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



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Dr. Timothy Buchman
Dr. Buchman

Emory Center for Critical Care receives Health Care Innovations Award


The Emory Center for Critical Care (ECCC) received a $10.7 million Health Care Innovations Award from the federal Centers for Medicare and Medicaid Services (CMS) for its project "Rapid Development and Deployment of Non-Physician Providers in Critical Care," a plan to build a collaborative network known as the North Georgia Critical Care Collaborative (NGCCC) to support intensive care units in North Georgia, thereby improving critical care for patients in rural and underserved areas. CMS is an operating division of the Department of Health and Human Services (HHS).

Made possible by the health care law—the Affordable Care Act—the first wave of Health Care Innovations awards will support 26 innovative projects nationwide that will save money, deliver high quality medical care, and enhance the health care workforce. The preliminary awardees are expected to reduce health spending by $254 million over the next three years.

Emory received the second highest sum of the awardees and was the first project highlighted by HHS in its press release announcing the awards.

As the NGCCC, the ECCC will partner with Saint Joseph's Health System, Northeast Georgia Health System, Southern Regional Medical Center, and telemedicine provider Philips Healthcare. Dr. Timothy Buchman, director of the ECCC, is the architect of the project as well as director of the new NGCCC. Dr. James Bailey, chief medical informatics officer at Northeast Georgia Health System, is co-director.

"Across the country, many ICUs—more than 1,000 between 1985 and 2005 and especially those in community and rural hospitals—have closed for lack of qualified doctors and other staff," says Dr. Buchman, explaining the extreme pressure that delivery of critical care has been experiencing. "Patients and families now find themselves traveling long distances to unfamiliar places for critical care, wherever an open ICU bed can be found. And those open beds have become much harder to find."

Emory and its community partners will address this problem by bringing more than 40 critical care professionals, including 20 nurse practitioners and physician assistants, from their local hospitals and communities to Emory for six months of advanced training. They will then return to their community hospitals to provide high-quality care, enabled by telemedicine ICU services that will feature highly experienced ICU doctors and critical care nurses working closely with the specially trained providers in the community ICUs. This process is expected to greatly improve access to dependable community ICU health care, will serve over ten thousand Medicare and Medicaid beneficiaries, and is calculated to save more than $18 million over three years.

"As our population ages, more and more Americans will require admission to an intensive care unit," says Dr. Buchman. "Those patients and their families depend on getting the right care right now, through life-supporting treatments that require not only advanced technology but also a team of skilled caregivers. For all Americans, this is a program that saves cost, saves money, saves time, and saves lives and can be quickly adopted and replicated in other communities and scaled to local needs."

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Emory CT team in the Saudi OR
The team in the OR
Emory surgical team with Saudi hosts
Emory surgical team with Saudi hosts

Of CABG and royalty: Emory cardiac team shines in Saudi Arabia

In 1997, one year after he joined Emory, Dr. John Puskas performed the world's first triple off-pump cardiac bypass surgery using minimally invasive coronary artery bypass graft instrumentation. In 2010 he presented long-term follow-up data of the first US randomized study supporting the medical benefit of off-pump cardiac surgery at the 46th Annual Meeting of the Society of Thoracic Surgeons. Little did he dream that his role in refining and validating the technique would lead to an invitation a few years later to Riyadh, the capital of Saudi Arabia, to operate on a prominent member of the Saudi royal family.

The patient's Saudi cardiologists and surgeons, who had advised him to undergo off-pump coronary artery bypass grafting (CABG), contacted numerous prominent cardiologists and surgeons in the Middle East, Europe, and North America for recommendations of who could best perform the procedure. After creating a spreadsheet of the responses, the patient's physicians saw that Dr Puskas' name was the only one listed by all of the consultants.

The patient's cardiac catheterization results were then hand-delivered to Emory University Hospital Midtown (EUHM) by Saudi security forces.

"I gave my opinion, was ultimately asked to perform the operation in Saudi Arabia, and was invited to bring a complete cardiac surgical team with me," says Dr. Puskas, professor and associate chief of the division of cardiothoracic surgery at Emory. "Finances were negotiated by Emory Healthcare CFO Jimmy Hatcher and off we went in early April."

The Emory team members included Dr. Puskas; Dr. Omar Lattouf, professor of surgery, division of cardiothoracic surgery; Dr. James Ramsay, director of the division of critical care medicine, Department of Anesthesiology; Mark Steele, chief perfusionist, EUHM; Keith Causey, chief physician's assistant, division of cardiothoracic surgery; and Scarlett Parks, acting director of CT OR Nursing, EUHM.

The team was flown first class to Dubai, then by private jet to Riyadh where they stayed in the Ritz-Carlton, a palatial hotel in a man-made oasis where Secretary of State Hillary Clinton also happened to be a guest. "Every day we dined adjacent to her secret service personnel, who clearly knew who we were and what we were doing there," says Dr. Puskas.

However, no amount of royal hospitality could dispel the fact that operating on a VIP in a foreign country is inherently stressful, especially with the extra layer of gravity added by the patient's imperial status. "There were literally dozens of staff, security, family members, and well-wishers around the patient at all times. Members of the royal family made clear how important our patient was to them."

While the Emory collective managed all apsects of the patient's preoperative, intraoperative, and postoperative care, their hosts mandated certain conditions beyond the OR, such as the scrub nurse having to wear traditional head-to-toe covering whenever she was outside the hospital.

The procedure was performed at King Faisal Specialist Hospital and Research Center (KFSHRC). The patient received no transfusion, was extubated one hour after surgery, and experienced a complication-free recovery. Upon returning to Emory, Dr Puskas conducted several follow-up consultations by Skype and confirmed the eradication of the patient's preoperative angina and shortness of breath.

With such an auspicious beginning, Dr. Puskas envisions future opportunities for Emory CT surgery to partner with colleagues at the King Faisal Hospital to advance innovation and quality at both institutions.

"We're discussing various possibilities, such as exchanging trainees, sending other Emory surgical teams over, and other mutually beneficial options. We look forward to broadening our relationship with KFSHRC and the Saudi royal family."

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Dr. Scott Davis
Dr. Davis
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Dr. Kalyana Nandipati
Dr. Nandipati

Recent study finds that variation in LYRGB technique reduces occurrence of internal hernias

"Counterclockwise rotation of Roux-en-Y limb significantly reduces internal herniation in laparoscopic Roux-en-Y gastric bypass (LRYGB)," published in the April 2012 edition of Journal of Gastrointestinal Surgery, posits that an alternative method of performing LRYGB significantly reduces the incidence of internal hernias. LRYGB is the most frequently performed weight loss surgery in the U.S., and internal hernias have been a significant source of morbidity after the procedure.

Senior author Dr. S. Scott Davis, assistant professor of surgery and associate program director of the Emory endosurgery fellowship, and first author Dr. Kalyana Nandipati, former Emory endosurgery fellow and current assistant professor of surgery at Creighton University Medical School, collaborated on the study with Emory faculty members Dr. Edward Lin, Dr. Jyotirmay Sharma, Dr. John Sweeney, and an additional, former Emory endosurgery fellow, Dr. Farah Husain.

With the intention of determining technical factors associated with the development of internal hernias, the study focused on 367 female and 75 male patients from the Emory Bariatric Center database who underwent LYRGB. In addition to assessing multiple pre- and post-operative factors, the study analyzed the direction of rotation of the Roux limb during creation of the bypass limb and jejuno-jejunostomy and whether or not the Petersen's defect was closed at time of surgery.

The patients were divided into two primary groups: those whose Roux limb was created using a clockwise rotation of the small bowel, leading to a jejuno-jejunostomy on the right side of the axis of the mesentery; and those whose limb was made using a counterclockwise rotation of the small bowel, leading to a jejuno-jejunostomy created on the left side of the axis. A subset analysis of the effect of closure of the Petersen's defect between the Roux limb and transverse mesocolon was also done.

A total of 21 hernias occurred in 442 patients, with 20 occurring in group one (6.9%) and one in group two (0.7%). Closure of the Peterson's defect did not materially result in lower rates of internal herniation. The study's conclusion that the method used for constructing the Roux limb is a major factor in the potential for internal hernias can be widely applied to other areas of gastric surgery involving Roux limb creation.

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Dr. Jeffrey Salomone
Dr. Salomone

Dr. Salomone honored for his commitment to Georgia's Emergency Medical Service

On the evening of Georgia's Region III Emergency Medical Services (EMS) Annual Awards Ceremony, held at Emory University Hospital-Midtown on May 16, 2012, Dr. Jeffrey Salomone was honored with the Dennis Lockridge EMS Pioneer Award. The award is given in recognition of contributions to the conception and development of Georgia's Emergency Medical Service and for ongoing support of the enhancement of pre-hospital emergency medical care delivery to the citizens of Georgia.

Dr. Salomone is an associate professor of surgery at Emory who holds multiple appointments at Grady Memorial Hospital, including chief of surgical infectious diseases and official surgeon for the Atlanta Police Department. He is a member of the Region III EMS Council and has chaired the organization's Trauma Advisory Committee for the past ten years.

The mission of Georgia EMS is to encourage, foster, and promote the continued evolution of an optimal system of emergency medical and trauma care which provides the best possible patient outcome. Region III's emergency services encompass Cobb, Fulton, Dekalb, Douglas, Gwinnett, Clayton, Newton, and Rockdale counties.

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2012 Department of Surgery Research Symposium Awardees

2012 research day awardees with Drs. Larsen, Kirk, & Lyerly
Left to right: Sarah Fisher, Laura Johnson, Doug Anderson, William Kitchens, Drina Freitas, distinguished visiting professor H. Kim Lyerly, Andrew Page, Chris Larsen, Allan Kirk

The commitment to research evidenced by Emory Surgery’s mentors and trainees was essential to the unqualified success of the 11th Annual Department of Surgery Research Symposium on May 3, 2012.

Best Basic Science Presentations:
Alessandrina M. Freitas, MD (First Place)
William H. Kitchens Jr., MD (Second Place)
Douglas J. Anderson, MD (Best Poster)

Best Clinical Science Presentations:
Laura S. Johnson, MD (First Place)
Sarah B. Fisher, MD (Second Place)
Andrew J. Page, MD (Best Poster)

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Dr. Sarah Fisher
Dr. Fisher

Dr. Sarah Fisher accepted into MSCR Program

Dr. Sarah Fisher, a general surgery categorical resident doing a two-year clinical and translational research sabbatical under the supervision of the division of surgical oncology, has been accepted into the prestigious Master of Science Clinical Research (MSCR) program of the Atlanta Clinical and Translational Science Institute (ACTSI). Her mentors will be Dr. Allan Kirk, Dr. David Kooby, and Dr. Shishir Maithel.

The MSCR program provides didactic and mentored clinical and translational research training for participants who have demonstrated commitment to a career in clinical investigation. Participants are selected on the basis of academic qualifications, departmental recommendations, diversity, and multidisciplinary background. The ACTSI is an Emory, Morehouse, and Ga. Tech collaborative partnership dedicated to facilitating inter-institutional research projects.

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Johanna Hinman
Ms. Hinman

New arrival: Johanna Hinman

Coming to us from the Emory Prevention Research Center in the Rollins School of Public Health (RSPH), where she was responsible for the administration of the core PRC grant, Johanna M. Hinman, MPH, MCHES, has joined the Department of Surgery as its first associate director of education programs. In this new position, Ms. Hinman will collaborate closely with Dr. Keith Delman and Dr. Barbara Pettitt and provide administrative leadership and management to the general surgery residency and surgery medical student programs as well as to various educational courses taught throughout the year by our faculty.

Ms. Hinman graduated magna cum laude from Carleton College with a BA in English and earned an MPH in Behavioral Sciences and Health Education from the RSPH, where she now teaches in the Career Master of Public Health program. She is also a Master Certified Health Education Specialist (MCHES). Prior to RSPH, Johanna worked at the CDC and the Arthritis Foundation.

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Save the date

ACS Clinical Congress

Emory reception at the ACS Clinical Congress, Tuesday, October 2, 2012. More details to come!

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Upcoming events

Surgery Division Chiefs Meeting 5:30-7:00 p.m., May 29, 2012 Whitehead Room, EUH
Topic TBA

Presented by Joseph F. Magliocca, MD
– Assistant Professor of Surgery, Division of Transplantation, Department of Surgery, Emory University School of Medicine
7:00-8:00 a.m., June 7, 2012 EUH Auditorium
Topic TBA

Presented by Carrie Chu, MD
– Administrative Chief Resident, Department of Surgery, Emory University School of Medicine
7:00-8:00 a.m., June 14, 2012 EUH Auditorium
Conference on Ethics of the Drug Shortage
Sponsored by the Emory Center for Ethics. More info available here.
June 14-15, 2012 Emory Center for Ethics
Topic TBA

Presented by Yazan Duwayri, MD
Assistant Professor of Surgery, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine
7:00-8:00 a.m., June 21, 2012 EUH Auditorium
Surgery Division Chiefs Meeting 5:30-7:00 p.m., June 26, 2012 Whitehead Room, EUH
Integrated Residencies

Keith A. Delman, MD
Associate Professor of Surgery and Program Director, General Surgery Residency, Department of Surgery, Emory University School of Medicine
Michael Halkos, MD
Assistant Professor of Surgery and Associate Program Director, Integrated CT Surgery Program, Department of Surgery, Emory University School of Medicine
Albert Losken, MD
William G. Hamm, MD Chair in Plastic Surgery and Program Director, Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University School of Medicine
Ravi Veeraswamy, MD
Assistant Professor of Surgery and Program Director, Vascular Surgery Fellowship, Department of Surgery, Emory University School of Medicine
7:00-8:00 a.m., June 28, 2012 EUH Auditorium
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