Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine


Dr. Nicole Turgeon
Dr. Turgeon
Dr. John Sweeney
Dr. Sweeney

Emory investigators find that bariatric surgery could be safe for kidney disease patients

bariatric surgery procedures
(left to right) Gastric banding, gastric bypass, sleeve gastrectomy

Dr. Nicole Turgeon was lead author and Dr. John Sweeney senior author of the largest study of its kind to focus on the impact of kidney function on patients' health following weight-loss surgery. Published in Journal of the American Society of Nephrology, "The Impact of Renal Function on Outcomes of Bariatric Surgery" suggests that obese chronic kidney disease patients who undergo surgery to achieve weight loss do not face a particularly dangerous rate of complications as a result.

Using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File, Drs. Turgeon, Sweeney, and their co-authors analyzed information from 27,736 patients who underwent weight-loss surgery between 2006 and 2008. Before surgery, 34 (0.12%) patients were undergoing long-term dialysis. Among those not undergoing dialysis, 20,806 patients (75.0%) had a normal estimated glomerular filtration rate (GFR) or stage 1 chronic kidney disease (CKD), 5011 (18.07%) had stage 2 CKD, 1734 (6.25%) had stage 3 CKD, 94 (0.34%) had stage 4 CKD, and 91 (0.33%) had stage 5 CKD. In an unadjusted analysis, CKD stage was directly associated with complication rate, ranging from 4.6% for those with stage 1 CKD or normal estimated GFR to 9.9% for those with stage 5 CKD (test for trend, P,0.001).

Multivariable logistic regression demonstrated that CKD stage predicts higher complication rates (odds ratio for each higher CKD stage, 1.30) after adjustment for diabetes and hypertension. Although patients with higher CKD stage had higher complication rates, the absolute incidence of complications remained 10%.

Taking into account the data demonstrating higher risks of bariatric surgery among patients with worse renal function, the researchers emphasized that further study is needed to establish whether the potential benefits outweigh the risks in this population. However, they also note, the upside of such a surgical intervention could be tremendous, as obesity can be an impediment to a patient's ability to undergo a lifesaving kidney transplant.

"This work provides strong evidence that it is safe to proceed with bariatric surgery in kidney failure patients who suffer from obesity," says Dr. Sweeney.

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Soddo Hospital
Soddo Hospital
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Dr. Jon Pollock
Dr. Pollock

ABS approves Global Surgery Program

Quick on the heels of the Residency Review Committee's approval of Soddo Christian Hospital in Soddo, Wolaita, Ethiopia, as a site for Emory general surgery resident rotations, the American Board of Surgery has granted approval to the Department of Surgery's Global Surgery Program, making it one of the first ABS-sanctioned international surgical training experiences.

Soddo Hospital, the centerpiece of the program, opened in January 2005 under the ownership of St. Luke’s Health Care Foundation of Wheaton, IL. The facility is located in the southern part of Ethiopia, a region where there is limited healthcare available for a population of more than three-million people.

In addition to providing medical services, the hospital partners with the Pan African Academy of Christian Surgeons (PAACS) as one of six PAACS training centers. PAACS trains national doctors over a four year surgical residency program. To address the trend of Ethiopian residents that train internationally and choose not to return to their homeland, PAACS stipulates that residents who complete the program must agree to practice in-country for a period of five years.

The development of Emory’s Global Surgery Program at Soddo is descended from the career goals of Dr. Jonathan Pollock, who is interested in providing surgical education and quality, cost-effective surgical care in low resource settings. Dr. Pollock joined our faculty in July 2010 after completing his general surgery residency at Emory. He left for Soddo Hospital in July 2011 to take on the position of assistant program director for its general surgery residency program while retaining his Emory appointment. This dual affiliation allows him to coordinate the Emory surgery resident experience in Ethiopia.

The program is approved for a single six week rotation per year for one PGY3 and/or one PGY4 general surgery resident beginning in July 2013. Those residents who pursue this elective option will find an exceptional clinical experience and many stimulating prospects for research in such areas as outcomes, public health, resource-poor surgical environments, and advanced and unusual disease states.

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Dr. Farish
Dr. Farish

Dr. Farish receives Allen Family Professorship

Sam E. Farish, DMD, has been named the inaugural holder of the J. David and Beverly Allen Family Professorship in Oral and Maxillofacial Surgery. In addition to being an associate professor in Emory’s Division of Oral and Maxillofacial Surgery, Dr. Farish is chief of oral and maxillofacial surgery at the Atlanta VA Medical Center, where he was a co-investigator in multi-site clinical trials conducted throughout the VA system. He is currently one of the leading surgeons in Atlanta performing bone grafting procedures to permit the placement of dental implants. He has served as an examiner for the American Board of Oral and Maxillofacial Surgery, authored numerous publications, and was honored with an outstanding senior resident teaching award established in his name in 2008.

Dr. and Mrs. J. David Allen established the Allen Family Professorship to support a leader in the field of oral and maxillofacial surgery. Dr. Allen, an alumnus of Emory University (67C) and Emory School of Medicine (70D 75DR), serves on Emory's Board of Trustees and is a 1994 recipient of the Emory Medal. He is the founder, former president, CEO, and managing partner of Oral and Maxillofacial Surgery Associates in the Atlanta area. His wife, Beverly, who served as CFO, is also an Emory alumna (68C). Together, they founded the Ina T. Allen Dental Center at Wesley Woods In 1989. They are co-chairs for Campaign Emory for the School of Nursing.

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Department of Surgery quality program joins BPBC

In addition to participating in the University HealthSystem Consortium Quality and Accountability Program (UHC-QAP, which ranked Emory University Hospital at 10 out of 101 centers in national quality rankings in 2011), the American College of Surgeons National Surgical Quality Improvement Program (ACS/NSQIP), and the Surgical Care Improvement Project (SCIP, which reported that EUH achieved a compliance level of 98.6% for the 1st quarter of FY12), the Department of Surgery's quality program recently joined Best Practices for Better Care (BPBC). This surgical safety collaborative is a multi-year initiative of the UHC and the Association of American Medical Colleges (AAMC).

The BPBC's mission is to expand the use of evidence-based best practices in surgery through cooperation between UHC-member academic medical centers. The institutions must subscribe to BPBC's five primary commitment areas: to teach quality and patient safety to the next generation of doctors; ensure safer surgery through use of surgical checklists; reduce infections from central lines using proven protocols; reduce hospital readmissions for high-risk patients; and research, evaluate, and share new and improved practices. Over time, BPBC plans on expanding its list of commitments.

The quality program of the Department of Surgery at Emory and over twenty other academic medical centers—including five in the UHC Top Ten for quality—will collect data and transmit it to BPBC for tracking, trending, and reporting. Since Emory has already implemented a Surgical Safety Checklist at EUH, the quality program has chosen to use its upcoming rollout of the Surgical Safety Checklist at Emory University Hospital Midtown as its first project for the BPBC. The initiative will allow Midtown's surgical process improvement teams to draw from the experience of physicians across the nation while also sharing Emory's innovations with other peer institutions.

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Dr. Lyerly
Dr. Lyerly
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Save the date: 11th Annual Emory Surgery Research Day

The 11th Annual Department of Surgery Research Day of the Emory University School of Medicine will commence at 7:00 a.m. on Thursday, May 3, 2012, with "Surgical Research: The Biology of Tissue Specific Immune Responses," a lecture by visiting professor H. Kim Lyerly, MD, George Barth Geller Professor of Research in Cancer; co-director of the Breast Cancer Research Program, Duke Comprehensive Cancer Center; and associate professor of pathology at Duke University School of Medicine. The lecture will be presented at surgical grand rounds in the EUH auditorium.

Dr. Lyerly is a pioneer in the development and testing of immunologic therapies and has consistently transferred immunotherapy from the bench to the bedside. He is nationally and internationally recognized for developing and leading novel clinical trials that evaluated the use of dendritic cells targeting HER2/neu, CEA, and RNA as a therapeutic vaccine to fight primary cancers as well as protect patients against recurrences. He serves on the Board of Directors, American Cancer Society, Southeast Division; chairs the Cancer Centers Subcommittee, National Cancer Advisory Board; co-chairs the Burroughs Wellcome Foundation Translational Research Advisory Board; is on the editorial boards of several peer-reviewed journals, including Annals of Surgery, Cancer Investigation, Journal of Clinical Oncology, and Cancer Gene Therapy; and has published over 180 papers, 75 book chapters, and edited or co-edited 11 books.

The symposium portion of the Annual Research Day will be held from 1:00-6:30 p.m. at SOM Lecture Hall 120. The research of the department's medical students, postdocs, residents, and fellows will be showcased in the form of oral presentations and posters in basic and clinical science categories that have been competitively reviewed and selected by a panel of distinguished departmental faculty. Posters will be presented in the SOM Commons Lobby. Dr. Lyerly will assist in ranking the posters and presentations, resulting in cash awards for the winners as well as dinner with the faculty immediately following the symposium.

For more information, please contact Griselda McCorquodale at 727-8461 or gmccorq@emory.edu.

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Upcoming events

4th Annual Georgia Nanotechnology & Infectious Disease Symposium
Sponsored by Coulter Dept. of Biomedical Engineering at Georgia Tech and Emory University
Keynote Speaker: Carl June, MD, Professor of Pathology and Laboratory Medicine, Perelman School of Medicine

8:30 a.m.-6:00 p.m., April 2, 2012 WHSC Administration Building Auditorium
Why Gift Law Matters: The Law and Ethics of First Person Consent to Donation

Presented by Alexandra Glazier
– VP & General Counsel for New England Organ Bank
7:00-8:00 a.m., April 5, 2012 EUH Auditorium
Evolution of Minimally Invasive Surgery

Presented by Ankit Patel, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
7:00-8:00 a.m., April 12, 2012 EUH Auditorium
5th Annual Ira Ferguson Lectureship
Topic TBA

Presented by Barbara Lee Bass, MD
– John F. & Carolyn Bookout Distinguished Endowed Chair, Methodist Hospital Department of Surgery
– Executive Director, Methodist Institute for Technology, Innovation and Education (MITIE)
– Professor of Surgery, Weill Cornell Medical College of Cornell University
7:00-8:00 a.m., April 19, 2012 EUH Auditorium
Plastic Surgery Contributions to Hand Surgery

Presented by Vincent Hentz, MD
– Professor of Surgery-Hand Surgery, Professor of Orthopaedic Surgery (by courtesy), Stanford University School of Medicine
– Chief, Hand Surgery Center, Palo Alto Veterans Affairs Medical Center
7:00-8:00 a.m., April 26, 2012 EUH Auditorium
Surgery Faculty Meeting 5:30-7:00 p.m., May 1, 2012 EUH Auditorium
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