Surgical Solutions Winter 2023

Surgical Solutions

Enterprise Collaboration Drives Surgical Quality, Safety Across Jefferson Health

and Radi Zaki, MD, at Einstein; Mohammed I. Kahn, MD, in Northeast Philadelphia; and David P. May, MD, MBA, and Roy L. Sandau, DO, in New Jersey.

“It’s been a privilege to get to know surgical quality and safety leaders across the enterprise,” Dr. Cowan says. “Now we’re working together to leverage what we’ve found to be successful at the different hospitals to provide consistently safe, high-quality care.”

For more information about Quality & Safety initiatives at Jefferson, please visit Jeffersonhealth.org/about-us/quality-safety

Quality & Safety Leaders

Hospital-acquired infections, such as pneumonia, can affect a patient’s length of stay, cost of care and risk of mortality following surgery. In 2016, a Department of Surgery team at Thomas Jefferson University Hospital in Center City launched a program aimed at reducing the incidence of postoperative pneumonia and respiratory failure. By applying a care bundle called ICOUGHSM , a significant decrease in postoperative pneumonia and respiratory failure has been observed through the Agency for Healthcare Research and Quality patient safety indicator reporting system.

More recently, a multidisciplinary team – including nurses and physicians, as well as speech and swallow experts – has expanded the program to include a swallow evaluation. The goal: decrease the number of postoperative aspiration events. With the support of Surgical Clinical Nurse Reviewers Christine Schleider, RN, MSN, and Kathleen Shindle, RN, BSN, the postoperative pneumonia and respiratory failure prevention program is now being shared and implemented in many of our Enterprise hospitals.

“Now that we are part of this large enterprise, we can share workflows, practices, and policies related to surgical safety,” says Scott W. Cowan, MD. “Multiple surgical leaders have worked together to develop pathways and order sets which serve to standardize care for patients undergoing common surgical procedures in our hospitals.”

Dr. Cowan works closely with quality and safety leaders across Jefferson Health, including Kristin M. Noonan, MD, in Abington; Ramsey M. Dallal, MD,

Members of the information technology team have created dashboards for surgical services, which surgeons can use to understand their quality, safety, and other performance metrics and compare themselves to their peers. This information also helps surgeons identify opportunities to learn from their colleagues to improve care – whether by modifying a technique or using different equipment.

Dr. Cowan explains that while some safety and quality programs have started in Center City, many exceptional programs have been launched by surgical colleagues at other hospitals. For example, the surgical teams at Jefferson Health – New Jersey and Jefferson Health – Abington championed the use of surgical debriefs. Surgical leaders from across the enterprise came together to discuss an effective – and practical – way to implement debriefs across the enterprise. At the time of the debrief, everyone in the operating room pauses to run through a checklist in the electronic medical record system. The list reviews important aspects of the surgery, including procedure type, blood loss during surgery, potential complications, and opportunities for continual improvement. In addition to improving safety and quality of care, the surgical debrief is intended to increase the accuracy of documentation in the medical record. As of September 2022, all Jefferson Health hospitals are using this practice.

Dr. Cowan states, “It is a very exciting time to partner and learn from our colleagues. All of our surgeons have successes to share that can be used to improve the care of all patients who undergo an operation in our Jefferson enterprise hospitals. It is a privilege to work with this amazing group of surgeon leaders.”

Enterprise Medical Director of Risk Management Scott W. Cowan, MD, works closely with Surgical Clinical Nurse Reviewers Kathleen Shindle, RN, BSN, and Christine Schleider, RN, MSN on quality and safety initiatives.

Charles J. Yeo, MD, FACS

Samuel D. Gross Professor and Chairman Department of Surgery Senior Vice President and Chair, Enterprise Surgery Jefferson Health

The Phillies, the Union, the Eagles and Jefferson Health

We are in the midst of a very successful spectator sports year in the City of Brotherly Love. The Phillies defied the odds, ended the regular season strong, and treated us to a World Series spectacle –playing baseball in November. (The World Series is now a November event; so much for the old moniker “Mr. October.”) The Union were there right up to the last minutes, in the MLS Cup, the championship game. Finally, the Eagles won the National Football Conference championship and headed to Super Bowl LVII.

The winning analogy is to Jefferson Health and our Department. We too are competitors and champions. We compete for terrific fourth year medical students who join us as interns and train in Surgery. We have been successful in recruiting “top talent” to our Department as faculty. We have been winners when it comes to the Dean’s Awards for Education, Mentoring, and Clinical Excellence. Working with our Office of Institutional Advancement team, we have had another very successful year, garnering philanthropic dollars to support our education and research missions. We have had some nice measure of success with grant proposals to support our young faculty. Many other examples of our successes exist.

Kudos to all in the Department, as we emerge from the negative specter of the COVID-19 pandemic, and embark upon our post-COVID activities. Soon to come - the year 2024, where we will be seeing our outpatients in the new 19 floor Honickman Center at 1101 Chestnut Street and celebrating the 200th anniversary of our Department and our Medical School: the bicentennial celebration of Jefferson Medical College (now Sidney Kimmel Medical College) – founded by a surgeon, Dr. George McClellan. Onward and upward!

Our Categorical Interns

Thomas Jefferson University Hospital

Allison Doermann, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Lindsay Edwards, MD, Chicago Medical School

George Ibrahim, MD, Virginia Commonwealth University School of Medicine

Haley Kittle, MD, University of Illinois at Chicago College of Medicine

Ellius Kwok, MD, Penn State University College of Medicine

Meghan Maceyko, MD, Lewis Katz School of Medicine at Temple University

Khaled Noueihed, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Jacob Woodroof, MD, University of Tennessee Health Science Center

Jefferson Hosts Meetings of Two National Surgical Societies

Jefferson Abington Hospital

Jennifer Dai, MD, Ohio State University College of Medicine

Brian Lifschutz, DO, Des Moines University College of Osteopathic Medicine

Hajar Rashid, MD, St. George’s University – London

Jinghong (Wesley) Yuan, MD, Cooper Medical School at Rowan University

James Zamora, MD, Lewis Katz School of Medicine at Temple University

Jefferson Health – Einstein

Moshumi Godbole, MD, Ross University

Zaid Haddadin, MD, Jordan University

Dimitra Papanikolaou, MD

Aristotle University of Thessaloniki

Johnathan Sadeh, MD, Sackler University

Annual Conference of the Women’s Leadership in Surgery Society: September 10–11, 2022

Achieving pay equity. Building resilience and leadership skills. Deciding whether, when and how to start a family (and then managing the demands of work and home). Such challenges are common to many working women; they can be even more complex for female surgeons. Those challenges were among the topics covered at the Annual Conference of the Women’s Leadership in Surgery Society (WLISS). Launched in 2008 as an annual meeting and formalized as a nonprofit membership society in 2021, the Society aims to “promote women and underrepresented groups in surgical specialties by enhancing awareness and education in business and leadership.” It welcomes faculty, junior faculty, fellows and residents who want to heighten their personal lives and professional careers in surgery.

This year’s meeting attracted about 200 attendees, half of whom attended in person. As Jefferson’s Talar Tatarian, MD, who served as local arrangements chair, explains, WLISS aims to provide educational content not usually covered by traditional surgical meetings.

“For example, we discussed the reality of the biologic clock and options for fertility preservation. We also talked about the business side of medicine – including how to craft an elevator pitch and negotiate contracts more effectively,” says Dr. Tatarian, who will serve as the program chair for the 2023 WLISS meeting in Washington, DC.

“We want to be candid about these issues. Our goal is not only to offer helpful information, but also to make it a little easier for people to have these conversations.”

For more information about WLISS, please visit: wliss.org

Scientific Meeting of the Society of Black Academic Surgeons: September 15–18, 2022

Last year’s thirty-second annual meeting of the Society of Black Academic Surgeons (SBAS) – whose mission is to “improve health, advance science and foster careers of African American and other underrepresented minority surgeons” – attracted a record 347 registrants. Jefferson Health and the Sidney Kimmel Medical College Department of Surgery hosted the meeting, with Nathaniel R. Evans III, MD, serving as the local program chair and leading a committee that included Orlando C. Kirton, MD, and Alliric Wills, MD. SBAS President Carla Pugh, MD, PhD, presided over the meeting.

Event highlights included a Leadership and Career Development Institute session and presentations by Jefferson leadership. Executive Vice President Edmund A. Pribitkin, MD, and Ex-Executive Vice President Sandra E. Brooks, MD, MBA shared highlights of Jefferson’s clinical, academic and community efforts. Attendees also heard lectures by Jefferson surgeons Charles J. Yeo, MD, and Ala S. Stanford, MD, as well as Patricia Turner, MD, MBA, who serves as executive director of the American College of Surgeons. More than 30 peerreviewed abstracts and posters were presented at the scientific sessions.

Attendees enjoyed an evening social event at the Museum of the American Revolution with a keynote by Stephen K. Klasko, MD, MBA, former President and CEO of Thomas Jefferson University and Jefferson Health.

For Dr. Evans, one of the most interesting sessions was one attended by more than 50 local high school students: “Our goal is to reveal the many pathways to success in medicine and surgery. It was rewarding to see that the students were very engaged. They asked some great questions of the senior leaders at the meeting.”

For more information about SBAS, please visit: sbas.net

In September 2022, the Department of Surgery hosted annual meetings for two surgical societies – both of which were the first in-person conferences since 2019.

Thoracic & Esophageal Surgery Team Conducts Diverse Research Studies to Improve Patient Care

Surgeons Nathaniel R. Evans III, MD, Tyler R. Grenda, MD and Olubenga T. Okusanya, MD, provide thoracic and esophageal surgical care to patients at Thomas Jefferson University Hospital in Center City, and throughout Jefferson Health. They also lead and participate in a variety of research initiatives aimed at further optimizing that care. As Dr. Evans, who leads the Division, notes, “Our research

Changing Lives Through Research On the Job

portfolio has become very diverse, running the gamut from simple to very complex questions.”

Past clinical trials have worked to enhance care to patients with esophageal and lung cancer. For example, one aimed to identify which patients with esophageal cancer need feeding tubes after surgery and which have better outcomes without them. Another explored a similar question

New Faculty

John D. Jacob, MD, has joined the Division of Thoracic and Esophageal Surgery. Dr. Jacob is a graduate of the University of Santo Tomas Faculty of Medicine and Surgery in the Philippines. He completed his general surgery residency at Abington Memorial Hospital in 2016 followed by a surgical critical care fellowship at the University of Pennsylvania and a thoracic surgery fellowship at the Montefiore Medical Center/Albert Einstein College of Medicine. Dr. Jacob is based at Jefferson Abington Hospital and also sees patients at Thomas Jefferson University Hospital, Jefferson Methodist Hospital, Jefferson Health – Northeast and Jefferson Health – Einstein.

Heather McMahon, MD, has joined the Division of Plastic Surgery. Dr. McMahon is a 2015 graduate of the Sidney Kimmel Medical College at Thomas Jefferson University. She completed her integrated plastic surgery residency at the University of Virginia School of Medicine followed by a fellowship in microvascular plastic surgery at the University of Texas (MD Anderson). She sees patients at Thomas Jefferson University Hospital in Center City.

Andrew Morgan, MD, has joined the Division of Colorectal Surgery. Dr. Morgan is a 2015 graduate of the Sidney Kimmel Medical College at Thomas Jefferson University. He completed his general surgery residency at Cooper University Hospital followed by a colorectal fellowship at Cleveland Clinic Florida. He sees patients at Thomas Jefferson University Hospital and Jefferson Methodist Hospital.

about which lung cancer patients benefit from surveillance chest X-rays following surgery.

An active study is exploring the optimal sequence of steps in surgical procedures for lung cancer. Dr. Evans explains that surgeons must divide the arteries and veins connected to the affected lung tissue. There is a longstanding debate about the best way to do so.

“Most surgeons do whatever they are most comfortable with or the order that’s easier for that particular patient,” he says. The Jefferson team has developed a study in which they will randomize patients into two groups and then assess whether the order affects the level of circulating tumor DNA (ctDNA) after surgery.

“Theoretically, if there is more ctDNA, there’s a higher risk of a recurrence,” Dr. Evans says. “There is some preliminary data to suggest that one method is better than the other, and we are hoping to be able to affirm or disprove those findings.” The design and operation of this trial has been facilitated by Dr. Okusanya’s participation in Bristol Meyers Squibb Foundation’s Diversity in Clinical Trials Career Development Program. As one of the first cohort in the selective group of up-and-coming

clinical researchers, he has gained invaluable insight into designing and running clinical trials.

Dr. Evans and his team are also collaborating on multiple studies with the Division of Pulmonary, Allergy and Critical Care in the Department of Medicine, and the Computational Medicine Center at Jefferson led by Isidore Rigoutsos, PhD. Two studies focus on better understanding micro RNA found in lung tumors. This work aims to accomplish what Dr. Evans calls the “Holy Grail” – the ability to diagnose lung cancer with a blood test. The thoracic surgery team has also completed numerous retrospective studies to drill down on disparities in care for lung and esophageal cancers. Dr. Evans says the findings consistently show that outcomes are worse for women, minorities and people of a lower socioeconomic class.

“Our studies have shown that it’s not just outcomes that are different,” he says. “The care that people receive is different. For example, some patients are more likely to be offered radiation when surgery might be a better option. The first step to addressing these disparities is being able to document the fact that some patients are being treated differently – often to their detriment.”

Correction

Keshava Rajagopal, MD, PhD, has joined the Division of Cardiac Surgery. Dr. Rajagopal is a graduate of the University of Chicago Pritzker School of Medicine. He completed residencies in general surgery and cardiothoracic surgery at Duke University Medical Center and has joined us after years of private practice in Texas. He sees patients at Thomas Jefferson University Hospital in Center City, and will be the lead surgical director of our new lung transplant program.

Sami Tannouri, MD has joined the Division of General Surgery. Dr. Tannouri is a graduate of Pennsylvania State University College of Medicine. He completed his general surgery residency at Thomas Jefferson University Hospital in 2015 followed by a minimally invasive surgery fellowship at University of Maryland Medical Center. He sees patients at Thomas Jefferson University Hospital and Jefferson Methodist Hospital.

Summer 2022 Issue: Changing Lives Through Research

An article last Summer incorrectly stated that the Jefferson Molecular Profiling of Pancreatic Cancer (JMP PaC) Program was developed by a handful of researchers in the Department of Surgery.

The program was spearheaded by Hien Dang, PhD, Director of the Division of Surgical Research, in collaboration with surgeons Charles J. Yeo, MD, Wilbur Bowne, MD, and Harish Lavu, MD. Senior leadership also includes representatives from non-surgical specialties: Babar Bashir, MD, and Jennifer M. Johnson, MD, PhD (Medical Oncology); Wei Jiang, MD, PhD (Pathology); and Christopher McNair, PhD, Associate Director for Data Science at Sidney Kimmel Cancer Center.

Drs. Olubenga Okusanya, Tyler Grenda, and Nathaniel Evans III, and Sung Whang, DNP, CRNP, (center) see patients at the Jane & Leonard Korman Respiratory Institute located at 834 Walnut Street.

For Renée Cardwell Hughes, April 30, 2021, started as an ordinary Friday. She arrived early to her office at Philadelphia Opportunities Industrialization Center (OIC), the workforce development corporation where she was president and chief executive officer.

The day took a turn just before 9 a.m. – when Hughes experienced crushing pain while walking from the ladies’ room back to her office.

“It felt like Wonder Woman had slammed her shield into my chest,” she recalls.

Security footage shows Hughes, who was alone on the fourth floor, stumbling in the hallway. She made it back to her office, where she collapsed on the floor, unable to move. When she didn’t respond to calls about her 11 a.m. appointment, building personnel came to check on her.

“I lay on the floor for two hours,” she says. “I now know that my heart was pumping blood into my chest the whole time.”

To this day, Hughes does not know the reason behind the ambulance transporting her to Jefferson rather than the closest hospital. What she does know: she’s incredibly grateful they did. When she woke up in the hospital on Saturday, May 1, she saw her husband, Ken, followed by her son and her sister. She also had two brothers in the waiting room, and a third brother on his way from Virginia. “That tells you – family is a big deal for me,” she notes.

Grateful Patient Supports Dr. Plestis and Jefferson Aortic Center Surgical Solutions

Jefferson Department of Surgery

620 Curtis Building 1015 Walnut Street Philadelphia, PA 19107 JeffersonHealth.org/Surgery

Jefferson Surgical Solutions is published by Thomas Jefferson University and Thomas Jefferson University Hospital.

Jennifer Brumbaugh, MA, Editor-in-Chief

Susan Murphy, Writer

Information in Surgical Solutions is not intended to provide advice on personal medical matters or to substitute for consultation with a physician.

Editorial Board

Kelly Austin

Andrea DelMastro

Nathaniel Evans III, MD

Amanda Malinchak

Florence Williams

Charles J. Yeo, MD

At the 20th Annual Jefferson Gala on November 30, Nathaniel R. Evans III, MD , received the 2022 Achievement Award in Medicine. This award honors a physician who has embraced Jefferson’s mission, provided exemplary care to their patients, and has been a recognized leader in their field. Dr. Evans is Director of the Division of Thoracic and Esophageal Surgery and Chief of Cancer Services at Sidney Kimmel Cancer Center.

Taki Galanis, MD , has been promoted to Associate Professor. He sees patients at the Jefferson Vascular Center in Center City.

Amanda Kohli, PA-C , received the Jefferson Enterprise Advanced Practice Providers (APP) Award for Clinical Excellence. She works in the Division of Acute Care Surgery at Thomas Jefferson University Hospital.

Orlando C. Kirton, MD, MBA , Chair of Surgery at Jefferson Health – Abington, has been elected Vice President of the American Association for the Surgery of Trauma (AAST).

Walter K. Kraft, MD , is President Elect of the American Society for Clinical Pharmacology and Therapeutics. He is a member of our Division of Vascular Medicine.

Danielle M. Pineda, MD , has been promoted to Associate Professor. She specializes in vascular surgery and sees patients at Jefferson Health – Abington.

That’s also when she learned what had happened the day before. Despite having no risk factors, Hughes experienced an aortic rupture. Konstadinos A. Plestis, MD, who leads the Jefferson Aortic Center, surgically repaired it by replacing the damaged part of her aorta with a piece of GORE-TEX. Hughes laughs as she remembers asking, “So I’ve got a North Face jacket in my chest?”

A retired Philadelphia Court of Common Pleas judge, Hughes is now recovered and receiving ongoing care from the Jefferson Aortic Center. She is effusive in praising Dr. Plestis and Jacqueline McGee, CRNP, as well as cardiologist Howard H. Weitz, MD. And she lauds the nurses who not only took “incredible care” of her but also shared stories about their families and their passion for patient care. In fact, Hughes says everyone she and Ken encountered at Jefferson – including food service workers, cleaning staff and parking valets – were amazing.

Hughes has expressed her gratitude to Dr. Plestis and his team with a contribution to the Jefferson Aortic Center. To learn more about supporting the Department of Surgery, contact Kelly Austin at 215-955-6383 or kelly.austin@jefferson.edu

The Sidney Kimmel Medical College recognized the following faculty members with 2022 Dean’s Awards:

Excellence in Education: Drs. Loren Berman, Caitlyn Costanzo, Jaime Glorioso, and Tyler Grenda

Faculty Mentoring Award: Dr. Nathaniel Evans III

Outstanding Clinician in Surgery: Dr. Francesco Palazzo

Renée Cardwell Hughes