SURGERY NEWS April 2021
NOTES FROM THE CHAIR While the unique circumstances of this pandemic have impacted all of us, I’m proud to say that through it all we continue to achieve great things as a department. Along with providing an exceptional level of quality care to our patients, we continue to expand our work in many areas. From quality improvement and clinical effectiveness, to diversity, equity, and inclusion we are looking for ways to create an exceptional workplace. In addition to our ongoing research, many COVID-19 research projects have been added as we join the fight against this virus. The following pages represent just a handful of the personal and professional accomplishments of our faculty, staff, and trainees. As always, it continues to be my privilege to share these highlights with you. I hope you enjoy the newsletter and please take care of yourself and your loved ones.
FIRST DEI LECTURESHIP
ISSUE HIGHLIGHTS 5
Richard D. Schulick, MD, MBA Professor & Chair, CU Department of Surgery Director, CU Cancer Center The Aragón/Gonzalez-Gíustí Chair
ON A MISSION 2
Johns Hopkins director of surgery, Robert Higgins, MD, MSHA, outlined problems and solutions around diversity and equity in medical schools.
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PANDEMIC IMPACT
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NAVIGATING THE PANDEMIC 14
TRANSPLANT Q&A
Surgery News
FIRST DEI LECTURESHIP HOSTS ROBERT HIGGINS, MD, MSHA The Johns Hopkins director of surgery outlined problems and solutions around diversity and equity in medical schools. Greg Glasgow “Diversity and inclusion in medicine can save lives.” That was the message from Robert Higgins, MD, MSHA, director of the Department of Surgery and surgeon-in-chief at the Johns Hopkins School of Medicine.
admit African Americans. And how, after his father died in a car accident and he and his mother went to live with his grandparents, the first house they bought in a segregated neighborhood was burned to the ground overnight.
Higgins spoke during Grand Rounds on February 22, 2021 for the first lectureship from the Diversity, Equity and Inclusion Committee in the Department of Surgery at the University of Colorado School of Medicine.
“These insults and injuries against persons of color have been going on for decades,” he said. “And yet my brothers and I were given the opportunity to grow up in an environment where we got great academic training, and we were taught to be resilient and hardworking. We all went on to academically distinguished environments and had professional careers that showed we can persevere.”
Higgins started by detailing his family and personal history with racism and division — how his parents met in the 1950s at Meharry Medical College in Nashville, which was then one of the only medical schools in the country to 2
Disparities and lack of diversity Higgins, who also serves as senior associate dean for diversity and inclusion at Johns Hopkins, spoke about the challenges medical schools face when it comes to diversity and inclusion, and some of the steps Johns Hopkins is taking to address those issues. “There’s a lack of diversity in terms of our student, resident, and faculty administrative leadership roles, and there is a culture of discrimination and exclusion based on academic elitism,” he said, pointing to statistics that show only between 1.5% and 3% of medical school faculty are Black or Hispanic. “That has a significant impact on www.cusurgery.com
April 2021 many of us who are underrepresented minorities in medicine.” He brought up the health care disparities that exist for patients of color in transplantation, emergency room care, heart failure, cancer care, and more, and suggested that increasing the diversity of the health care workforce is the most direct way to tackle the issue. A multifaceted approach that includes research targets, public policy funding, improved access to care, and improved cultural competency is important as well, he added. Importance of allyship Later in his talk, Higgins brought up the concepts of implicit bias and microaggressions and how they hinder efforts to increase diversity in the medical workforce.
“We created a group called Women in Surgery at Hopkins, and through that we identified that mentorship really supports and promotes the personal and professional needs of our trainees and our workforce,” he said. “Peer support is critically important to help us grow and develop these programs going forward.” Johns Hopkins also is putting a focus on academic leadership, he said, and creating an atmosphere where all students, residents, and faculty members feel seen, heard and valued. “We are trying to create an environment where diversity, equity, and inclusion are a part of our strategic focus,” he said. “We are committed to embracing and celebrating our differences, educating and developing our staff and learners, and engaging in equitable health care delivery and workforce practices. Through recruitment and retention, and through professional and leadership development, we hope to make the environment more inclusive and satisfying for all those who participate.”
“They extract a psychological and physical toll, with the societal price of harming an already-fragile pipeline of underrepresented populations in medicine,” he said. “We have to do everything in our power to demonstrate respect in our work environments and ultimately help our persons of color who are training nearby and working nearby to feel “There’s welcomed and appreciated.” It’s important for those in the majority to practice allyship, Higgins said, and to speak out on behalf of oppressed and marginalized groups. “Justice will only be served when those who aren’t affected are as outraged as those who are affected” by racial injustice, he said. Recruitment and retention Higgins urged all medical schools to focus on inclusive excellence as a core mission, focusing on recruitment programs to attract members of underrepresented populations and mentorship programs to retain those individuals once they are part of the program.
a lack of diversity in terms of our student, resident, and faculty administrative leadership roles, and there is a culture of discrimination and exclusion based on academic elitism.” - Higgins
focus on diversity, equity, and inclusion efforts. “It struck me that he highlighted things we were already doing. That was a good feeling,” Shimamoto said. “He talked about the importance of understanding the challenges and recognizing the difference between equality and equity and what diversity actually is. I think we’re on the same page. Any time we can compare ourselves to Johns Hopkins, that’s always a good thing.” Shimamoto added that Higgins’ focus on mentorship and sponsorship only reinforced the DEI committee’s desire to step up its retention efforts. “We need mentorship — someone who maybe looks like us or might have had similar experiences to ours to be able to be there to guide us — but we also need sponsorship,” Shimamoto said. “That can be anybody who says, ‘Hey, this is an upcoming rising star, and when there’s an opportunity, I want to put their name forward and sponsor them and bring them to people’s awareness. “I liked that he said we’re on the right track and doing the same things they are; that felt really great to me,” Shimamoto continued. “He raised the bar to say that not only do we need to recruit these candidates who are underrepresented in medicine, but we need to then support them when they’re here by creating these opportunities for peer support.”
Reinforcing and inspiring efforts on campus Brian Shimamoto, organizational and employee development manager in the CU Department of Surgery and a member of the department’s Diversity, Equity and Inclusion Committee, said he appreciated the focus Higgins put on leadership in his talk, and how he made it clear that in order to develop future leaders, current leaders need to
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Surgery News
AWARDS & RECOGNITION
Leah Lleras The Society of Hospital Medicine has awarded Leah Lleras, director of finance for the Department of Surgery, an Award of Excellence in Leadership for Practice Manager. Way to go, Leah!
Trina Smidt
Elizabeth Pomfret, MD, PhD In celebration of International Women’s Day, the International Live Transplantation Society recognized Dr. Pomfret as a physician who has contributed and continues to contribute to advance the field of liver transplantation. Congratulations Dr. Pomfret!
The CU School of Medicine Graduate Medical Education Program has named Trina Smidt the recipient of the 2021 Outstanding Program Coordinator Award. Fantastic work, Trina!
CELEBRATING OUR ADVANCED PRACTICE PROVIDERS On February 24, 2021, the Department of Surgery took a moment to show its appreciation for all of the great work our Advanced Practice Providers (APPs) are doing on a daily basis.
Click here to view the APP Appreciation Event Video
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For those that may not know, APPs are medical providers who can diagnose, treat, and manage the care of patients, order and prescribe medications, and perform or assist in surgical procedures, all in
collaboration with physicians and surgeons. Take a moment to watch this event and see how integral these professionals are to the patient care we provide and to those who work alongside them. Thank you to all of our APP’s!
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April 2021 and affirming Black community, but much of her time was spent in a predominantly white elite private school, Sidwell Friends, which was attended by children of Presidents Obama and Clinton. She found her Black community at Stanford, but the majority of her fellow undergraduates were white. The same goes for her medical career, where she often has felt she had to hide parts of herself in order to fit in.
Kia Washington, MD, vice chair of diversity, equity, and inclusion for the Department of Surgery
ON A MISSION
Creating meaningful progress on diversity and inclusion. Greg Glasgow Kia Washington, MD, looks back on her undergraduate experience as four years that helped to shape who she is. One of those years in particular stands out as not just formative, but transformative. As a young Black woman who grew up attending mostly white schools, it was important to Washington to experience more diversity when she went to college. One reason she chose to go to Stanford University in California was the school’s exchange program with Spellman College, a historically Black women’s college in Atlanta. Washington spent one year there.
“It was important to me to have that experience of being in an academic community where I wasn’t the minority,” says Washington, director of research and professor of plastic and reconstructive surgery at the University of Colorado School of Medicine. “It was very affirming to have classes where the teachers were all Black women and all the other students in the class were Black women.”
“In certain institutions, it has been hard to have a sense of belonging where I could totally express my authentic self, because I’ve often been the only one,” she says. “Has it been difficult? Yes. Has it been something that’s crushed me or defeated me? No, because of what my parents instilled in me and the awesome educational background I received.” As vice chair of diversity and inclusion in the Department of Surgery at the CU School of Medicine, Washington is now on a mission to radically improve the experience for young doctors from underrepresented backgrounds in medicine, looking to substantially increase their numbers in the department.
Click here to read more about Washington’s mission.
Raised by parents who had moved to Washington, D.C., from the Jim Crow South to attend Howard University, Washington led a double life of sorts as a child — D.C. had a vibrant
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Surgery News
THE PANDEMIC’S IMPACT ON VASCULAR SURGERY Max Wohlauer, MD, is leading research on the effects of postponed and canceled surgeries. Greg Glasgow In a normal year, vascular surgeons would never postpone surgeries for patients with aortic or carotid disease or other conditions. But 2020 was anything but normal. When the COVID-19 pandemic forced some elective and semi-elective surgeries to be postponed in the spring, Max Wohlauer, MD, saw an opportunity to conduct research on the effects of delayed operations.
Max Wohlauer, MD Assistant Professor Vascular Surgery
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“I know of patients waiting for an operation whose aneurysms have ruptured, and about patients who have lost limbs that were likely salvageable had they not been delayed — I know this is happening because I’ve heard about it,” says Wohlauer, assistant professor of vascular surgery at the
University of Colorado School of Medicine and a vascular surgeon at UCHealth. “What we don’t know is what the frequency is, and we don’t know what the risk factors are.” Through a set of new studies, Wohlauer and other doctors hope to gather data to better counsel patients. Social origins leading to connections across the world The research has its origins in a WhatsApp chat Wohlauer started with vascular surgery colleagues across the globe shortly after the pandemic started. The doctors traded notes on conditions in their respective countries, their role in caring for COVID patients, the availability of PPE and more. As the conversations continued, Wohlauer www.cusurgery.com
April 2021 realized the seeds were being sown for a research project that could capture valuable lessons necessitated by the pandemic. “We’ve got anecdotes, we’ve got great discussions,” he recalls thinking at the time, “but if we could collect data and really analyze this, we could disseminate it to a much larger audience and help a lot of people and a lot of patients.” So Wohlauer and Robert Cuff, MD, of Michigan State University, in March 2020 launched the Vascular Surgery COVID-19 Collaborative (VASCC). By surveying vascular surgeons around the globe, they are gathering data on the impact of COVID-19 on scheduled vascular operations and thrombotic complications of COVID-19. “We’re also looking at if patients themselves are avoiding the health care system,” Wohlauer says. “We may not have canceled their surgery, but sometimes a patient calls and they say, ‘I just don’t want to be around the hospital right now. I don’t know that it’s safe.’ They’re postponing their own surgeries, and there’s an impact from that.” By understanding what the barriers are for those patients, Wohlauer says, the surgeons can help overcome them. “With all this information, we anticipate being able to reach out to patients and say, ‘You’re at an increased risk for these reasons, and this is why, even though we’re in the middle of this surge, you really need to come in and have this operation.’ Or we can say, ‘I think you’ll be OK if we postpone this another month.’ We’ll have data to guide us. We’ll have information that will help the patients and help the hospitals.” The collaborative also is looking to capture outcomes for patients who had a surgery delayed and then deteriorated and had to have the operation performed as an emergency procedure.
Disseminating the results So far the group has been involved with four published papers: the impact of the pandemic on vascular surgery trainees; the impact of the pandemic on vascular surgery in the U.S.; the global impact of the pandemic on vascular surgeons; and the experience of Brazilian vascular surgeons during the pandemic. Sherene Shalhub, MD, MPH, associate professor of vascular surgery at the University of Washington, is the lead author on the publications. The latter paper’s first author, Rafael Malgor, MD, is an associate professor of vascular surgery at the CU School of Medicine. Wohlauer and the collaborative are now working on a paper looking at the longer-term impacts of postponing and canceling surgeries. They hope it can be used to help doctors and patients not only as the COVID-19 pandemic continues, but any time a health crisis or natural disaster forces interruptions in normal medical operations and hospital loads. “It takes the conversation from, ‘I’ve got this specific patient with this condition’ or ‘I’m postponing one patient with one condition here,’ and someone else is doing something similar for a similar patient in a different place,” Wohlauer says. “We’re trying to understand what happens and what we should do. We’ve got experiences, we’ve got intuition to help guide each other, but at a certain level of complexity, we’re doing the best we can. The data will give us the precision to talk about this in a lot more technical, evidencebased fashion.”
The Vascular Surgery COVID-19 Collaborative (VASCC) was founded by Max Wohlauer, MD, at the University of Colorado, and Robert Cuff, MD, at Michigan State University, in March of 2020.
The primary aim of the VASCC is to evaluate the effect of the systematic, widespread, and immediate postponement of vascular surgery on patient outcomes around the world. We are evaluating the vascular manifestations of patients infected with COVID-19 in addition to several other projects. Our research could impact lives of countless patients caught up in the current pandemic, and knowing the effect on the health system will improve subsequent responses. Your participation could have a lasting impact locally and on the international community for generations.
Click here to view a list of projects you can join.
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Surgery News
THE IMPORTANCE OF NAMED LECTURSHIPS Each year the Department of Surgery sets aside six of our Grand Rounds presentations to honor our named lectureships. There are a number of reasons a named lectureship is established. Whether recognizing the accomplishments of a great leader, honoring a beloved faculty and mentor, or remembering the tragic loss of a colleague taken too soon, each is a valued part of our history.
Guest speakers are chosen for their reputation within a similar field of work, for characteristics that embody that of the individual the lecture is named for, or for their unique perspectives that spur innovation. Below are links to our most recent named lectureship presentations. We hope you enjoy these unique opportunities to both visit our past and look into the future.
The importance of these lectures is not only in the person in whose name the lecture is delivered but also in the content of the lecture itself.
39th Annual Henry Swan Visiting Professorship in Surgery
12th Annual H. James Fox Lectureship in Surgery
15th Annual Marvin Pomerantz Lectureship in Cardiothoracic Surgery
In Pursuit of the Optimal Treatment for Rectal Cancer
Controversies in Surgical Thyroidology in 2021: Separating Truth from Fiction
Advancing Multidisciplinary Cancer Patient Care: Early Results from the Baptist MD Anderson Cancer Center
Julio Garcia-Aguilar, MD, PhD Benno C. Schmidt Chair in Surgical Oncology Chief, Colorectal Service, Department of Surgery Director, Colorectal Cancer Research Center Memorial Sloan Kettering Cancer Center Professor of Surgery, Weill Cornell Medical College
Julie Ann Sosa, MD, MA, FACS, FSSO, MAMSE Chair, Department of Surgery
Chief, Thoracic Surgery
Leon Goldman, M.D. Distinguished Professor of Surgery
Baptist Medical Center Jacksonville
Professor, Department of Medicine Leader, Endocrine Neoplasia Destination Center Program University of California San Francisco
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Bill Putnam, M.D., F.A.C.S.
Medical Director, Baptist MD Anderson Cancer Center Professor of Surgery, Thoracic and Cardiovascular Surgery University of Texas MD Anderson Cancer Center
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April 2021
WELCOME NEW HIRES FACULTY Rayni Baskowitz, PA-C Instructor GI, Trauma, and Endocrine Surgery
Heather Pupavac, NP-C, MSN Instructor GI, Trauma, and Endocrine Surgery
Kristen Garnett Business Manager CCTCARE Transplant Surgery
Kelly Calero, PA-C Instructor Surgical Oncology
Meredith Stasi, PA-C Instructor Cardiothoracic Surgery
Jennifer Hall Quality Improvement/Data Analyst Pediatric Surgery
Steffanie Durkin, PA-C, MS Instructor Vascular Surgery
Kristen Struble, PA Instructor Transplant Surgery
Lynda Jefferson Business Support Specialist II Cardiothoracic Surgery
Mitchell Erickson, PA-C Instructor Cardiothoracic Surgery
Jessica Suprise, PA-C Instructor GI, Trauma, and Endocrine Surgery
Danielle Koffenberger Quality Improvement Manager Finance and Administration
Hani Grewal, MD Associate Professor Transplant Surgery
Susan Tallieu, ANP Instructor Transplant Surgery
Julie LeBlanc Laboratory Coordinator I Finance and Administration
Mona Hamermesh, PA-C Instructor Cardiothoracic Surgery
Kerri Thurman, MD Assistant Professor Urology
Tanner Lehmann Professional Research Assistant Pediatric Surgery
Marisa Harris, PA-C, MMSc Instructor Cardiothoracic Surgery
Peggy Walsh, PA-C Instructor Cardiothoracic Surgery
Ian Lenk Professional Research Assistant Surgical Oncology
Madison Hexter, PA-C Instructor GI, Trauma, and Endocrine Surgery
Abbey Webb, PA-C, MHS Instructor Urology
Leah Lleras Director of Finance Finance and Administration
Ashley Jacob, MPAS, MS Instructor Plastic and Reconstructive Surgery Barbie Jones, FNP, MSN Instructor Cardothoracic Surgery Jay MacGregor, MD Assistant Professor GI, Trauma, and Endocrine Surgery Jordan Macri, PA-C Instructor GI, Trauma, and Endocrine Surgery Danica Martin, PA-C Instructor Cardiothoracic Surgery
STAFF Taylor Clarkson Professional Research Assistant Urology
Niyati Nakra Professional Research Assistant Plastic and Reconstructive Surgery Jill Quinn Division Administrative Director Vascular Surgery
Kylea Depottyondy Patient Affairs Coordinator Cardiothoracic Surgery Samantha Eckman Special Projects Manager Finance and Administration Salvador Rodriguez Franco Research Associate Surgical Oncology
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Surgery News
Featured Experts
NAVIGATING THROUGH THE PANDEMIC The Department of Surgery reflects on the challenges and successes of the past year.
Robert McIntyre Jr., MD Professor & Division Chief GI, Trauma & Endocrine Surgery
Elizabeth Pomfret, MD, PhD Professor & Division Chief Transplant Surgery
Richard D. Schulick, MD, MBA Professor & Chair Department of Surgery
Franklin Wright, MD Assistant Professor GI, Trauma & Endocrine Surgery
Greg Glasgow As they look back on one of the most challenging years in their medical careers, members of the Department of Surgery at the University of Colorado School of Medicine remember the low points — the crowded emergency rooms, the delayed surgeries, the deaths from the disease — but they remember some high points as well. New workflows and efficiencies that will last long after the pandemic has faded. Newly formed relationships with other departments. Not to mention new collaborations and a stronger sense of teamwork. “I loved the way our department responded,” says Richard Schulick, MD, MBA, chair of the Department of Surgery. “People just took care of it. They worried about the welfare of our patients and, as surgeons typically do, they just rolled up their sleeves and dug in. The Department of Surgery actively staffed a COVID unit, which is not the
usual around the country. We said, ‘Forget we’re surgeons; we’re going to roll up our sleeves and contribute to the care of COVID patients.’ We weren’t doing surgical work; we were doing COVID work.” Surgeons shifting focus to provide care When the COVID-19 pandemic was officially declared in March 2020, CU surgeons — like other medical professionals around the world — weren’t sure what they were dealing with. The stresses and questions mounted quickly. Were there enough beds? Enough staff? Enough ventilators? Enough personal protective equipment? What to do about surgeries that have already been scheduled? Patient safety was the primary concern, but there were concerns about the surgery team’s health as well.
Click here to read more about how our faculty adapted during the pandemic.
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NEW VASCULAR SURGERY CLINIC Greg Glasgow A new vascular surgery clinic opened in February on the Anschutz Medical Campus in Aurora, offering easy access for patients with venous disease, peripheral artery disease, and mesenteric and renal artery disease. The clinic also offers hemodialysis procedures for arteriovenous fistula and graft maintenance. “This clinic is for procedures we don’t have the perfect venue for currently,” says Donald Jacobs, MD, chief of the Division of Vascular Surgery and professor of surgery at the University of Colorado School of Medicine. “There are some straightforward, minimally invasive procedures we’re currently doing in the hybrid operating room, which is a very high-tech facility.” Moving some of those simpler procedures to a standalone clinic, Jacobs says, will provide lower cost of care and better patient experience in a smaller but fully equipped facility. “We have the latest in imaging guidance equipment for doing catheter and wire, and endovascular procedures for treating peripheral arterial disease and venous disease, mostly in the extremities, but also blockages of the kidney arteries or bowel arteries,” he says. “The advantage for patients is that they can park less than 150 feet from the door or get dropped off at the curb. They can get set up for the procedure, do the intake and IV, get the procedure, and be done and go home in half the time the process would take in the hospital.”
OFFICE OF QUALITY & CLINICAL EFFECTIVENESS
treatments. Jacobs says advances in vascular treatment using special catheters and wires that are able to cross long blockages in the legs provide high success and durability of treatments not seen before. Newer plaque removal procedures such as modified peripheral laser atherectomy, which uses a laser to unblock arteries, can allow minimally invasive treatment of total artery blockages without open surgery. If there is a need for surgical treatment of complex disease that is not able to be done in the new office procedure suite, the surgeons are able to provide seamless care of such procedures in the hospital. “The nice thing about the clinic is that it’s a small team, you have a personal relationship with the people who are treating you, and the facility is much more user friendly,” Jacobs says. “Studies show that standalone clinics have much higher patient satisfaction.”
The Office of Quality & Clinical Effectiveness is committed to continuous improvement in quality and safety and is creating surgical pathways to define and deliver perfect care for our patients’ surgical journey. Our education and training promotes quality care and safety for our patients. Currently, the team is working with colleagues across the department on projects to decrease pulmonary embolisms and deep vein thrombosis; detect and treat sepsis more quickly; and even streamlining the intake processes so new patients can meet with their surgeons more quickly, to name a few. To learn more about their initiatives, educational resources, or to request project support or data analysis, please visit their website.
Visit the Office of Quality & Clinical Effectiveness Website.
The vascular surgeons are all trained in the latest clinical trials and 11
Surgery News
RESIDENT RECOUNTS SON’S NICU BATTLE Greg Glasgow As a resident in the Department of Surgery at the University of Colorado School of Medicine, Heather Carmichael, MD, was accustomed to the emotional remove doctors have from their patients. The distance that allows surgeons to cut into someone without hesitation or to deliver bad news without falling apart. But when her son was born with a congenital diaphragmatic hernia (CDH) — a hole in the diaphragm that
allows abdominal organs to move into the chest during fetal development, hindering lung and heart development — Carmichael found herself torn between the surgeon’s remove and the concern of a mother worried about her child’s survival. She wrote a personal essay about the experience that was published in January in the New England Journal of Medicine. I did not know if I wanted you to become a child, my child, whom I
Heather Carmichael, MD could love and therefore lose. It was easier to see you as a patient, to imagine that you were that other baby, the one I cared for in the same room just a few years earlier, when I was an intern diligently holding a retractor for the same operation you had at just two days old.
Click here to read more about Heather’s journey.
PROGRESS AFTER SURGERY Greg Glasgow For the past nine years, the Surgical Outcomes and Applied Research (SOAR) group at the University of Colorado School of Medicine has been conducting research on health services within the Department of Surgery. A large part of that research has to do with clinical outcomes for surgery patients and how patients fare — in the short term and the long term — after an operation. Members of SOAR recently published a paper looking at how patient-reported outcomes (PROs) can help surgeons
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keep tabs on how patients are recovering after a surgical procedure. “Patient-reported outcomes give patients a voice in their care,” says Robert Meguid, MD, MPH, FACS, who published the study along with CU School of Medicine faculty members William Henderson, MPH, PhD, Anne Lambert-Kerzner, PhD, MSPH, Michael Bronsert, PhD, MS, and Karl Hammermeister, MD. “I see it as furthering the partnership between patients and providers in
those patients’ care. We are getting improved buy-in from the patients in the care delivered Robert Meguid, MD, MPH to them, and Associate Professor getting improved Cardiothoracic Surgery engagement from the providers, that the care they’re delivering is what the patients truly want.” Click here to read more about patient-reported outcomes.
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April 2021
PERSONALIZED TREATMENTS FOR PEDIATRIC KIDNEY CANCER PATIENTS Noelle Musgrave Although rare, kidney cancer is the third most common type of solid tumor affecting children. Thankfully, pediatric kidney tumors are generally treatable and most have high cure rates. Treatment outcomes depend on several factors including age, tumor type, staging, genetics, the overall health of the patient, and the risk of treatment side effects. Nicholas Cost, MD, associate professor in the Department of Surgery, Urology Division, CU Cancer Center member, and physicianresearcher at Children’s Hospital Colorado, explains how treatment should be personalized based on these factors. “Not all patients need the same
treatment,” explains Cost. He stresses the positive outcomes associated with receiving care from a specialized multidisciplinary team, which can open the door for more treatment options, clinical trials, and a well-rounded care plan. Cost brings an exceptional breadth of knowledge to pediatric urologic oncology, as one of the nation’s only urologists who is fellowship trained in both pediatric urology and urologic oncology. Renal tumors in children Most childhood kidney cancers are discovered before they metastasize (spread) to surrounding organs.
Nicholas, Cost, MD Associate Professor Division of Urology However, due to the location of the kidney, there is an increased likelihood of the diagnosis occurring after the tumor has become large enough to cause pain and swelling. “Even if the cancer spreads, we can still usually achieve high cure rates. It will just take more therapy which can often mean more toxicity and side effects,” Cost says. Click here to read more about fertility preservation.
IMPROVING QUALITY OF LIFE FOR BREAST CANCER PATIENTS Greg Glasgow Though breast cancer patients are now living longer than ever before, treatments for the disease can have wide-ranging effects on their long-term quality of life. Physical, social, and sexual wellbeing all can be impacted by radiation, chemotherapy, surgery, anti-endocrine therapy and other challenges that go along with a breast cancer battle. University of Colorado Cancer Center member Sarah Tevis, MD, is investigating those quality-of-life issues through patient-reported outcomes, surveying women about their breast
cancer treatment, and looking for ways to use that data to improve care for future patients. “One of the things I’ve always been interested about in oncology and surgical oncology is quality of life,” says Tevis, assistant professor in the division of surgical oncology. “The thing that initially got me interested in oncology was that when I was in high school, my dad had lung cancer. He had a thoracotomy and he had radiation and chemotherapy, and he had tons of side effects from his treatment and long-term side effects
Sarah Tevis, MD after he Assistant Professor completed Surgical Oncology treatment. During my general surgery residency, I really enjoyed my time in clinic,seeing patients throughout all the phases of their care. That was something that resonated with me — the different oncology patients and the different quality-of-life issues they faced.” Click here to read more about Tevis’ patient-first approach.
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Surgery News
WHAT’S NEW IN ORGAN TRANSPLANT AND HOW DOES THE PROCESS WORK Megan Adams, MD, and James Burton, MD, sat down with us for a Q&A for National Donate Life Month. Valerie Gleaton April is National Donate Life Month — an awareness month that encourages Americans to register as organ, eye, and tissue donors and that honors those who have saved lives through the gift of donation.
transplantation, mainly serves adult patients. Here’s what they had to say.
To highlight this month, we interviewed two liver transplant specialists at the University of Colorado School of Medicine to learn the basics of donation and the latest news in transplants. Megan Adams, MD, associate fellowship director of surgery, primarily works with pediatric patients, while James Burton, MD, professor of medicine and medical director of liver
Could you explain how the patient transplant list works?
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Burton: A patient is carefully evaluated for transplant to look for contraindications or conditions that would make the procedure risky. Each program in the United States does its own evaluation. If the patient is a candidate, they get added to the
national transplant list. For adult liver transplant patients, their place on the list is based on their blood type, MELD score (Model For End-Stage Liver Disease), and proximity to the donor hospital. The MELD scoring system goes from 6–8 being normal and 40 being the highest. It predicts one’s three-month mortality risk without a liver transplant. For example, a patient with a MELD score of 40 has about a 90% risk of death in three months, while a patient with a score of 26 has about a 20% risk. When an organ becomes available, it’s offered to the person on the list with the highest
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April 2021 MELD score first. Waiting time doesn’t really affect liver transplantation unless two people happen to have the same MELD score simultaneously. For kidney transplantation, on the other hand, it’s entirely based on waiting time. Adams: The pediatric list is similar, but there are some differences. The MELD score is only for candidates 12 and older, whereas kids under 12 have a PELD score (Pediatric End-Stage Liver Disease). From there, the ways organs are allocated depends on your blood type, your proximity to the donor hospital, and your MELD score or PELD score. What are the different types of donors and donations? Burton: Most liver donations are performed after brain death, and the organs are procured while the heart is still beating. Donation after circulatory death occurs after the heart has stopped beating and the patient has already passed away. In those cases, the organs have to be procured quickly. Then there’s living donation. Directed donation is when someone has decided to donate to someone they know, like a family member or friend. When someone’s dealing with a family member, it’s a little bit like running into a burning building. You’ll do anything you can to help that person, but there are definitely risks. That’s why the living donor transplant team evaluates every donor carefully. We have an obligation to ensure that they’re making an appropriate decision for themselves and that they understand the risks. And that’s the same for someone who comes forward who has no contact with a patient and is doing it for altruistic reasons. In the past three years, we’ve had several people come forward who want to be donors but who don’t know anyone on the transplant list. These are what we call non-directed donors — altruistic people who really want to help someone. But again, we need to make sure that it’s very safe for them. Adams: We are very fortunate at Children’s Hospital Colorado to have
the largest altruistic live donor liver transplant program in the country. And Children’s benefits from that immensely, in that most of our kids don’t have to wait on the list very long. Because if they don’t have access to their own living donor, there’s often an altruistic or non-directed donor across the street from the UCHealth University of Colorado Hospital (UCH). Why do you think CU has so many non-directed living donors? Adams: I think people in Colorado are just uniquely nice and also generally very healthy. One thing that our program does that’s a little bit different is we allow altruistic donors who have already donated a kidney to donate a small portion of their liver as well, so they actually become double donors. We usually use those grafts in children so that we’re able to take less liver from the donor, making it a safer operation. Burton: Even when it comes to driver’s license organ donors, Colorado has one of the highest donor rates. Why is that? I don’t know — I think it just has a lot to do with who we are. We have one of the largest transplant communities for Hispanics. But there’s also been a lot of research recently about barriers to transplant for underserved communities. Is that something you’ve seen in your practice? Burton: I think that’s particularly true in kidney transplantation, and it probably has a lot to do with the Hispanic population having a higher rate of obesity, high blood pressure, and diabetes. This puts those patients at higher risk for developing end-stage renal disease and needing a kidney transplant. For liver transplantation, we’re starting to see more need for liver transplants in patients with nonalcoholic fatty liver disease, and some of the same risk factors that go into end-stage renal disease, like obesity and diabetes, can also be risk factors for non-alcoholic fatty liver disease. So, the need for donors can definitely be greater there. In terms of the donor
list, access to organs isn’t impacted by race, but these patients may not have as many options for living donor transplants if their family members also have the same medical problems, which is sometimes the case. Adams: One of my research and clinical interests is increasing organ availability to pediatric patients across the board and better examining socio-economic and racial disparities in terms of who has access to organs. We recently received a grant that will allow us to conduct a series of miniinterviews with caregivers or parents of kids who have gotten a transplant to find out what family characteristics either allowed or didn’t allow them to be potential donors. Were they ruled out because their anatomy wasn’t suitable to be a donor? Or were they ruled out because maybe they’re a family with one breadwinner, and if that breadwinner became a donor and their work wouldn’t compensate them to be out for that time, they could no longer provide for the family? Understanding the social background of each different ethnic group will help us care for those patients better and figure out what we can do to help these families so that their kids can get transplanted faster and move on to a normal life. Another change that’s really helped is making sure we have someone who speaks the language. A couple of years ago we hired a nephrologist who is originally from Puerto Rico and is a very fluent Spanish speaker. She runs a Hispanic kidney clinic, which consists of pre-transplant care and post-transplant care. Now we’re hoping to do the same on the liver side.
Click here to read the entire interview with Adams and Burton.
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Surgery News
FIRE SAFETY IN THE OR Greg Glasgow Edward Jones, MD, MS, an associate professor of surgery at the University of Colorado School of Medicine, is a nationally recognized expert on preventing operating room (OR) fires. He has published multiple articles on the subject and annually lectures with the Fundamental of Surgical Energy (FUSE) curriculum at the Society of American Gastrointestinal and Endoscopic Surgeons meeting, which was held virtually in 2020 due to the COVID-19 pandemic. Jones, who also is director of surgical endoscopy at the Rocky Mountain Regional VA Medical Center in Aurora, Colorado, says OR fires result from combining three ingredients: an oxidizer, most commonly supplemental oxygen; a fuel, most often alcohol-
based prep; and a spark, which is typically caused by the “Bovie,” an energy device surgeons use for cutting and coagulating tissue. To cut tissue, you can use a scalpel or an energy device,” Jones says. “With a Bovie, the energy jumps from the metal tip and into the tissue. Any spark can ignite alcohol vapors and start a fire with potentially devastating results. It is important for surgeons to consider what they can do to reduce the risk of a fire, especially in high-risk situations such as surgery above the xiphoid or when using an open oxygen source such as a mask or nasal cannula.” Jones, who was recently featured in the General Surgery News, is part of the Fundamental Use of Surgical
Edward Jones, MD, MS Associate Professor GI, Trauma, and Endocrine Surgery Energy (FUSE) program, which is designed to educate surgeons and staff about the safe use of surgical energy-based devices in the OR.
Click here to read the complete Q&A interview with Jones.
MEDICAL STUDENT PRESENTS AT ACADEMIC SURGICAL CONGRESS Greg Glasgow Eighteen physicians, residents, and medical students from the University of Colorado School of Medicine presented on their research in February at the Academic Surgical Congress, an annual convention hosted by the Society of University Surgeons. Among the CU School of Medicine representatives presenting virtually due to the COVID-19 pandemic was Monica Patten, a second-year medical student who conducted research on the increased risk of suicide among
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lesbian, gay, bisexual, and transgender individuals. “I care a lot about the LGBTQ population, as I myself am a part of the population, and I am interested in the social determinants of health and health care policy in general,” says Patten, a former president of the CU chapter of Medical Student Pride Alliance. “I wanted to make sure that my research focused on those policies and populations in addition to just being surgical in nature.”
Monica Patten
Click here to read more about Patten’s discoveries.
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