CLINICALUpdate St. Francis Hospital
News for Physicians from St. Francis Hospital, The Heart Center®
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Roslyn, NY • A Member of Catholic Health Services of Long Island
St. Francis Hospital a Part of Nationwide Study on Transcatheter Aortic Valve Replacement Research Team: (clockwise from top) Andrew Berke, M.D., Newell Robinson, M.D., Roberto Colangelo, M.D., and George Petrossian, M.D., are looking forward to the possibilities the new CoreValve device (inset) will bring to St. Francis Hospital and its patients.
Robotic Surgery Moves Toward Single Incision Access Robotics experts: (l. to r.) Michael Giuffrida, M.D.; Felix Badillo, M.D.; George DeNoto, M.D.; and Keith Bloom, M.D. Gary Gecelter, M.D., Chairman of Surgery, (far right), says, “The role of robotics continues to expand to procedures previously requiring traditional surgery.”
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hen St. Francis Hospital first acquired a da Vinci robotic system to perform minimally invasive radical prostatectomy, kidney, and adrenal surgery six and a half years ago, only about 2 percent of hospitals across the country were using robotic systems. St. Francis was one of the first hospitals on Long Island to investigate the new technology. Felix L. Badillo, M.D., Director of Urology, estimates that at this point about 95 percent of U.S. hospitals have acquired robotics. But they may have some catching up to do in terms of experience. Surgeons at St. Francis have performed more than 1,000 robotic radical prostatectomies, and have also used the robotic approach for kidney, adrenal, and bladder surgeries. The next big thing on the horizon for robotics at St. Francis is single port surgery, in which all components of the procedure, including specimen removal, are performed through a single small incision. “Robotics is a perfect platform, because the problem with single port surgery is your left hand becomes your right hand – you're crossing swords. But with robotics, you can correct that just by pushing a button,” Dr. Badillo says. That said, although he thinks the single port approach will be good for adrenal surgery and cholecystectomy, Dr. Badillo has his doubts about its application in radical prostatectomy. “It will be used in prostate surgery, but you will have to ask in some situations whether
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Pain Management Team Runs 24/7 Service New Developments in Neurosurgery
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it’s really worth it,” he says. For robot-assisted radical prostatectomy, Dr. Badillo makes five incisions about a quarter-inch long, and one incision one to two inches through which the prostate is removed. “With single port surgery, yes, the number of stabs drops from six to one, but the size of the incision would be dictated by the size of the prostate. So I'm not a hundred percent sold on it.” The robot-assisted radical prostatectomies Dr. Badillo performs now may be hard to improve upon. Patients who undergo a robotic procedure go home the next day and can usually have their catheter removed six days later. About 90 percent of these patients regain urinary control within four days after the catheter is removed; that is compared with open procedure patients who are usually told they will need a diaper for about a month. As far as sexual function goes, that’s still an issue no matter which procedure is performed. But Dr. Badillo tells patients that their chance of having sexual function as good as they had before surgery is about 60 percent, and with the use of medications can boost that to 95 percent. Most importantly, however, robotic surgery provides an advantage in cancer control. The reduction in blood loss provides a clearer field, allowing surgeons to perform a cleaner dissection. “I looked at my own data, and my margin positive rate has dropped significantly,” Dr. Badillo says.
St. Francis Expands Orthopedics Service Advanced Techniques in Hernia Surgery
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Hospitalist Program Finds Success Campaign to Combat Sepsis
Neurosurgery Expands Brain and Spinal Care
It has been a productive year for the Neurosurgery department at St. Francis Hospital, which has increased patient volume, particularly for spinal procedures, as the Hospital continues to gain national and regional recognition for medical services beyond its primary designation as a heart center. “St. Francis is a center of excellence for cardiac care,” says Richard Johnson, M.D., Director of Neurosurgery. “But for patients who have concomitant neurologic disease – which is most of them – where better to have a neurosurgical procedure than a hospital where they specialize in cardiac care?” In the two years since Dr. Johnson took the helm of Neurosurgery, the department has experienced a rapid increase in procedures on patients who once would have been referred elsewhere. “Craniotomies for subdural hematomas are being diagnosed and treated at St. Francis,” Dr. Johnson says. “We see these cases often because a lot of our older patients tend to be on anti-coagulation medication, which can increase the risk of this problem. It used to be that these simple cases were transferred out, but now we are able to care for those patients here.” With the addition of Nicholas Post, M.D., who started in June, Dr. Johnson anticipates more patients with brain tumors will receive their surgical care in-house. “Dr. Post just performed a Richard Johnson, M.D. (left)
retro-sigmoid craniectomy for a cerebellopontine (CT) angle tumor at the skull base,” Dr. Johnson says. “We used some of our new equipment, such as our microscope and navigational system, to locate and remove the tumor.” In the world of spinal care, our neurosurgeons continue to investigate minimally invasive procedures (such as percutaneous spinal screw placement) which tend to result in less pain, shorter hospital stays, and faster recovery rates. Dr. Johnson anticipates further growth in the near future. “As more of the community is aware that we do spine and brain work at St. Francis, our service will expand accordingly.” St. Francis Hospital CLINICAL UPDATE Winter 2012
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Patrick Annello, M.D.
Pain Management Center Brings on New Staff for Round-the-Clock Service
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hen Patrick Annello, M.D., joined New York Cardiovascular Anesthesiologists and senior partner Dan Sajewski in 2008, it was an opportune moment for St. Francis Hospital’s Pain Management Center. With patient volume growing dramatically, the Hospital realized it had an unaddressed need. Current estimates say there is only one doctor for every 8,500 chronic pain sufferers, of whom there are 40 to 70 million in the United States. “Our service area is heavily populated, and there are many pain doctors. But few of them are fellowship trained and board certified, which in my mind is the gold standard,” says Dr. Annello, who is board certified in anesthesiology and fellowship trained in pain management. “We seek out physicians with the best training.” The anesthesiology group recently hired Trusha Shah, M.D., who is fellowship-trained in pain management, and Penny McNicholas, a physician assistant, to join Dr. Annello. A third attending physician will come aboard in mid-January. “It will be a four-person rotating physician team running a 24-hour, seven days a week pain service for the hospital, which has always been my goal,” Dr. Annello says. Since coming to St. Francis, Dr. Annello has been able to introduce novel treatments and approaches to pain management. For in-
stance, St. Francis is one of the first hospitals in the northeast to offer minimally invasive lumbar decompression (MILD), a treatment for spinal stenosis in which doctors use a small, image-guided probe to remove bits of bone and ligament and relieve pressure around the spinal cord. The procedure is done under local anesthetic and takes less than an hour; patients go home the same day –a fairly radical notion for back surgery. Dr. Annello credits the success of the Pain Management Center to a team that includes several physical therapists, an acupuncturist, and a chiropractor. “It’s not me alone who will give the patient relief, but this team of specialists that will get the patient back to a better quality of life,” he says. Ultimately, Dr. Annello hopes to establish a separate clinic as a Center of Excellence that will include physical therapy, imaging, radiation oncology, and an ambulatory surgery center. “That’s the idea of a multi-disciplinary pain clinic, which is our goal here,” he says.
St. Francis Nationally Recognized in Cardiac and Non-Cardiac Care For the fifth consecutive year, St. Francis Hospital, The Heart Center® was recognized by U.S. News & World Report as one of the best hospitals in the nation. The magazine’s annual ranking of medical institutions honored St. Francis once again as a leader in cardiology and heart surgery, geriatrics, and neurology and neurosurgery. The Hospital was the only one on Long Island to be nationally ranked in cardiac care and the only one to be nationally recognized in three specialties. The Hospital was rated regionally as high-performing in eight additional specialties: cancer, ear-nosethroat, gastroenterology, gynecology, nephrology, pulmonology, urology, and for the first time, orthopedics.
Richard D’Agostino, M.D.
Orthopedic Surgery at St. Francis Steps into the Spotlight
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t a hospital best known for its heart center, the Department of Orthopedic Surgery is beginning to get some of the attention Richard D’Agostino, M.D., believes it deserves.
“I always said that St. Francis Hospital was one of the best kept secrets on Long Island,” says Dr. D’Agostino, Director of Orthopedic Surgery at St. Francis. However, with a favorable profile in U.S. News & World Report and a recent five-star evaluation for total joint replacement from the largest patient-driven ratings web site, it seems that secret is getting out. “As much as St. Francis has been recognized for cardiac care for years, we’re starting to get recognized for orthopedic care. Really, that just comes from our great staff of orthopedic surgeons and the people who work with us—our nurses and physician assistants—and with the backing of the
administration,” he says. The department performs many types of joint replacements, but the steadiest growth has been in knee and, to some degree, hip replacement, as “baby boomers,” the first generation to embrace recreational fitness in large numbers, seek relief from the accumulated stress and strain of their high-impact decades. “They were the running generation from back in the 1970s and 1980s, and they may be paying the price for that at a younger age— we're seeing more and more people in their late 50s and 60s who require orthopedic care,” Dr. D’Agostino says. While some institutions may be eager to try
out the latest novel technology, St. Francis tends toward a more conservative approach to joint replacement. For example, navigated total knee replacement, which theoretically increases a surgeon’s precision, has captured the public's attention. But the technology is expensive and difficult to learn—qualities that make the procedure difficult to foster. Though a few St. Francis surgeons have experimented with it, the navigational approach has yet to catch on with the department. “The reality is, these guys are so good at knee surgery that they really don’t need the navigation system,” Dr. D’Agostino says. “The jury is still out on this technology, but what’s tried and tested is what works for us, because of the sheer volume of procedures we perform and our experience in doing them.”
Orthopedics Department Expands As part of a planned expansion to the Department of Orthopedic Surgery, five members of the Insall Scott Kelly Institute (ISK) for Orthopaedics and Sports Medicine have joined St. Francis Hospital. They are: • Timothy G. Reish, M.D. • Michael N. Kang, M.D. • Craig S. Radnay, M.D. • William J. Long, M.D. • Michael P. Nett, M.D. Also, Bruce A. Seideman, M.D., has been appointed Chief of Joint Replacement Surgery at St. Francis. To contact any of the physicians or surgeons mentioned in this publication, call 1-888-432-7869.
New Techniques Offer Better Results in Hernia Repair Not long ago, ventral hernia repair was merely about patching the hole, and fixing the defect. But with increased understanding of what makes a good abdominal wall repair, surgeons are now better able to avoid the risk of post-operative complications, restore patients to a better level of functioning, and even achieve a more pleasing cosmesis. “This is all new with hernia surgery,” says George DeNoto, M.D., Director of St. Francis Hospital’s General Surgery Department. Dr. DeNoto has given George DeNoto, M.D. courses in hernia repair at the Mayo Clinic, Walter Reed Army Medical Center, and on campuses across the country. The optimization of outcomes begins before the patient even approaches the operating room. Patients are screened and treated with antibiotics pre-operatively to avoid the risk of infection especially against Staphylococcus aureus. Smokers are instructed to stop at least a month before surgery. Patients with morbid obesity may be referred to bariatric surgery for weight loss to reduce their risk of wound-healing problems and infection after hernia repair. And for patients with diabetes mellitus, the control of blood sugar levels is established. “We will not be taking someone into the operating room with a blood sugar over
200, because they are not going to heal well and are at risk for infection,” Dr. DeNoto says. Even exercise has come into the pre-operative picture, as it has been shown to significantly reduce the length of the hospital stay. “We never used to discuss exercise, but we found that patients who exercise pre-operatively had half the length of stay in the hospital than those who don't exercise,” he says. Intra-operative techniques, too, have evolved to minimize complications and maximize outcomes. Dr. DeNoto performs periumbilical perforator sparing procedures that preserve blood flow to the abdominal wall and to the skin of the abdomen. According to data he presented at the American Hernia Society Meeting 2010, this approach reduces the incidence of post-operative wound complications three-fold. In patients whose defects preclude closing the muscles, a components separation procedure allows surgeons to bring the muscles back to the midline. “That provides a barrier over the mesh repair, which reduces the recurrence rate; and it allows the patients to increase their core strength by 40 percent,” Dr. DeNoto says. “This means they can get out of a car, out of bed, and off the sofa.” In addition, complex abdominal wall repairs are now often performed with the help of a plastic surgeon, “so we get the best cosmetic results that we can,” Dr. DeNoto says.
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St. Francis Hospital CLINICAL UPDATE Winter 2012
St. Francis Hospital
CLINICALUpdate
is published by St. Francis Hospital, The Heart Center®. Questions or comments can be directed to St. Francis Hospital, Office of Development and Public Affairs, 100 Port Washington Blvd., Roslyn, New York 11576. (516) 705-6655. Copyright© 2012. All Rights Reserved. St. Francis Hospital is a member of Catholic Health Services of Long Island, the healthcare ministry of the Diocese of Rockville Centre. Jack Soterakis, M.D., Senior Vice President Medical Affairs/Medical Director Gary Gecelter, M.D., Chairman of the Department of Surgery Writers: Monica Smith, Rosemary Gomez Contributing Photographer: William Baker Designer: Roger Gorman, Reiner Design
www.stfrancisheartcenter.com
Connect with St. Francis For physician referral, please call 1-888-432-7869. For more information about clinical services at St. Francis Hospital, please call (516) 562-6725.
Raising Awareness about the Dangers of Sepsis Along with 40 members of the New York Greater Hospital Association, St. Francis Hospital is participating in a metropolitan-wide program to raise awareness about sepsis and to expedite aggressive treatment for those at risk for septic shock, a condition that claims the lives of about 210,000 people in the United States every year. St. Francis’ program, spearheaded by Evan Sorett, M.D., Director of Critical Care Medicine, is based on guidelines developed by the Surviving Sepsis Campaign, an international group of health care providers determined to systematically reduce sepsis-related mortality. The guidelines have been shown to reduce such deaths by about 20 percent. “What we're trying to do is recognize the early signs of sepsis and pick it up before it progresses to septic shock, before it even gets to severe sepsis,” Dr. Sorett says. The program takes a four-pronged approach:
Evan Sorett, M.D. (right)
raising awareness through lectures, staff meetings, and courses; educating all care providers on the signs and symptoms of sepsis and its pro-
Hospitalist Program a Success If physician feedback and repeat referrals are any indication, the new Hospitalist Program at St. Francis Hospital is proving to be a popular and successful initiative. “We know the doctors who have been referring patients to us are satisfied because they continue to use our service. Furthermore the physician surveys we've received have been very positive and complimentary,” says Marianne Hamra, M.D., FACP, Director of the program. Early results of a patient telephone survey pilot also suggest patients are very happy with the care they have received from the Hospitalists. The Hospitalist Program, which launched June 1, St. Francis Hospital CLINICAL UPDATE Winter 2012
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2011, has already established its full complement of staff, comprised of six full-time physicians and six to eight per diem hospitalists. “Our Hospitalists are all Medicine or Family Practice Board-Certified, and our schedule is such that we run a 24-hour program seven days a week,” Dr. Hamra says. This includes daytime physicians present in the Hospital throughout the entire week as well as nocturnists who rotate overnight shifts. To contact the Hospitalist Program at St. Francis Hospital, call (516) 562-6385 or ask the operator to page the Hospitalist service.
gression; making sure the appropriate antibiotics, other supplies, and equipment are available in the emergency department; and following an evidence-based protocol for those arriving to the ER already in septic shock, making sure those patients receive adequate fluid resuscitation, along with pressors and inotropes if need be. St. Francis participates in monthly meetings and biweekly teleconferences with other hospitals participating in the campaign to submit data on how well both patients and providers are doing. “The idea is that the best practices will rise to the top and everyone will adopt the best practices,” Dr. Sorett says. Although it's too early to tell if the campaign has improved survival at the community hospital, Dr. Sorett reports that he and others have seen a significant improvement in the timeliness of these septic patients receiving the care they need. “We believe that, over time, this will improve outcomes and reduce mortality.”
Bishop McHugh Health Center Opens
St. Francis Hospital opened the Bishop McHugh Health Center in Hicksville, New York in November. The center provides high quality primary care to the community regardless of a patient’s ability to pay. Services include establishing a full medical history, physical examinations, lab work-ups, x-rays, flu shots, appropriate immunizations, and specialty referrals as needed. The center is located at 750 South Broadway, Hicksville, New York 11801. Phone: (516) 827-2727.