsible and caring physicians misled by the above-mentioned authorities and institutions. This group includes cardiothoracic surgeons who, for decades, have utilized thoracotomy incisions to achieve intrathoracic access. This approach produces a combination of muscular, skeletal, mesothelial, and neuropathic pain, which arguably makes thoracotomy the most painful incision one can undertake, both with regard to the immediate postoperative period and in the long term. A paper presented in January at the STS Annual Meeting reported that 14% of patients undergoing thoracoscopy or open thoracotomy were still filling opiate prescriptions 6 months after surgery. As surgeons, we need to be conscious of such results and take action directly addressing the issue of post-thoracotomy narcotic usage. As surgeons, we need to … take action directly addressing the issue of postthoracotomy narcotic usage. STS recognizes its role and that of its members in confronting this ongoing epidemic. Our first action is to better understand the current state of practice and, therefore, the Society has undertaken an electronic member survey requesting specific information regarding the routine practice of opioid administration and prescription following cardiothoracic surgery. Information regarding standard dosage, number of pills, and duration of treatment has been requested both from surgeons and associated providers who have been asked to participate (physician assistants, advanced practice nurses, anesthesiologists). This information will help form the foundation for the Society’s response to this nationwide problem. It is hoped that the results of this survey will help STS identify best practices and then issue expert clinical opinion regarding optimal perioperative utilization of both opioid medication and nonnarcotic pain control methods and medications.  In addition, the Society will undertake ongoing education initiatives to help guide the membership in future practice. This will include emphasis of ERATS (Enhanced Recovery After Thoracic Surgery) protocols, a topic that was highlighted at the recent Fort Lauderdale meeting (see page 8 for information on how to access a related video roundtable and podcast). ERATS also will be addressed specifically at the upcoming STS Critical Care Conference in October, and it is expected that next year’s Annual Meeting in San Diego will highlight the issue of perioperative pain management and responsible perioperative opioid utilization in breakout sessions. It is unrealistic to expect that cardiothoracic surgeons will be able to forgo narcotic medication completely given the nature of our operative incisions. However, both you the members and our patients can and should expect the Society to help guide practitioners in the measured and judicious approach to opioid usage in both inpatient and outpatient arenas. Such an approach will help minimize the risk of addiction for our patients and help address the ongoing epidemic. It seems that this scourge caught most of America flat-footed in 2017, and our specialty was no exception. But now I believe we all recognize that the problem exists and it is one in which cardiothoracic surgeons have unwittingly played a role, however unintended. Yes, we have a problem, but now we pledge that—together—we will become part of the solution.