Consult - Advancing Surgery - Spring 2010 by Mary Jones Smith

Consult Spring 2010 | Advancing Surgery

Contents 3 Vascular and Cardiology 9 Neurology 15 Bariatrics 21 Robotics 27 Lung Volume Reduction 31 News and updates from the Medical Center New clinical research and continuing medical education opportunities

Ohio Stateâ&#x20AC;&#x2122;s

Consult Spring 2010

The Ohio State University Medical Center

Cardiac and Vascular Surgery w Updates on new procedures available for your patients w New MRSA/MSSA screening protocol w Reducing postoperative atrial fibrillation

Ohio State’s Cardiac and Vascular Surgery Specialties | Vascular Surgery

The Ohio State University Medical Center has a rich history of leadership in cardiovascular care, education and research. Our exceptional team of cardiovascular specialists is taking this care to a new level—from vascular surgery and heart transplants to the latest treatments for heart failure.

Our vascular surgeons are experts in many areas, from the relatively routine to the highly complex cases. We provide a single source for care, regardless of your patient’s need— whether it is balloon angioplasty and stenting or surgery.

Ohio State’s Richard M. Ross Heart Hospital has state-ofthe-art facilities for heart and vascular procedures, from cardiovascular imaging to cardiac catheterization, from electrophysiology studies to surgical treatments.

Every cardiovascular procedure is significant, is serious and has risks. And every patient deserves treatment at a center of excellence from surgeons who have performed hundreds of procedures, trained dozens of other physicians and are go-to leaders for major clinical trials.

In addition to our ongoing programs, we are involved in more than 50 trials of new therapies at any given time. This means that practically any treatment available for cardiovascular care is available at Ohio State’s Ross Heart Hospital. Simply put, there is no reason for patients to go anywhere else for cardiovascular care.

“When you refer a patient to a vascular surgeon, you refer to someone whose entire career is dedicated to treating vascular disease, someone who can select the right tool from a complete toolbox to fix the patient’s individual problem,” says Patrick Vaccaro, MD, vascular surgeon at Ohio State.

Points of excellence

Spotlight on minimally invasive treatment of peripheral vascular diseases: “Traditionally, when a patient has had poor blood flow to an organ, major surgery is necessary, including general anesthesia, large incisions and a four- to fiveday hospital stay,” says Michael Go, MD, vascular surgeon.

• The Ohio State University Medical Center has the only adult cardiac transplant center in central Ohio. • The Ohio State University was one of the largest enrollers in a trial studying the efficacy and safety of a continuous flow left ventricular assist device (VAD) in the treatment of patients with advanced heart failure who were ineligible for transplantation. Results from Ohio State, published in the December 2009 issue of The New England Journal of Medicine, revealed two-year survival rates of 58 percent, almost doubling the survival of the best alternative currently available. The study and its findings are an important breakthrough in ventricular assist technology.

“Often, we can use a minimally invasive procedure, and the patient can go home a day or two later.” Our surgeons have expertise in all endovascular disorders, including: • • • • • • •

• Ohio State’s Richard M. Ross Heart Hospital is a national leader in the extracorporeal membrane oxygenation (ECMO) treatment of patients with H1N1 who have severe respiratory failure and of other patients in acute cardiogenic/respiratory shock.

Aortic aneurysm disease Carotid artery disease Deep vein thrombosis Mesenteric and renal arteries Peripheral vascular disease of the leg Varicose veins Venous disease

Spotlight on complex aneurysm repair: Our surgeons have expertise in endovascular and open procedures to treat thoracic and abdominal aneurysm, including complicated cases in which patients have had aortic dissections and developed secondary aneurysms.

• Our Division of Cardiovascular Medicine and the Cardiovascular Clinical and Translational Research Organization led investigations of the efficacy and safety of hemodynamic monitoring devices for improving treatment outcomes of patients with heart failure, managing more than 100 clinical trials for novel technologies, including those for the HeartPOD, Wireless Pressure Sensor and Chronicle ICD.

Spotlight on carotid artery stenting: Carotid artery stenting is a relatively new therapy for treating blockages in the carotid artery. This treatment, which helps to prevent stroke, is done with angioplasty and is appropriate for patients who are at high risk for traditional carotid endarterectomy. 4

Cardiac and Vascular Surgery

Specialties | Cardiac Surgery

We also have the only adult heart transplant program in central Ohio. While the program has grown, transplant is considered only when other options have been exhausted.

Spotlight on valve-sparing aortic root repair: When an aneurysm occurs at the aortic root causing the valve to leak, our surgeons can repair the aorta and maintain the patient’s original valve. Preserving the original valve helps the patient avoid the lifelong need for blood-thinning medication. Surgeons at The Ohio State University Medical Center are the only ones of a few in Ohio who routinely perform this complex procedure.

“Our cardiac surgery program is progressive, meaning we strive to explore suitable treatment options before determining transplant is necessary,” says Benjamin Sun, MD, thoracic surgeon. “Because we work with so many patients who have congestive heart failure, we do more ventricular assist device procedures and, ultimately, transplants. But our preference, for our patients’ health and well-being, is to take steps along the treatment continuum to prevent the need for mechanical devices and transplant.”

Spotlight on atrial fibrillation therapy: Our cardiothoracic surgeon John Sirak, MD, developed the only procedure for atrial fibrillation that replicates and intraoperatively verifies the critical left-sided lesion set of the original Cox-maze procedure through a totally thoracoscopic approach. The very high (95-percent) efficacy of the original open-heart operation is reproduced in an operation performed through pencilsized port incisions in the chest. This operation is unique in its creation of multiple compartments enclosing the arrhythmiacausing areas of the heart, enabling definitive confirmation of all the ablations by demonstrating simple electrical block. Typically, patients return home in just two days.

Spotlight on coronary revascularization: One of our surgeons has developed an effective hybrid approach to coronary revascularization. The procedure, for patients with triple vessel coronary artery disease, combines robotic coronary artery bypass and percutaneous coronary revascularization with stents. This procedure avoids opening the patient’s chest and, thus, results in fewer complications and a faster recovery. Spotlight on robotics: We are a leader in robotic cardiovascular procedures, which offer benefits such as smaller incisions, less trauma to the patient, shorter hospital stays and faster recovery. The most commonly performed cardiovascular procedures for which we use robotic techniques include:

Spotlight on congestive heart failure surgery: We excel at surgery for congestive heart failure. Our surgeons have some of the world’s best outcomes in left ventricular assist devices for long-term mechanical support. Our outcomes are 10- 20-percent better than other institutions’ published data. We implant more than 50 of these devices each year. We’ve had a 179-percent increase in growth of ventricular assist device procedures in the last three years.

• Mitral valve repair • Coronary artery bypass • Total endoscopic coronary artery bypass

How to refer patients... Contact us for a cardiac or vascular surgical consultation. We welcome and appreciate your referrals. We are enthusiastic about applying the surgical expertise and unmatched experience of our cardiac and vascular surgery teams to optimize the health of your patients. Cardiac and Cardiothoracic Surgery at Ohio State’s Ross Heart Hospital | 614-293-5502 Ross Heart Hospital Admissions, Consultations and Diagnostic Procedures | 1-888-293-7677 Vascular Diseases and Surgery | 614-293-8536

Our promise to you We partner with referring physicians to provide specialty surgical care for your patients. We hope you will refer patients to us when you are no longer comfortable treating them and want more specialized care. We promise to communicate with you about your patients, provide feedback about their care and refer them back to you for ongoing care. 5 Cardiac and Vascular Surgery

Cardiac and Vascular surgery

Practice Tool

Decolonization of Patients with MRSA/MSSA Prior to High-Risk Surgery

What patients are receiving prophylaxis and what are they receiving?

The Ohio State University Medical Center’s Department of Clinical Epidemiology has implemented a protocol for patients undergoing cardiothoracic and peripheral vascular surgery. Surgery candidates are being asked to undergo nasal screening to assess for nasal colonization with MRSA and MSSA to potentially avoid a surgical site infection with these pathogens.

• All patients undergoing open heart surgery receive the treatment except those undergoing maze procedure, receiving a ventricular assist device or heart transplant, or those who have a treatment exclusion.

Your patients may ask you about this protocol, which may be administered at the Medical Center or in your office depending on proximity.

• Exclusions include: – Heart rate <60BPM – Concurrent anti-arrhythmics (amiodarone, dronaderone, sotalol, propafenone, dofetilide, verapamil and diltiazem) – Untreated hypo- or hyperthyroidism

“This preoperative step is helping to reduce the risk of infection,” said Linda Wellington, RN, BSN, CIC, manager of the Department of Clinical Epidemiology.

• Patients receive amiodarone 400 mg po q12 for five days before surgery, then 200 mg po qd for nine days after surgery

“In cardiothoracic patients, approximately 17 percent of patients screened are positive for MSSA colonization and only one percent are positive for MRSA colonization,” Wellington explains.

How are patients to take the medicine and when? Amiodarone is prescribed to be taken five days prior to surgery. Patients will take 400 mg of amiodarone every 12 hours. Date

Patients who test positive for colonization for either MSSA or MRSA follow a preoperative schedule that includes nasal mupirocin twice daily starting a few days prior to surgery for a total of five days, along with a presurgical bathing protocol using 4-percent chlorhexidine gluconate soap on the day prior and day of surgery.

Amiodarone

If you are referring patients to Ohio State’s Medical Center for cardiac or vascular surgery, we will arrange for a nasal swab to be conducted as early as possible to allow for time to start the decolonization process on any positive patients.

MORNING

5 days before surgery

Evening 1st dose

Take two tablets for each dose.

4 days before

2nd dose

3rd dose

Doses should be 12 hours apart.

3 days before

4th dose

5th dose

2 days before

6th dose

7th dose

1 day before

8th dose

9th dose

Day of surgery

10th dose

What should patients do if they miss a dose? Instruct the patient to take the missed dose as soon as possible. If it is almost time for the next dose, skip the missed dose and return to the regular schedule. Instruct the patient NOT to take a double dose or extra doses.

New Protocol Aimed at Reducing Postoperative Atrial Fibrillation Postoperative atrial fibrillation (POAF) occurs in 20-40 percent of patients following cardiac surgery, increasing the risk of stroke, hospital length of stay and cost of treatment. Studies have shown the incidence of POAF can be reduced by as much as 50 percent when oral beta-blockers and amiodarone are administered prophylactically prior to open heart surgery.

What are the precautions when taking this medicine? Patients can experience an increased sensitivity to sun and can get sunburned more easily. Patients are advised to avoid sun, sunlamps and tanning beds, to use sunscreen and wear protective clothing and eyewear. What are common side effects of this medicine? Side effects may include nausea, vomiting rash, hives, itching, shortness of breath, wheezing or a cough. Swelling of face, lips, tongue or throat, slow heart rate or any other symptoms should be reported to the surgeon.

The following information can help to address many of the questions your patients might ask you about this protocol when you refer them to Ohio State’s Medical Center for cardiac surgery. 6

Cardiac and Vascular Surgery

Surgical Team John Sirak, MD

Juan Crestanello, MD Board-certified thoracic surgeon Associate professor of surgery

Board-certified thoracic surgeon Assistant professor of clinical surgery

• Clinical interests: Minimally invasive and robotic cardiac surgery, cardiac valve repair, aortic surgery, adult congenital heart disease, aortic aneurysm

• Clinical interests: Minimally invasive atrial fibrillation, valve surgery

William Smead, MD

Michael Firstenberg, MD

Board-certified vascular surgeon Associate professor of surgery

Board-certified thoracic surgeon Assistant professor of surgery

• Clinical interests: General vascular surgery, treatment of varicose veins

• Clinical interests: Surgical treatment for adult-acquired and congenital cardiac conditions, cardiothoracic critical care, mechanical assist devices, heart failure

Jean Starr, MD Board-certified vascular surgeon Assistant professor of clinical surgery

B. Mohan Das, MD Board-certified vascular surgeon Assistant professor of clinical surgery

• Clinical interests: General vascular surgery, endovascular surgery, treatment of refractory hypertension

• Clinical interests: General vascular surgery, dialysis access surgery

Benjamin Sun, MD

Michael Go, MD

Board-certified thoracic surgeon Associate professor of surgery, Director of Cardiac Transplantation and Mechanical Support

Board-certified vascular surgeon Assistant professor of clinical surgery

• Clinical interests: General vascular surgery, endovascular surgery

• Clinical and research interests: Heart transplant, mechanical support, artificial heart

Susan Moffatt-Bruce, MD, PhD

Patrick Vaccaro, MD

Board-certified thoracic surgeon Assistant professor of surgery

Board-certified vascular surgeon Professor of clinical surgery, Director of the Division of Vascular Diseases and Surgery

• Clinical interests: Lung transplantation, heart transplantation, transplant outcomes, thoracic oncology

Chittoor Sai-Sudhakar, MBBS, FACS, FRCS

• Clinical interests: General vascular surgery, endovascular surgery, thoracic and abdominal aneurysms

Board-certified thoracic surgeon Assistant professor of surgery

• Clinical interests: Cardiac mechanical assist devices, heart transplantation, aortic surgery

Blair Vermilion, MD Board-certified vascular surgeon Associate professor of clinical surgery

• Clinical interests: General vascular surgery, treatment of varicose veins

Bhagwan Satiani, MD Board-certified vascular surgeon Professor of clinical surgery

• Research interest: Medical economics

7 Cardiac and Vascular Surgery

Clinical Trials The Ohio State University Medical Center leads or participates in a number of cardiac and vascular clinical trials, providing patients with access to therapies not available elsewhere, including carotid artery stenting, thoracic endovascular aneurysm repair, atrial fibrillation, cardiac imaging and pulmonary hypertension among many others. Call us for more information at: 614-292-1616

Outreach Clinics Our cardiovascular surgeons see patients in Columbus and in communities throughout Ohio in our outreach clinics. We evaluate patients who might be surgical candidates and provide post-operative care closer to home. Locations include: OSU Heart Center at Bellefontaine Phone: 937-599-6105 OSU Heart Center at Cambridge Phone: 740-435-2700 OSU Heart Center at Lancaster Phone: 740-653-5668 OSU Heart Center at Marysville: The Heart Partnership with Memorial Hospital of Union County Phone: 937-642-5490

The Ohio State University Medical Center Cardiac and Vascular Surgery www.medicalcenter.osu.edu/referringphysicians

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Ohio Stateâ&#x20AC;&#x2122;s

Consult Spring 2010

The Ohio State University Medical Center

Neurosurgery w Advances in neuromodulation w Ohio Stateâ&#x20AC;&#x2122;s Comprehensive Spine Center

w Tools to identifiy candidates for these advanced procedures

Ohio State’s Neurosurgery Neurosurgery services at The Ohio State University Medical Center include procedures to treat diseases and conditions of the brain, spinal column, spinal cord and peripheral nerves. In our Department of Neurological Surgery and Ohio State’s Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, we provide comprehensive leading-edge care in all aspects of neurosurgery.

• The National Institute for Neurological Disorders and Stroke awarded two contracts to The Ohio State University’s Center for Brain and Spinal Cord Repair to perform training and replication studies in the field of spinal cord injury. The contracts, totaling approximately $6 million and running from 2008-13, will fund research training for investigators throughout the world in principles and best practices of spinal cord injury research techniques. The contracts also will support efforts to replicate promising preclinical spinal cord injury studies with hopes of clinical translation.

We are involved in research as well as clinical care, allowing us to convert treatment advances into patient care— from bench to bedside—more quickly in this highly specialized field.

• E. Antonio Chiocca, MD, chair of our Department of Neurological Surgery, was elected to the board of directors of the Society for Neuro-Oncology, which has 1,100 members around the world.

Points of excellence Distinction • World-renowned expert in neuromodulation, or deep brain stimulation (DBS), Ali Rezai, MD, is working with his colleagues at The Ohio State University Medical Center to develop future generations of the brain pacemaker. Dr. Rezai has more experience with DBS than any other physician in the state.

• The OSUCC-James is one of only 40 comprehensive cancer centers in the United States designated by the National Cancer Institute. • The OSUCC-James is ranked among the top 20 cancer hospitals in the nation by U.S.News & World Report. • The OSUCC-James is one of only five centers in the country approved by the National Cancer Institute to conduct phase I and phase II clinical trials.

• We are the only central Ohio facility that offers gamma knife radiosurgery. • One of our neurosurgeons was part of a 20-member panel that drafted the first national evidence-based multidisciplinary treatment guidelines for brain metastases patients. The panel was formed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons.

10 neurosurgery

Neurosugery Specialties Neuromodulation Neuromodulation or deep brain stimulation (DBS) uses a pacemaker-like device to treat neurological disorders including severe movement disorders—Parkinson’s disease, tremors and dystonia—and treatment-resistant mood and anxiety disorders. The surgeon implants millimeter-thin electrodes in the brain and a small device that powers the electrodes in the patient’s chest. The electrodes deliver tiny electrical signals that block abnormal brain signals. This procedure can alleviate long-troubling and disabling symptoms and restore patients to better functioning. Ali Rezai, MD, a board-certified neurosurgeon, recognized the promise of this technology in the early 1990s. Dr. Rezai trained with French researchers, who developed DBS in the late 1980s while looking for a way to mitigate the tremors caused by Parkinson’s disease. Now a world-renowned expert in this field with an extensive track record of more than 1,500 DBS procedures, Dr. Rezai was recently appointed director of The Ohio State University Medical Center’s new Center for Neuromodulation.

Our surgical services for cervical, thoracic and lumbar spine conditions treat: • Nerve impingement • Herniated disk • Degenerative arthritis

Dr. Rezai and his colleagues, including neurosurgeon Atom Sarkar, MD, PhD, are investigating new clinical applications for DBS. DBS is currently being used to treat severe movement and behavioral disorders including:

Patients have immediate access to our fellowship-trained, board-certified spine surgeons if surgery is warranted.

• Parkinson’s disease • Other movement disorders, such as essential tremors and dystonia • Obsessive-compulsive disorder (OCD)

Other neurosurgical services Our comprehensive neurosurgery services also include:

The success of our DBS program is due, in part, to the strong relationship among our movement disorder experts, psychiatric specialists, neuroradiologists, pharmacists, neuropsychologists and nurse practitioners. This relationship ensures optimal selection of surgical candidates.

• Functional neurosurgery • Neuro-oncology • Cerebrovascular and skull base • Gamma knife/radiosurgery – This procedure is a method of delivering high-dose radiation with surgical precision to a very specific area of tissue within the cranial region. The gamma knife is effective for treating neurological disorders including tic douloureux (trigeminal neuralgia), particularly for patients who are elderly or too weak for traditional neurological surgery.

Spinal surgery The Ohio State University Comprehensive Spine Center provides one-stop care for surgery, physical medicine and rehabilitation, physical therapy and pain management in a single location. We strive to resolve patients’ conditions as quickly and safely as possible so they can return to their hometown physicians with improved function and quality of life.

11 neurosurgery

neurosurgery

Practice Tool

Patient Selection Neuromodulation – Psychiatric disorders To determine if a patient who has a severe psychiatric disorder is appropriate for deep brain stimulation, the patient should have treatment-resistant mood and anxiety disorders with these criteria:

Neuromodulation – Movement disorders The ideal candidate for deep brain stimulation will have had the movement disorder for at least five years, with the following symptoms: Parkinson’s disease • Significant resting or action tremor not responsive to trials of multiple medications

• Failure to respond to three well-documented trials with selective serotonin reuptake inhibitors (SSRI) for at least three months at maximum tolerated dose

• A 33-percent improvement on the motor section (Part III) of the Unified Parkinson’s Disease Rating Scale (UPDRS) as measured with an on/off medication challenge

• One failed trial of SSRI with clomipramine • One failed trial of SSRI with an atypical antipsychotic • Well-documented evidence of 20 cognitive behavior therapy sessions with exposure and response prevention

• Persistent medication refractory motor fluctuations including but not limited to dyskinesia and end-ofdose wearing off

• No history of psychotic disorder, bipolar mood disorder, severe personality disorder, serious suicidal behavior or current or unstable remitted substance abuse of dependence, or of pregnancy or woman of child-bearing age not using an effective form of contraception

Essential tremor • Significant postural or action tremor not responsive to trials of multiple medications and that significantly interferes with quality of life

For additional help determining if a patient is appropriate, contact The Ohio State University Medical Center’s Center for Neuromodulation (see below).

Dystonia • Generalized or focal dystonia not responsive to trials of multiple medications

Spinal surgery You may wish to refer a patient to us for any of these reasons: • A patient with back pain as a primary symptom does not improve within seven to 10 days of treatment with medication, or develops new symptoms. • A patient with back pain also has extremity weakness or a bowel or bladder symptom. • You are uncomfortable managing a patient who has back pain. If surgery is not indicated, we provide a single location for physical therapy, pain management and other treatments.

How to refer patients... The Ohio State University Medical Center | Neuromodulation Movement disorders:

Cory Finnell, patient care coordinator, 614-366-6639, Cory.Finnel@osumc.edu

Psychiatric disorders:

Megan Swart, psychiatry coordinator, 614-366-4600, Megan.Swart@osumc.edu

Spinal Surgery:

612-293-BACK (2225)

Contact us for a neurosurgical consultation. We welcome and appreciate your referrals. We are enthusiastic about applying the surgical expertise and unmatched experience of our neurosurgical team to optimize the health of your patients. We are committed to communicating with you about patients you refer so you are well informed about the care they receive. 12 neurosurgery

Leadership Radu Saveanu, MD

E. Antonio Chiocca, MD Board-certified neurosurgeon Chair, Department of Neurological Surgery Dardinger Family Endowed Chair in Oncological Neurosurgery

Board-certified psychiatrist Chairman, Department of Psychiatry Associate professor of clinical psychiatry Executive director, OSU Harding Hospital

• Recent recipient of a $5.5 million, five-year grant from the National Institutes of Health to develop a more potent oncolytic virus to treat brain cancer

• Research interests: Depression and anxiety in HIV-infected individuals and depression in co-morbid medical conditions • Distinguished Fellow, American Psychiatric Association

• Board of Directors, Society for Neuro-Oncology • Clinical interests: Brain, spine and nerve tumor therapies; degenerative spinal disorders; peripheral nerve surgery; neurofibromatoses; schwannomas

Stephen Pariser, MD Board-certified psychiatrist and obstetrician/ gynecologist Director, Psychiatry Clinics, Mood Disorders and Geriatric Psychiatry Clinics, Department of Psychiatry Professor, psychiatry and obstetrics and gynecology

• Research interests: Use of biologic therapies and gene delivery methods to treat brain tumors and other central nervous system disorders

• Associate editor, Contemporary Psychiatry • Editorial reviewer, American Journal of Obstetrics and Gynecology, The Journal of Reproductive Medicine, Schizophrenia Research

Ali Rezai, MD Board-certified neurosurgeon Director, Center for Neuromodulation and Functional Neurosurgery Program Professor and vice chair for Clinical Research

• Joined The Ohio State University after almost a decade at the Cleveland Clinic

Quality Scores and Outcomes Overall Safety The Ohio State University Hospital is among the safest and most effective hospitals in the country, according to Leapfrog’s 2009 review.

• Clinical areas of expertise: Neurosurgical management of patients with severe movement disorders such as Parkinson’s disease and dystonia, psychiatric disorders such as depression and obsessive-compulsive disorder, chronic pain and brain injuries • Published 100+ peer-reviewed articles; was senior author of the 2007 paper in Nature describing the use of deep brain stimulation in brain injury • Co-authored 20+ book chapters; serves on editorial board of Neurosurgery and several other journals

Surgical Care The Ohio State University Medical Center exceeds the national average for surgical care. This information represents the percentage of patients who received all of the recommended care based on their medical condition and individual needs. National average median score for the nation’s academic medical centers (University HealthSystem Consortium) – July 2009 to September 2009; OSUMC data includes patients seen from October 2008 through September 2009.

• Has been principal and co-investigator on seven National Institutes of Health grants

Mortality The recently released HealthGrades Hospital Quality and Clinical Excellence study named Ohio State’s Medical Center among the top 5 percent of hospitals in the nation for clinical excellence. Top hospitals have a 29-percent lower mortality, which means more of our patients go home to their families.

Carole Miller, MD Board-certified neurosurgeon Medical director, The Ohio State University Comprehensive Spine Center

• Published 50+ peer-reviewed journal articles, and authored or co-authored five book chapters 13 neurosurgery

The Ohio State University Medical Center Neurosurgery www.medicalcenter.osu.edu/go/neurosurgery

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Consult Spring 2010

The Ohio State University Medical Center

Bariatric Surgery and Comprehensive Weight Management Program w Experienced surgeons performing nearly 400 procedures each year w A variety of surgical options for every patient need w Tips on speaking to your patients about bariatric surgery

Ohio State’s

Bariatric Surgery and Comprehensive Weight Management Program

Morbid obesity is a serious, life-threatening medical state that requires aggressive treatment to relieve the symptoms of obesity-related health conditions and the excess weight.

Points of excellence Firsts • Surgeons at The Ohio State University Medical Center performed the first minimally invasive gastric bypass surgery in central Ohio and the first laparaoscopic gastric banding surgery in the state.

Compared to a person of healthy weight, a 25-year-old clinically severe obese man can expect to reduce his lifespan by approximately 12 years.

• Dean Mikami, MD, bariatric surgeon, helped to develop the special endoscopic device used in the new incisionless StomaphyX procedure, and he was the first surgeon in the United States to perform it. The procedure is appropriate for patients who have gained weight after gastric bypass surgery. Dr. Mikami has helped to train more than 500 surgeons in the United States on this procedure.

Obesity is the second-leading cause of preventable death and a significant risk factor for heart disease and stroke, type 2 diabetes, liver disease, bone and joint disease and certain types of cancer. For reasons not yet fully understood by researchers, chronic health conditions including type 2 diabetes go into remission for many patients after bariatric surgery.

Distinction • Ohio State has had a weight loss surgery program for more than 30 years. Our surgeons perform 300-400 weight-loss surgeries each year. Studies show that the risk of complications is lower when weight-loss surgery is performed by surgeons with expertise in the procedure.

Life-changing, life-saving possibilities • The most striking evidence of the positive effects of bariatric surgery is with type 2 diabetes. Almost 90 percent of morbidly obese patients in a national study* returned to normal blood sugar levels within the first year after bariatric surgery. Approximately 60 percent remained diabetes-free five to 16 years later. Ohio State researchers estimate that bariatric surgeries pay for themselves in two to four years when the costs of medications, treatment and loss of productivity are calculated.

• The Ohio State University Medical Center was designated a Bariatric Surgery Center of Excellence® by the American Society of Metabolic and Bariatric Surgery in 2005 and was redesignated in 2009. • Our bariatric surgery program has complication rates that are superior to the national standards. • Our surgeons have trained hundreds of physicians from central Ohio and around the United States in weight-loss surgery techniques.

• Weight-loss surgery can reduce or eliminate conditions including sleep apnea, high blood pressure and high cholesterol. On average, patients who have bariatric surgery have reduced rates of premature death due to heart disease, stroke, diabetes and cancer. • The Swedish Obesity Study showed that bariatric surgery for severe obesity is associated with decreased overall mortality. In addition, the study showed that two years after intentional weight loss, patients’ cardiovascular risk factors had improved to a greater extent among those who had bariatric surgery compared to those who lost weight from conventional methods. And those who had gastric bypass surgery had significantly greater improvements in cardiovascular risk factors than those who had gastric banding procedures. * Duke University Medical Center Bariatric Outcomes Longitudinal Database study and Virginia Commonwealth University study, 1993-2003. 16

Bariatrics

Surgical services

stomach. This creates pleats and reduces the size of the stomach.

Roux-en-Y gastric bypass In this inpatient procedure, a pouch the size of an egg is made from the stomach and connected to the rest of the gastrointestinal tract, chang< 30 cc pouch ing the pathway of the small 12 – 14 mm stomach intestine. This procedure 75 – 150 cm or longer Roux limb requires two to three days in BP limb Common channel the hospital, with two to six weeks recovering.

Since The Ohio State University Medical Center began performing StomaphyX in 2007, it has completed more than 60 procedures. “Incisionless surgery is at the forefront of surgical procedures and could lead to the development of new ways to adjust the stomach, even before weight gain occurs,” says Dean Mikami, MD.

Roux-en-Y results in greater weight loss than other surgical options on average, and patients who have the procedure are more successful at maintaining weight loss over time, especially when combined with our Comprehensive Weight Management Program.

Patient selection Clinically severe obesity is defined by a body mass index (BMI) of more than 40 (approximately 100 pounds overweight for a man or 80 pounds overweight for a woman) or a BMI of 35 and higher accompanied by any of these medical problems:

Adjustable gastric band In this laparoscopic procedure, an adjustable band is placed around the upper stomach. The band is inflated with saline, making a small stomach pouch that limits food conSmall gastric pouch Adjustable band sumption and creates a feelPort for adjustments ing of fullness. The procedure is performed outpatient or with an overnight stay, with a 10-day recovery period.

• • • •

Diabetes High blood pressure Coronary artery disease Hyperlipidemia

• Apnea and hypoventilation • Osteoarthritis • Reflux esophagitis

Most bariatric surgeries at The Ohio State University Medical Center are performed with minimally invasive techniques, which result in less trauma to skin and muscle, shorter and less painful recovery and less scarring. Weightloss surgery is usually only recommended for people who have severe obesity and who have attempted weight loss with diet, exercise or medication without success. We work closely with surgical patients to assist them in the lifelong journey of eating sensibly and being physically active.

The band is adjustable and tailored to the patient’s specific weight-loss needs. The procedure is reversible. Sleeve gastrectomy In this newer procedure, three-fourths of the left side of the stomach is removed, making the procedure irreversible. The remaining portion is a narrow sleeve or tube that connects to the intestines.

Not all patients need weight-loss surgery. At Ohio State, we also offer a comprehensive nonsurgical weight-management program and recommend the most appropriate treatment for each patient based on weight, lifestyle, eating habits, medical conditions, experience with traditional weight-loss means and goals.

Patients who may be very obese or ill may have a sleeve gastrectomy to begin the weight-loss process and then have gastric bypass surgery a year or two later. The effectiveness is comparable to or greater than gastric band procedures.

The Ohio State University Medical Center bariatric services are in a single convenient location and offer physical and nutrition assessments, consultation with exercise psychologists, insurance pre-certification, postoperative follow-up and support groups. In addition to bariatric surgery, we provide diabetes management, orthopaedics and cosmetic surgery services—all of interest to select weight-loss surgery patients.

StomaphyX (gastric bypass revison) Surgeons at The Ohio State University Medical Center offer the first nonsurgical procedure in the United States for weight gain after gastric bypass surgery. StomaphyX helps the 10 to 15 percent of gastric bypass patients who have regained some weight avoid the high rate of complications associated with traditional revisional surgery. This outpatient procedure has been approved by the Food and Drug Administration to help shrink the stomach to the original gastric bypass size. Through an endoscopic tube that passes through the patient’s mouth into the stomach, the surgeon places 12 to 20 staple-like fasteners into the tissue of the

All candidates for bariatric surgery must attend one of our free bariatric surgery information sessions which are offered monthly at an off-campus location with free, convenient parking. Visit our Website for a class listing at medicalcenter.osu.edu/ 17

bariatrics

bariatric surgery

Practice Tool

go/bariatric.

Physician’s guide to speaking with your patients about bariatric surgery Despite the growing obesity epidemic in the United States, studies indicate that fewer than half of people who are obese receive weight-loss counseling from their primary care providers.

Tip 1: Address the patient’s health concerns independent of weight first. Addressing the comorbidities rather than obesity helps establish the framework for the weight-loss conversation, without putting all the blame on the patient’s weight.

“It can be difficult to initiate a conversation suggesting bariatric surgery with a patient,” says endocrinologist Dara Schuster, MD. “But the life-saving benefits of this intervention cannot be emphasized enough.

Tip 2: Start a neutral dialogue with the patient. Asking for the patient to give you permission to hold the conversation helps foster a more open dialogue and establishes a sense of respect and trust.

Primary care physicians must start the discussion about the possibility of weight-loss surgery for medically compromised patients who have exhausted traditional means of weight loss.”

“Pat, do I have your permission to talk to you about the role your weight is playing in your diabetes and high blood pressure?”

“If a patient had colon cancer, you wouldn’t tell him or her about radiation and chemotherapy only, without explaining surgical options,” says bariatric surgeon Bradley Needleman, MD. “As physicians try to assist obese patients with getting dangerous chronic diseases under control through weight loss, they need to tell about all the options, including surgical, to help patients achieve better health. The efficacy of weight-loss surgery on chronic diseases is remarkable.

“Alex, you’ve mentioned past attempts to become more active and to try diet programs. Is it okay if we talk about other options to improve your health by getting your weight under control?” “Joan, I’m concerned that your weight might be driving some of your health problems. What do you think about your weight?” Tip 3: Give the patient a chance to discuss his or her weight-loss goals

For the majority of bariatric surgery patients, blood sugar levels normalize within months after surgery. The importance of this transformation of the physical condition must be considered.”

This step helps your patient feel a sense of ownership and control over his or her future and strengthens your role as a partner in helping achieve weight-loss goals.

The majority of overweight patients wants help from their providers, but may find it difficult or embarrassing to start the dialogue. At the same time, it can be equally difficult for the physician to broach this delicate subject with a patient.

“Pat, what are your goals for your weight?” “What help can I provide with your weightloss challenges?” Tip 4: Emphasize the ease of taking the next step.

Many primary care physicians want to know:

• What questions can I ask to put my patient at ease when discussing this subject?

When you are ready to introduce the idea of bariatric surgery to the patient, it is helpful to emphasize the easy entry into learning more—attending a bariatric surgery information session.

• How can I have this conversation without introducing feelings of shame, blame or embarrassment in my patient?

“It never hurts to learn about all your options. Do you think you’d like to learn more about bariatric surgery?”

This practice tool can help guide you in starting this crucial conversation and having an open dialogue that addresses patients’ health concerns in a positive, productive manner.

“Ohio State has free information sessions where you can learn about surgical options to see if that’s something you’d be interested in. There’s no commitment, just a chance to learn about all the options available to you.”

• How can I establish an open dialogue?

18 bariatrics

Quality Scores and Outcomes

Leadership

Overall Safety The Ohio State University Hospital is among the safest and most effective hospitals in the country, according to Leapfrog’s 2009 review.

Bradley Needleman, MD,

board-certified general surgeon, is medical director of the Bariatric Surgery Program at The Ohio State University Medical Center

National average median score for the nation’s academic medical centers (University HealthSystem Consortium) – July 2009 to September 2009; OSUMC data includes patients seen from October 2008 through September 2009.

Dean Mikami, MD, board-certified general surgeon, is with the Bariatric Surgery Program at The Ohio State University Medical Center

Dara Schuster, MD board-certified endocrinologist, is associate director of the Clinical Research Center at The Ohio State University Medical Center

Contact

Radu Saveanu, MD, board-certified psychiatrist Chairman, Department of Psychiatry Associate professor of clinical psychiatry Executive director, OSU Harding Hospital

The Ohio State University Medical Center Bariatric Surgery Program 614-293-2888 • e-mail: obesitysurgery@osumc.edu

Free bariatric surgery information sessions Sessions are offered monthly. For a detailed listing of classes and times, please call or visit our website. • 614-293-5123 (information and registration) • medicalcenter.osu.edu/go/bariatric

Kathy Foreman, CNP

We appreciate your referrals and welcome the opportunity to partner with you. We will work to assess your patients for their suitability for bariatric surgery as quickly as possible, and enthusiastically apply our surgical expertise and unmatched experience to optimize the health of your patients. We are committed to consistently communicate with you about patients you refer so you are well informed about the care they receive. We will provide you with follow-up care recommendations for your patients who have bariatric surgery to help ensure their success.

Visit our Web site, medicalcenter.osu.edu/go/bariatric 19 bariatrics

The Ohio State University Medical Center Bariatric Surgery and Comprehensive Weight Management Program www.medicalcenter.osu.edu/go/bariatric

ÂŠ 2010 The Ohio State University Medical Center â&#x20AC;&#x201C; 05

Ohio Stateâ&#x20AC;&#x2122;s

Consult Spring 2010

Ohio Stateâ&#x20AC;&#x2122;s

Center for Advanced Robotic Surgery w Unmatched regional robotic surgery expertise in urologic, gynecologic, head and neck and cardiothoracic procedures w 25+ surgeons skilled in robotic procedures w 70+ robotic procedures, offered among 8 surgical specialties w 1,200+ robotic surgeries/year

Ohio State’s Center for Advanced Robotic Surgery We were the first. Surgeons at Ohio State’s Center

• Head and neck surgeons at The Ohio State University Medical Center were the first in the world to report robotic surgery of the nasopharynx.

for Advanced Robotic Surgery performed the first robotic procedure in North America more than a decade ago. And we’re still on top. Today, we perform more robotic procedures in a day than most hospitals do in a month. Not only does that make us the leader in Ohio and among the top five hospitals in robotic procedures in the world but – more importantly – it means your patients benefit from our experience.

The Most • Our surgeons perform more gynecologic oncology procedures than any hospital in Ohio, making us among the most experienced in this field in the United States. • Our surgeons perform more robotic surgeries for prostate cancer than any other hospital in Ohio.

In the right hands. Improved precision and increased

• The most experienced robotic surgeon in the state of Ohio in any specialty is at Ohio State.

accuracy aren’t automatic. Having robotic tools isn’t enough. Robotics is simply a surgical instrument. What matters is the experience of the surgeon and his or her team. Our unparalleled robotics expertise means your patients have minimally invasive options for even the most complex conditions. Our pioneering leadership means your patients can benefit from advances sooner for both benign and malignant conditions.

• Many of our surgeons have performed more robotic procedures than any surgeon in their field in Ohio. Distinction • Our program features the most experienced robotic surgery team in Ohio and is one of the most comprehensive programs in the United States. • We have one of the most experienced teams of robotic surgery technicians and surgical nurses for cardiac procedures in North America, including the technician involved in the first ever robotic cardiac procedure in 1999.

Points of excellence Firsts • Our surgeons were the first in North America to perform surgery with the da Vinci® robot – a cardiac procedure in 1999.

• The Ohio State University Medical Center is one of only a few institutions in the United States to offer robotic head and neck surgery, and we are pioneering research in this area via clinical trials.

• Our surgeons performed the first robotic closed-chest heart bypass surgery.

• Dr. Ronney Abaza developed an annual national course for urology residents in robotic surgery that is the only one of its kind in the country. He leads a fellowship program dedicated to robotic urologic surgery training.

• One of our surgeons was the first in central Ohio to perform robotic surgery procedure to remove a cancerous kidney through a single small incision. Ronney Abaza, MD, a urologic surgeon, was also the first in the world to report robotic surgery for cancer of the adrenal gland as well as for other conditions including kidney cancers invading the vena cava. • We were one of the earliest adopters in the country of robotics in gynecologic oncology and reported the largest experience with robotic surgery for endometrial cancer. • Our cardiac surgeons are pioneering an approach for hybrid robotic surgery-coronary catheterization cases in a specialized surgical suite. • Many robotic surgical procedures performed today were developed at The Ohio State University Medical Center, including mitral valve repair, heart bypass surgery and esophageal and pancreatic procedures. 22

Robotics

Ohio State’s Center for Advanced Robotic Surgery Specialties Urology This is the future. Robotic surgery is the next generation of minimally invasive procedures. From prostatectomy for prostate cancer to cystectomy for bladder cancer, from nephrectomy to pyeloplasty, robotic surgery is rapidly replacing most traditional, large-incision urologic operations. Our expert robotic urologic surgeons, led by Dr. Ronney Abaza, the most experienced robotic surgeon in Ohio, have developed clinical pathways that allow for typical hospital discharges three days after bladder removal, the day after nephrectomy and partial nephrectomy for kidney tumors and prostatectomy and the day of surgery for some kidney, adrenal and reconstructive procedures.

Cardiac

Spotlight on robotic prostatectomy: Robotic prostatectomy incorporates the latest advancements in robotic-assisted technology and allows a surgeon superior precision and control. For appropriate patients with localized prostate cancer, this procedure offers potential advantages over traditional prostatectomy, including: • • • • • • • • • •

We take it to heart. We are a leader in robotic cardiac procedures, which offer benefits including smaller incisions, less trauma to the patient, shorter hospital stays and faster recovery. The most commonly performed cardiac procedures for which we use robotic techniques are described here. Spotlight on mitral valve repair: More patients can benefit from valve repair instead of replacement with the advent of robotic surgery. In the right hands, the improved visibility and precision achieved with the robotic technique allows repair in many patients who previously would have had no option but valve replacement, which is done through a large and painful, chest-splitting incision.

Shorter hospital stays Less postoperative pain Fewer postoperative complications Less blood loss Less scarring Lower risk of infection Faster recovery Quicker return to normal activities Improved erectile function Improved bladder control

“Most patients do not need to have the large, disfiguring incisions of yesteryear that some physicians still perform,” says Paul Vesco, MD, a board-certified cardiothoracic surgeon. “With robotics, we make only tiny incisions. Some patients are back to work and off pain medication in a week or two. For patients whose conditions are well-suited to robotics, this is just the best way to go. Patients deserve to have as little physical trauma as possible with the better outcomes possible with robotics.”

At OSUCCC-James, we continue to examine these beneficial outcomes as part of our research initiatives. Few patients, even those with the most complex anatomy and highest risk prostate cancers, are not candidates for robotic prostatectomy at the OSUCCC-James. Less than one percent of prostatectomies are performed in traditional, open surgical fashion at Ohio State.

Spotlight on coronary artery bypass: Simply put, four tiny holes totaling 2.5 centimeters long are all that are required for patients well-suited for a closed-chest, off-pump, minimally invasive robotic bypass procedure. Most patients go home in two or three days. Some patients return to work five days after surgery.

There are other treatment options for prostate cancer in addition to robotic prostatectomy. At OSUCCC-James, a comprehensive team of renowned experts in medical oncology, surgical oncology and radiation oncology for prostate cancer works directly with patients to determine the best treatment option for each patient.

“When you don’t have to cut open the patient’s chest, a speedy, problem-free recovery is possible,” says Dr. Vesco. 23

Robotics

Spotlight on total endoscopic coronary artery bypass: A closedchest, off-pump, minimally invasive robotic procedure – a significant advancement over single- and double-bypass robotic surgeries. The procedure is only as successful as the skills and expertise of the surgeon and surgical team.

Good news for the hundreds of thousands of U.S. women who require noncancerous hysterectomies each year: robotic procedures offer a patient-friendly option to traditional open abdominal surgery. And good news for patients who are deemed unsuitable for robotic procedures elsewhere: many of them are able to have successful robotic surgery at Ohio State’s Center for Advanced Robotic Surgery. That includes patients who:

“Some patients’ physicians tell them they are not candidates for a cardiac robotic procedure when they may very well be an appropriate patient,” says Dr. Vesco. “If you need mitral or tricuspid valve repair or coronary bypass, it’s worth your time and healthy to explore robotic options.”

• Are obese • Have scar tissue from previous surgeries • Have complex cases

Gynecologic Experience matters. Surgeons at Ohio State’s Center for Advanced Robotic Surgery have been using robotic techniques for several years, making it a high-volume center and one of the first in the country to apply robotics to gynecologic cancers. Our surgeons train other surgeons and lecture around the country about gynecologic robotic techniques.

Head and neck Heads-up. Our surgeons are pioneering robotic-assisted head and neck surgery on cancerous tumors and benign lesions including the tonsils, base of the tongue, voice box and skull base and thyroid and parathyroid. These procedures, performed through the mouth, involve small incisions and are a significant advancement in overcoming the limitations of more traditional head and neck surgery. Advanced three-dimensional imaging capabilities and robotic instruments improve surgeon dexterity and precision – particularly vital concerns for patients having surgery on the head and neck.

Robotic surgery has revolutionized gynecologic and gynecologic oncology surgeries. Traditionally, most of these procedures were performed through large abdominal incisions. Today, many more major operative procedures can be performed through small abdominal incisions with robotic techniques. As many as 50 percent of gynecologic surgeries performed at Ohio State now use robotic techniques.

Robotic head and neck surgeries, now in clinical trials, usually lead to shorter hospital stays and quicker recovery, and less blood loss, pain, scarring and infection. Another important consideration—without the need for external incisions, risk of disfigurement is lessened and, therefore, the patient’s quality of life is enhanced.

How does this benefit patients? Compared to conventional surgery, gynecologic surgery patients who have robotic procedures benefit from less blood loss, pain and scarring, and less risk of infection. Fewer complications mean fewer readmissions and fewer healthcare expenses. Good news for the 40,000 U.S. women diagnosed with a gynecologic cancer each year including endometrial, uterine and early-stage cervical and ovarian cancer. Robotic surgery offers a viable, much less-invasive option than open surgery.

General surgery Ahead of the rest. General surgeons at The Ohio State University Medical Center were among the first in their field nearly 10 years ago to perform robotic surgery and reported several procedures that were the first of their kind. Today, our surgeons offer robotic-assisted procedures for treatment of gastrointestinal and other disorders including: • • • • • • •

Colon resection Pancreatectomy Adrenalectomy Splenectomy Esophagectomy Nissen fundoplication Gastric bypass

24 Robotics

Leadership Co-directors of Ohio State’s Center for Advanced Robotic Surgery

Diseases and Conditions Our experienced, skilled surgeons perform robotic procedures to treat: • • • • • • • • • • • • • • • • • • • • • • • • •

Adrenal gland disorders and cancer Atrial septal defect Bladder cancer Cardiac tumors Cervical cancer Coronary artery disease Endometrial cancer Endometriosis Esophageal disease Fistula repair Gynecologic abnormalities including uterine fibroids, ovarian cysts and pelvic pain Head and neck cancer Kidney cancer Lung cancer Mitral valve disease Myasthenia gravis Ovarian cancer Pelvic mass Pelvic prolapse Prostate cancer Thymoma Urinary incontintence Urinary tract disorders and cancer Uterine fibroids Uterovaginal prolapse

Ronney Abaza, MD, FACS Director of Robotic Urologic Surgery Assistant Professor of Urology, The Ohio State University College of Medicine • Has performed more robotic procedures than any surgeon in Ohio • First to report robotic surgery for adrenal carcinoma, kidney cancer involving the vena cava, among other procedures • Awarded the Distinguished Robotic Surgeon Award: Pioneer of da Vinci® Urologic Surgery by Intuitive Surgical, Inc.

Jeffrey Fowler, MD, FACS Director of the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at The Ohio State University Medical Center • Professor at The Ohio State University College of Medicine • Has published seven papers on robotic surgery • Awarded with Best Doctors in America 1998-1999, 2001-2010 • Editorial Board, Gynecologic Oncology, Journal of Robotic Surgery

How to refer patients... Ohio State’s Center for Advanced Robotic Surgery Patient referral and scheduling: 1-800-293-5123 Contact us for a surgical consultation to discuss robotic surgery for a urologic, gynecologic, cardiothoracic, head and neck or general surgical condition. We welcome and appreciate your patient referrals. We are enthusiastic about applying the surgical expertise and unmatched experience of our progressive, comprehensive robotics program to the health of your patients. We also are committed to communicating with you about patients you refer so you are well informed about the care they receive. Visit our Web site, medicalcenter.osu.edu/go/robotics 25 Robotics

More than you think. We’re using robotics across all surgical disciplines – for treatment from heart to head, from prostate to prolapse, from glandular to gynecologic. Our expertise means that we are able to offer robotic surgery for many conditions that others cannot, which means patients can benefit from a minimally invasive approach whenever possible.

More than others do. Many patients we accept in our Center for Advanced Robotic Surgery have been denied robotic surgery at other hospitals. Our experienced surgeons are able to successfully treat patients with conditions determined elsewhere to be too complicated or high-risk and patients with complex anatomy, obesity or prior surgery or radiation.

We like a challenge. Whether your patient’s need is a standard minimally invasive procedure or an unusually complicated case, there is no better choice than Ohio State’s Center for Advanced Robotic Surgery. If it can be done with robotics, there is no better place to have it done.

Ohio State’s Center for Advanced Robotic Surgery conducts clinical trials in the prevention, diagnosis and treatment of disease and injury. Trials can lead to sophisticated new treatments for patients around the world. To learn about robotic surgery clinical trials, visit medicalcenter.osu.edu/go/robotics and click on the ‘Research and Clinical Trials’ link.

Ohio State’s Center for Advanced Robotic Surgery www.medicalcenter.osu.edu/go/robotics

Ohio Stateâ&#x20AC;&#x2122;s

Consult Spring 2010

Advances in

Lung Volume Reduction Surgery w Surgical relief for people severly affected by emphysema

The Ohio State University Medical Center

Lung Volume Reduction Surgery LVRS provides symptom relief for people who are severely affected by emphysema, characterized by shortness of breath with the activities of daily living. The difference between what many LVRS patients can do before and after surgery cannot be overstated. Simply stated, more patients who have severe emphysema should be considered for this procedure. Lung volume reduction surgery is a very effective treatment for certain patients who have severe pulmonary emphysema. Patients can achieve significant improvement in quality of life, including: • • • •

Being able to discontinue use of supplemental oxygen Travel Participate in sports or exercise Return to work

Points of Excellence about our LVRS Program

Improvements such as these typically are not achievable through other treatments, short of transplant.

Firsts w Our lung volume reduction surgery program was the first in the United States to be recognized with a two-year certification by the Joint Commission. This certification represents our commitment to the highest national standards for safety and quality of care.

The Ohio State University Medical Center has unparalleled experience in LVRS. We participated in a large multiyear national clinical trial that provided scientific evidence about who is most likely to benefit from the procedure. The minimally invasive surgery, which removes 25 percent to 30 percent of the most damaged sections of the lungs, alleviates the symptoms of severe emphysema in appropriate patients. Patients typically experience improvement in quality of life characterized by: • • • • • •

Distinction w Patrick Ross, M.D., a thoracic surgeon, and Philip Diaz, M.D., a pulmonary disease specialist at The Ohio State University Medical Center, were two of the lead investigators in the landmark National Emphysema Treatment Trial (NETT) multicenter trial (1996–2002) involving 1,218 patients with severe emphysema.

Decreased shortness of breath Improved lung function Increased energy level Increased physical mobility Improved ability to function at normal daily activities Possible elimination of the need for supplemental oxygen

As part of NETT, The Ohio State University Medical Center was one of only 18 U.S. locations selected to provide lung volume reduction surgery to Medicare beneficiaries.

Certain patients also experience increased longevity.

w Our thoracic surgeons have performed more than 110 LVRS procedures.

Lynn Gordin

Recent Results | (2008 – present) • No operative mortality • 60 percent of those who used supplemental oxygen before surgery discontinued it

describes his life before lung volume reduction surgery (LVRS): “I basically just existed. I couldn’t walk from one room to another without sitting down and gasping for every breath.” After surgery to relieve symptoms from severe emphysema, he describes his life: “I exercise five days a week. I don’t get out of breath like I used to. I can play with my grandchildren. I’ve been given a second chance at life.”

Outcomes at one year: • 100 percent had improved quality of life • 92 percent have improved forced expiratory volume in one second (FEV1) • 77 percent had improved 6-minute walk distance

Hear Lynn’s full story at medicalcenter.osu.edu/go/lungvolume

28 Lung volume reduction surgery

Lung volume reduction Surgery

Practice Tool

Patient Suitability

Patient Selection

The procedure should be performed only on patients likely to benefit and have the lowest risk of complications. Appropriate patients are non-smokers and have:

If you believe you have patients who may be candidates for LVRS, you can contact Mahasti Rittinger, 614-6884587, to refer a patient or inquire about our program. Our team of pulmonary and surgical specialists reviews all information gathered to determine a patient’s suitability for LVRS. Suitable candidates do not smoke and have:

w Moderate to severe emphysema w Hyperinflated lungs w Disabling dyspnea

w FEV1≤45% of predicted

More specific patient suitability is determined, in large part, from the results of the NETT trial. Patients in the trial, which compared the results of LVRS to medical therapy, were followed for five years or until they died. The NETT study results indicated that on average, patients who have LVRS are more likely to have improved exercise tolerance, less dyspnea and improved survival compared to those who have had medical therapy only. The NETT discovered two main characteristics of patients most likely to benefit from LVRS compared to medical therapy alone: 1. Upper-lobe predominant emphysema on high-resolution CT scanning 2. Poor exercise tolerance after pulmonary rehabilitation The NETT also discovered that patients with very poor pulmonary function FEV1≤20% of predicted and diffusing capacity of the lung for carbon monoxide (DLCO) ≤20% had an increased risk of death with surgery and should not have the procedure. Other exclusion criteria include a previous lung resection, significant pleural or interstitial disease, and clinically significant bronchiectasis.

w Total lung capacity (TLC) 100% of predicted w Severe upper-lobe predominant emphysema on CT scanning and lung perfusion scanning The patient must be willing to participate in a comprehensive program of pulmonary exercise and education prior to (six to 10 weeks) and after surgery (10 sessions). The patient must be smoke-free for at least four months prior to our evaluation and throughout the duration of treatment and post-surgical rehabilitation. Any other medical conditions the patient may have must be reasonably well controlled to make LVRS feasible. Patients who have LVRS are at risk for post-surgical complications, including prolonged air leakage and pneumonia. Our team’s experience in caring for these patients helps to ensure complications are minimized. We offer other treatment options for patients who are not good candidates for LVRS.

Leadership w Patrick Ross, MD, PhD, board-certified thoracic surgeon w Susan Moffatt-Bruce, MD, PhD, board-certified thoracic surgeon w Philip Diaz, MD, board-certified pulmonary disease specialist

Patient Referrals Contact Mahasti Rittinger, 614.688.4587, to refer a patient or inquire about our program. We welcome and appreciate your patient referrals. We are enthusiastic about applying the surgical expertise and unmatched experience of our pulmonary and surgical specialists to optimize the health of your patients. We also are committed to communicating with you about patients you refer so you are well informed about the care they receive when you entrust their care to us. 29 Lung volume reduction surgery

The Ohio University Medical Center Lung Volume Reduction www.medicalcenter.osu.edu/go/lungvolume

ÂŠ 2010 The Ohio State University Medical Center â&#x20AC;&#x201C; 05

Ohio State’s

Consult | Spring 2010 |

Dr. Michael Ruff leads New Hand and Upper Extremity Center Led by Michael Ruff, MD, chief of the Division of Orthopaedic Hand Surgery, the OSU Hand and Upper Extremity Center is home to the area’s only team of physicians, surgeons, plastic surgeons and therapists focused on total hand care that includes the advanced specialties of reconstructive surgery and microsurgery. Michael Ruff, MD

Our fellowship-trained hand surgeons performed more than 1,200 surgeries and procedures last year alone. They can treat conditions ranging from arthritic fingers to severed hands, as well as: • • • • • • • •

carpal tunnel syndrome fractures distal radio-ulnar conditions tendon lacerations joint replacement severed nerves crush injuries dislocations

Our unique center is designed so patients can receive evaluation, diagnosis, treatment and rehabilitation in the same, convenient location. This allows for greater patient satisfaction and, because we are a multidisciplinary team, it allows for better patient outcomes as well.

For referrals, please contact: OSU Hand and Upper Extremity Center (614) 366-HAND [4263] 915 Olentangy River Road 31

New Facilities at OSU Medical Center: CarePoint Outpatient Facility Openings CarePoint at Gahanna, a 56,000-square-foot outpatient facility, recently opened with Family Practice, Cardiovascular, Obstetrics and Gynecology, Sports Medicine, Orthopaedics, Physical Therapy, Neurology, Imaging and Lab services. CarePoint at Lewis Center in Delaware County will be home to Family Practice, Sports Medicine, Cardiovascular, Orthopaedics, Physical Therapy and Imaging services when it opens in late 2010. Refer patients to CarePoint at Gahanna by calling 614-366-0375. JamesCare Women’s Oncology Center Targeted for completion in early 2011, the new JamesCare Women’s Oncology Center, located on Olentangy River Road, will provide more than double the space of the existing JamesCare facility in Dublin. The new center will enable patients to access a full spectrum of women’s health services including digital mammography, chemotherapy, radiation oncology, reconstructive surgery, Hope’s Boutique and survivorship in one convenient location. $1 Billion Expansion Project Under Way The ProjectONE expansion of the Medical Center is under way, which will significantly advance our education and research programs and improve patient care. ProjectONE will result in 276 beds in the new Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, and 144 beds in the new critical care building, each with 11 floors, allowing the Medical Center to serve 310,000 additional patients annually.

Save Time, Expense with new Digital Imaging Service

Outpatient Rehabilitation Opens New Assistive Technology Center

Benefits at a Glance:

• Save time and reduce costs by eliminating shipping costs

• New resource for patients with neurological impairment

• Reduce staff time involved in preparing images

• Helps patients achieve functionality at home and work

• Quick image delivery for your patients Our new Assistive Technology Center provides individualized assessments and services for people with cognitive, sensory or physical disabilities.

A new, free program for referring physicians allows you to submit patient-study images in minutes, rather than days, to OSU Medical Center.

The goal is to help clients achieve maximum functionality at home, work and play through the use of appropriate assistive technologies. These technologies include:

Using BuckIImage Gateway, images are transmitted via a secure, HIPAA-compliant high-speed network, eliminating the time and expense involved in burning and shipping CDs, and the need to store optical media in physicians’ offices.

• Augmentative and alternative communications • Computer access

BuckIImage Gateway provides delivery confirmation to eliminate wondering about lost or delayed items. There is no cost to send or receive patient images with this system.

• Electronic aids to daily living for controlling appliances • Wheelchair seating and positioning • Worksite accommodations/ergonomics

Get Started: Contact The Ohio State University Medical Center Imaging Informatics at 614-293-8448 (press option 1) or email PACS@osumc.edu.

Types of referrals accepted include clients with neurological impairments such as ALS, MS and Muscular Dystrophy; spinal cord injury, cerebral palsy, brain injury, and stroke. Learn more: Call 614-293-3847 OSU Martha Morehouse Medical Plaza 2050 Kenny Road, Suite 2100 • Columbus, OH 43221 Fax: 614-293-6400

Dr. Doug Pope’s Unexpected Journey to Becoming a Preceptor I used to view teaching as an activity to be avoided so that I could better function as a clinician in my Med/Peds practice. My conversion into a proponent of teaching happened unexpectedly, and is solely due to Dr. Peg Cuthbert.

suitable tribute for her. To teach medical students and residents was the obvious choice. Some days, I am too busy to stop and list all the things I’m thinking about or to look up a chapter in Harrison’s. I am never too busy, however, to look at a student and say, “Did you hear that? That’s the laryngeal edema of viral croup. You’ll never forget that sound and, when you hear it with stridor, your hair should stand up.”

Dr. Cuthbert was my classmate in medical school and a resident with me in IM/Peds. She was a teacher the students cherished. After school, Dr. Cuthbert decided to start a primary care IM/ Peds practice with me in Lancaster, Ohio. Endless questions filled our conversations – which equipment to buy, what business hours to keep, should we take credit cards, should we take medical students and residents? To this last question, her resounding “YES!” reflected her passion on the point.

Through catastrophe, I had been shown the overwhelming benefits of teaching. I also developed a modified opinion of my own role as a teacher: the role of perpetuator. Interested in Becoming a Preceptor? Call Diana Bahner at 614-292-2998 or e-mail Bahner.2@osu.edu

In 1998, only seven months after opening our practice, Peggy died in an automobile accident on an icy road. I wanted to find a 32

Regional Outreach

Advanced Epilepsy Monitoring Unit Now Open Benefits at a Glance: • Largest and most advanced unit in central Ohio • Specially trained staff experienced in epilepsy • Direct admit scheduling for referring physicians Recognizing the unmet need to serve adult patients with epilepsy, Ohio State has constructed a new Epilepsy Monitoring Unity (EMU), featuring:

Team... Here

to Serve You

Our Regional Outreach team is here to assist physicians in accessing the resources, education and patient referral information you need most from OSU Medical Center. Call on your Regional Outreach Coordinator at any time for information such as: • Help with referring patients

• Expanded capacity (eight beds total)

• Requests for visits/calls with OSU physicians

• All private rooms • State-of-the-art equipment

• Requests for patient materials

• Day room for patients to have social activities

• Access to CME and clinical research opportunities

A new direct-admit scheduling system allows you to call one number to schedule or complete and fax a referral sheet. Direct referrals are available if a patient has failed at least two epilepsy medications, has had seizure activities for more than six months and has at least one event every two weeks.

Franklin County: Noreen Palmer 614-366-6680 East/Southeastern Ohio: Karen Mitchell 614-293-4352

Learn more: Call 614-293-4661 for direct scheduling OSU Medical Center, University Hospital 10 East Rhodes Hall

North/West Ohio: Bill Cox 614-293-2824

Tools You Can Use:

Do you have a copy?

Physician Consult Line There are times when you want to discuss additional options for your patients or need specialized information in a hurry. You can get the information you need from an Ohio State colleague quickly and easily by calling 1-800-293-5123. One toll-free call connects you to more than 1,000 specialists in 50 medical specialties. A trained coordinator will answer and route your call to an appropriate physician or expert. Call to: • Discuss specific patient cases • Make a patient appointment • Transfer a patient to an OSU Medical Center hospital

Contact your Regional Outreach Coordinator to request a copy. 33

Save the Date:

Ohio State Physicians Earn National Posts

2010 Personalized Health Care Conference

October 14 and 15, 2010 The third annual Personalized Health Care National Conference at The Ohio State University Medical Center, “Advancing Predictive, Preventive, Personalized and Participatory Medicine,” will be held October 14 and 15, 2010. Physicians from all fields of medicine are encouraged to attend. Find details at www.cphc.osu.edu.

Copeland

Caligiuri

Ellison

Lucey

w Michael Caligiuri, MD, director of Ohio State’s Comprehensive Cancer Center and CEO of The James Cancer Hospital and Solove Research Institute, has been elected president of the Association of American Cancer Institutes. w Larry Copeland, MD, professor of Obstetrics and Gynecology, has been elected president, American Board of Obstetrics and Gynecology. w E. Christopher Ellison, MD, associate vice president for Health Sciences Clinical Affairs; vice dean for Clinical Affairs; chair, Department of Surgery; associate dean, Surgical Services; chair, OSU Physicians Board of Directors, has been elected Vice Chair of the American Board of Surgery. w Catherine Lucey, MD, vice dean for Education, College of Medicine; associate vice president for Health Sciences Education, OSU Office of Health Sciences; vice chair of Education, Department of Internal Medicine, has been elected chair, Executive Committee of American Board of Internal Medicine.

Referring Physician Resources DocLink healthsystem.osu.edu Web-based program allowing referring physicians access to their patients’ OSU Medical Center visit-specific treatment results

Physician-to-Physician Consultation Line 800-293-5123, option 1 Consult with an OSU Medical Center physician, discuss specific patient-related cases, appointment referral, transfer a patient

Referring Physicians medicalcenter.osu.edu/referringphysicians Referring physician information, links, downloads and forms, patient education materials, maps and directions

Physician Relations 800-293-4326 or mdrelations@osumc.edu Physician Relations supports the needs of community physicians and their staff as they interact with OSU Medical Center

The Ohio State University Comprehensive Cancer Center– Arthur G. James Cancer Hospital and Richard J. Solove Research Institute The James Line: 614-293-5066 cancer.osu.edu Patient referral center, clinical trials and research information, patient education materials

OSU Regional Outreach Program Franklin County, Noreen Palmer....................614-366-6680 East/Southeast Ohio, Karen Mitchell..........614-293-4352 North/West Ohio, Bill Cox..............................614-293-2824 Outreach provides access to OSU Medical Center services, specialty physicians, continuing medical education and other Medical Center programs Physician Directories To request a copy of our physician directory or to request updated sections for your existing directory, please call your Regional Outreach Coordinator (above).

Continuing Medical Education ccme.osu.edu Continuing Medical Education programs, including Category I CME offerings online through OSU MedNet21, traditional lecture series and Grand Rounds

Physician Referral Guide To request a copy of the Physician Referral Guide, call your Regional Outreach Coordinator or visit medicalcenter.osu. edu/referringphysicians to access an online version. 34

Physician Resources

Contact

DocLink healthsystem.osu.edu

Web-based program allowing referring physicians access to their patientsâ&#x20AC;&#x2122; OSU Medical Center visit-specific treatment results

OSU Medical Center medicalcenter.osu.edu

Referring physician information, patient education materials, maps and directions

The Arthur G. James Cancer Hospital and www.cancer.osu.edu Richard J. Solove Research Institute

Patient referral center, clinical trials and information, patient education materials

OSU Medical Center http://ccme.osu.edu Center for Continuing Medical Education

Web site featuring Continuing Medical Education programs including: Category I CME offerings online through OSU MedNet21, traditional lecture series and Grand Rounds

Physician-to-Physician 1-800-293-5123; option 1 Consultation Line

Consult with an OSU Medical Center physician, discuss specific patient-related cases, appointment referral, transfer a patient

1-800-293-4326 Physician Relations

Physician Relations supports the needs of community or mdrelations@osumc.edu physicians and their staff as they interact with OSU Medical Center

OSU Regional Outreach Program Franklin County: 614-366-6680 East/Southeast Ohio: 614-293-4352 North/West Ohio: 614-293-2824

Outreach provides referring physicians with access to OSU Medical Center services, specialty physicians, continuing medical education and other medical center programs