2022–2023 ANNUAL REPORT DEPARTMENT OF SURGERY AND PERIOPERATIVE CARE
1 | ANNUAL REPORT 2022-2023
Welcome From the Chair Dear Colleagues, The 2022-23 academic year was one marked by revolutionary change within Dell Medical School at The University of Texas at Austin. In December 2022, we welcomed our new dean and senior vice president for medical affairs, Claudia Lucchinetti, M.D., who joined us from the Mayo Clinic, along with many other new faces who joined our Dell Med executive leadership team. In August 2023, the UT System Regents announced plans to build the UT Austin Medical Center on the site of the former Erwin Center. This exciting new endeavor will involve exponential expansion of our clinical practice, along with the building of a specialty hospital and a cancer hospital in collaboration with our UT System partner MD Anderson Cancer Center. This sentinel announcement has ushered in the next chapter of Dell Med. Commensurate with the changes occurring around us, in addition to the fact that our department has quadrupled in size since our initial mission statement was created, our Department Leadership Council met for two days in February 2023 to ideate around the future of our department and develop a new mission statement: Transforming the health and lives of the diverse communities we serve through innovation in surgical care, research and education.
DELL MEDICAL SCHOOL
Revolutionizing How People Get & Stay Healthy Dell Medical School at The University of Texas at Austin is rethinking the role of academic medicine in improving health — and is doing so with a unique focus on our community. Created in unprecedented partnership with local taxpayers who voted to support the vision of improving health and making Austin a model healthy city, Dell Med is focused on harnessing the power of innovation, technology and partnerships to modernize academic medicine, create new clinical care delivery models and foster a thriving research environment.
Hand in hand with the missions of Dell Med and UT Austin, our new mission will serve as a compass, guiding our strategic decisions, actions and resource allocation as we navigate the ever-evolving health care landscape. Please read on to learn more about the many other exciting advances and innovations that we have witnessed over the past academic year. Sincerely,
TABLE OF CONTENTS 3
Department at a Glance
6
Educating Future Leaders
12 Divisions 30 Initiatives Kevin J. Bozic, M.D., MBA Chair, Department of Surgery and Perioperative Care
31 Research 37 Happenings 39 What’s Next 2
SURGERY AND PERIOPERATIVE CARE AT A GLANCE 2023 Statistics
12
3
62
Divisions
Residency Programs
Total Residents
(General Surgery, Emergency Medicine, Orthopaedic Surgery)
4
35
16
Fellowships
Electives and Acting Internships
Active Clinical Trials
DEPARTMENT LEADERSHIP
ACUTE CARE SURGERY:
ORTHOPAEDIC SURGERY:
Carlos V.R. Brown, M.D.
Karl Koenig, M.D., M.S.
ANESTHESIA AND PERIOPERATIVE MEDICINE:
PEDIATRIC SURGERY:
Thomas Vetter, M.D., MPH ADULT CARDIOTHORACIC SURGERY:
George Arnaoutakis, M.D. PEDIATRIC CARDIOTHORACIC SURGERY:
Charles Fraser, Jr., M.D. EMERGENCY MEDICINE:
Nicholas Steinour, M.D. ELECTIVE GENERAL SURGERY:
F.P. “Tripp” Buckley II, M.D.
Nilda Garcia, M.D. SURGICAL ONCOLOGY:
Declan Fleming, M.D. SURGICAL SUBSPECIALTIES:
Stuart Wolf, Jr., M.D. TRANSPLANT SURGERY:
Nicole Turgeon, M.D. VASCULAR SURGERY:
Pedro Teixeira, M.D.
Faculty by Designation
DEPARTMENT LEADERSHIP
Kevin Bozic, M.D., MBA DEPARTMENT CHAIR
Regular Faculty Stuart Wolf, M.D. EXECUTIVE ASSOCIATE CHAIR AND ASSOCIATE CHAIR OF CLINICAL INTEGRATION AND OPERATIONS
Kimberly Brown, M.D. ASSOCIATE CHAIR OF EDUCATION
Research Funding by Type
Alex Haynes, M.D., MPH ASSOCIATE CHAIR OF INVESTIGATION AND DISCOVERY
Jeremy Marshall, MHA SENIOR DIRECTOR OF OPERATIONS AND STRATEGY
5 | ANNUAL REPORT 2022-2023
EDUCATING FUTURE HEALTH CARE LEADERS Over the past year, our learners have shown exceptional promise in various domains of medical education, research and clinical practice. Their achievements highlight the various opportunities for innovation and growth available in the department. Ongoing pathway programs with initiatives aimed at inspiring the next generation of surgical talent continue to develop new ways of fostering access and opportunity.
6
EDUCATING FUTURE HEALTH CARE LEADERS
UNDERGRADUATE MEDICAL EDUCATION Bias, Equity and Outcomes in Trauma Population: James Bradford, M.D. James Bradford, M.D., a member of Dell Medical School’s Class of 2023, spent his third year of medical school completing a Distinction in Research experience. He created a unique database that merged the pre-hospital data from the Travis County EMS providers with the inpatient electronic health record data for trauma patients. This dataset allowed researchers to study the connections between care provided before patients arrived at the hospital with their experience and outcomes. Bradford used the database he created to study differences in pain medications provided to trauma patients of different races and ethnicities, seeking to understand what inequities may exist as a way to address conscious or unconscious bias in the care of injured patients.
7 | ANNUAL REPORT 2022-2023
Bradford presented his work at the American College of Surgeons’ annual Clinical Congress, and the manuscript was published in the Journal of the American College of Surgeons. Bradford is now a categorical general surgery resident at the University of Chicago, where he hopes to continue his work in improving equity for trauma patients.
JAMES BRADFORD, M.D.
EDUCATING FUTURE HEALTH CARE LEADERS
GRADUATE MEDICAL EDUCATION Resident Spotlight: Simin Golestani, M.D. For Simin Golestani, M.D., her time at Dell Med has been marked by triumph and remarkable achievements that have garnered widespread recognition. In 2022, she was named the winner of the American college of surgeons’ Jameson L. Chassin, M.D., FACS, Award for Professionalism in General Surgery, a recognition reserved for one resident across the entire country who epitomizes compassion, technical prowess and a fervent pursuit of scientific knowledge. “To be recognized for my hard work and dedication was extremely meaningful, and I’ll continue to challenge myself to uphold the professionalism and dedication to the field of medicine that this award embodies,” Golestani said.
(PICTURED) Simin Golestani, M.D., during her General Surgery Residency at Dell Med
However, having been pregnant as an intern, she feels her greatest accomplishment was the combination of being a surgery resident and a mother, an experience that was both challenging and rewarding. This inspired the focus of her distinction project: improving breastfeeding facilities at Dell Seton Medical Center. She raised awareness of the challenges faced by breastfeeding residents. Her solution was to provide information on the lactation facilities to fellow breastfeeding residents and ensured the rooms were accessible and equipped with the necessary amenities. Golestani is now pursuing a Trauma and Critical Care Fellowship at Medical College of Wisconsin in Milwaukee. She plans to continue being involved in clinical research to help find the best practices that guide trauma care of patients.
“
I’ve loved all of my experiences during residency and plan to continue learning and contributing to the field of surgery. My time at Dell Med has given me invaluable skills and training, and I’m so grateful for my time here.”
SIMIN GOLESTANI, M.D. 8
EDUCATING FUTURE HEALTH CARE LEADERS
GRADUATE MEDICAL EDUCATION Nurturing Interest From Middle School to Residency Since its inception in 2018, the comprehensive pathway program has made tremendous strides. Established under the leadership of Anthony “AJ” Johnson, M.D., director of the Orthopaedic Surgery Residency Program, the pathway partners with faculty, students and community organizations to recruit diverse talent to orthopaedic surgery, including those from underserved backgrounds. Through a near-peer mentoring style, students have access to mentors with greater approachability and emotional support than traditional faculty mentoring. The program’s emphasis on recruiting individuals starting in middle school ensures a steady influx of talented minds into the field, paving the way for a better future. “Our mission is to guide leaders to transform orthopaedic health care. It is not just about diversity in terms of underrepresented people — we also try to recruit those with diverse experiences and diversity in thought. We consider socioeconomic status, first generation in medicine and geographic location,” says Johnson. The program’s dedication to cultivating community has garnered wide recognition and support. Most notably, orthopaedic surgery residents Erik Slette, M.D., (Class of 2023) and Chizitam Ibezim, M.D., (Class of 2025) won a $20,000 IDEA grant from the American Academy of Orthopaedic Surgeons for their project, “University of Texas Peer Mentor and Scholarship Program.” The program will help establish a feasible recruitment and retention pathway to generate a wide orthopaedic applicant pool through professional exposure, relationship intentionality and elimination of academic disparity across all levels of education. In 2023, the program established the first-ever
9 | ANNUAL REPORT 2022-2023
chapter of Pride Ortho at the medical school level. Pride Ortho, now a registered student organization led by students, is a community of LGBTQ+ individuals and their allies “with a mission to provide mentorship, networking in a safe space and a sense of belonging for members.” Through this organization, students aim to increase visibility, professional opportunities and inclusivity of LGBTQ+ medical students pursuing orthopaedic surgery. With each passing milestone, the pathway program remains steadfast in its mission to dismantle barriers and ensure that the field of orthopaedic surgery reflects the communities it serves. Driven by the vision of Johnson, the program also has dedicated resident champions, including Claire Ryan, M.D., (Class of 2022) and Elizabeth Duckworth, M.D. (Class of 2025). “The goal is to continue cultivating a sense of belonging and a welcoming culture at the faculty and resident levels,” said Johnson.
Surgical Oncology Fellowship Match The Surgical Oncology Division members were thrilled when mentee and former chief resident Kristofor Olson, M.D., Ph.D., became the first general surgery resident to match into a Comprehensive General Surgical Oncology Fellowship at City of Hope Comprehensive Cancer Center. His journey at Dell Med has been marked by countless accolades, including a publication in the New England Journal of Medicine, numerous national and international conferences and being named the Raleigh Ross Scholar in Surgery by the Texas Surgical Society. Since medical school, Olson has had a strong passion for surgical oncology. His graduate research was in cancer metabolism, and he spent over a year of training on surgical oncology services, which cemented his decision to pursue this specialty.
Faculty, students and community organizations gathered at the orthopaedic pathway program conference.
“Complex general surgical oncology is an apt name for the field. The operations are often long, and the patients have unique challenges — thrombocytopenia, immunosuppression, general deconditioning — all of which require the surgeon to be at the top of their game,” says Olson. “Furthermore, cancer itself is an unjust disease both at the molecular and human level.” Training at a comprehensive cancer center will allow Olson to focus on cancer, all the time. It will also provide research opportunities that are less accessible elsewhere. His fellowship training will position him to tackle the most complex oncological problems and perform paradigm-changing research that will propel his career as an academic surgical oncologist. As he has begun his time as a fellow at City of Hope, Olson has found that the clinical, technical and organizational skills he developed while a resident at Dell Med have prepared him to excel in this next phase of his career.
“
Complex general surgical oncology is an apt name for the field. The operations are often long, and the patients have unique challenges — thrombocytopenia, immunosuppression, general deconditioning — all of which require the surgeon to be at the top of their game. Furthermore, cancer itself is an unjust disease both at the molecular and human level.”
KRISTOFOR OLSON, M.D., PH.D. 10
11 | ANNUAL REPORT 2022-2023
DIVISIONS
12
DIVISIONS
ACUTE CARE SURGERY VASCULAR SURGERY Few surgeons in the United States are dual trained in trauma and vascular surgery, and even fewer actively practice in both fields.
Combined Trauma and Vascular Program The Division of Acute Care Surgery, under the leadership of Carlos V.R. Brown, M.D., and the Division of Vascular Surgery, under the leadership of Pedro G. Teixeira, M.D., have joined forces to establish the combined trauma and vascular program focused on providing a unique collaboration between specialties that streamlines vascular injury care as well as patient follow-ups and postoperative management. After a joint recruitment, the two divisions added Joseph J. DuBose, M.D., to the team, making the department one of the few across the country to have two dual-trained trauma and vascular surgeons in Teixeira and DuBose. Trauma patients often suffer from multisystem injuries, which increases the need for a collaborative approach to treatment. The two divisions optimize patient care by utilizing improved integration of hybrid endovascular suites, incorporation of the trauma team for overall care decisions and the ability to bring open and endovascular skill sets to the bedside of vascular injury. The team has also published a textbook with the intention of demonstrating the value of a close partnership between trauma and vascular surgery to the broader medical community. Paramount to the success of novel treatment strategies is data acquisition and interpretation. The two divisions have spearheaded multi-institutional
13 | ANNUAL REPORT 2022-2023
collaborations to develop data sources to guide their decision-making and identify optimal treatment pathways. The Prospective Observational Vascular Injury Treatment Registry is a multinational registry that has accrued almost 6,000 injuries to date over the last 13 years. From this registry, nearly 20 academic papers have been published with several more in progress. A secondary resource is the Aortic Trauma Foundation, a nonprofit organization founded in 2016 that is centered around the international collection of data on blunt thoracic aortic injuries. This registry has informed a half dozen manuscripts and has been influential in changing therapy and guidelines. Additionally, all the surgeons have their own investigations utilizing data from national trauma and vascular registries that include a robust and growing team of learners to assist them in answering challenging questions surrounding vascular injury. “What we are trying to do is attract the attention of undergraduates, medical students and residents to this field that has a lot of opportunity in clinical and research pathways,” said Teixeira. Beyond delivering a level of care that they uniquely provide, “the ultimate goal is to train another generation of surgeons who can provide similar skill sets,” shared DuBose. As part of the expansion, a new Surgical ICU Fellowship has started at Dell Medical School, with plans to introduce an Acute Care Surgery Fellowship and a Vascular Surgery Integrated Residency, which depend on a combination of open and endovascular capabilities. Trainees will be mentored in an environment in which the treatment of vascular injuries is delivered in a structured and collaborative way.
HIGHLIGHTS The Division of Vascular Surgery continued to grow this year with the addition of Dimitrios Miserlis, M.D., who joined in January 2023.
DIMITRIOS MISERLIS, M.D.
14
DIVISIONS
ADULT CARDIOVASCULAR AND THORACIC SURGERY Following the immensely successful path of the Texas Center for Pediatric and Congenital Heart Disease, Dell Medical School and Ascension Texas partnered to establish the Division of Cardiovascular and Thoracic Surgery. Dell Medical School and Ascension Texas partnered to establish the Division of Cardiovascular and Thoracic Surgery in January 2023. Led by George Arnaoutakis, M.D., six adult cardiovascular surgeons complement the pediatric and congenital heart surgery team with a commitment to fostering multidisciplinary collaborations with cardiologists, surgeons and other specialties.
A hallmark of the division’s approach is the commitment to fostering multidisciplinary collaboration in solid partnership with esteemed cardiologists at Ascension Cardiovascular. Surgeons, cardiologists and other health care professionals work collectively to address various patient needs. This seamless coordination allows for comprehensive care, particularly for the myriad cases requiring a team-based approach. The division’s collaborative spirit extends beyond its walls. It has led to partnerships with fellow medical disciplines, research institutions and community health care providers to improve patient outcomes and drive medical progress in Central Texas.
Adult cardiac surgery team from L to R: Satoshi Furukawa, M.D., Karen Kim, M.D., George Arnaoutakis, M.D., Bill Kessler, M.D., Joshua Grimm, M.D., Masa Ono, M.D.
15 | ANNUAL REPORT 2022-2023
Adult cardiovascular surgery team members.
Education and training are prominent in the division’s journey to excellence. Residents from the general surgery program at Dell Med are integrated into the clinical service, with additional rotation experiences already underway for Brooke Army Medical Center residents. Under the mentorship of seasoned surgeons, these surgical trainees are developing techniques and judgment with broad exposure to cardiovascular surgical techniques. The faculty are actively strategizing the formation of an independent cardiothoracic surgery training program. Today, the impact of the Division of Cardiovascular and Thoracic Surgery extends far beyond its initial establishment. Patients from diverse backgrounds have sought the expertise of the program, finding solace and hope in the face of challenging cardiovascular conditions. Innovative cardiac surgical techniques and devices have become available to the local community and beyond, extending countless lives and transforming families. One of several
examples is the initiation of the PERSEVERE study at Dell Med and Ascension Texas, which utilizes an investigational device to potentially limit the need for future procedures in patients who suffer the lethal condition of acute Type A aortic dissection. Research is a significant pillar of the division’s success. Embracing a culture of exploration and inquiry, surgeons within the division are expanding the boundaries of medical knowledge. The Division of Cardiovascular and Thoracic Surgery has significantly altered the landscape of cardiovascular care in the heart of Texas through dedication, passion and an unwavering commitment to the art of healing. The ongoing pursuit of excellence drives medical advancements and positively influences the cardiovascular health of the local community and beyond, creating a legacy of hope and healing.
16
DIVISIONS
ANESTHESIA AND PERIOPERATIVE MEDICINE Pediatric Anesthesia Group Over the past year, the Division of Anesthesia and Perioperative Medicine has experienced remarkable growth. They welcomed Karen Thomson, M.D., as the newest addition to their ranks who brings a wealth of experience in cardiac anesthesiology. Cynthia Keene, M.D., and Jerry Dong, M.D., are also slated to join the team in early 2024. In addition, they now offer a range of educational programs, including a visiting medical student rotation and a visiting resident rotation. These programs underscore their commitment to shaping the future of anesthesia and perioperative medicine by nurturing the next generation of medical professionals.
The division’s stellar accomplishments also extend to the operating room, where Erin Gottlieb, M.D., played a pivotal role in a lifesaving surgery. Le’Lani Bryant was born prematurely at just 27 weeks with a rare congenital heart condition with great vessels in the wrong position. Charles Fraser, M.D., renowned for performing hundreds of arterial switch surgeries, performed the critical procedure on the 800-gram baby. After enduring two openheart surgeries and spending 139 days in Dell Children’s NICU, Le’Lani finally was able to go home with her family.
KAREN THOMSON, M.D.
Le’Lani goes home with her mother Jasmine Matthews after spending 139 days in the Dell Children’s NICU and undergoing two open heart surgeries. (Photo courtesy: Matthew Hooker, Dell Children’s Digital Media Manager)
17 | ANNUAL REPORT 2022-2023
Humanities, Heart and the Art of Medicine
The pediatric anesthesia team at Dell Children’s operates on Le’Lani Bryant, born prematurely with a rare congenital heart condition. (Provided by Dell Children’s Medical Center)
The pediatric cardiac anesthesiology team is expanding service to care for the most critically ill pediatric heart patients with the recruitment of Karen Thomson, M.D., and two additional faculty members starting in Spring 2024.
In fall 2022, Thomas R. Vetter, M.D., MPH, MFA, chief of the Division of Anesthesia and Perioperative Medicine, and David Ring, M.D., Ph.D., associate dean for comprehensive care, offered an elective course titled “Humanities, Heart and the Art of Medicine” to engage students in a comprehensive exploration of the medical humanities. Every week, students met interactively with speakers and facilitators who presented on a variety of principles and practices, such as mindfulness, narrative medicine, spirituality and more. The course involves several learning objectives to promote the delivery of patient-centered care: 1) incorporate the emotional and humanistic aspects of medicine into patient care and clinician self-care; 2) improve empathic ability and capacity for relationship-centered care; 3) balance cognitive experience and embodied experience, thus setting the seed for career sustainability and joy in practice; and 4) grasp how one can use cultural practices and pleasures as part of a personal health and wellness plan. Immersion in the humanities enhances critical thought, creativity, observational skills, comfort with uncertainty and puzzlement, empathy, curiosity and compassion. Since meaningful relationships will be as important as clinical acumen for future patient care and their joy in practice, medical students gain crucial skills. Available data demonstrates that those who can process emotions and unspoken communication, and convey greater humanism in the clinical encounter, achieve better patient outcomes.
18
DIVISIONS
EMERGENCY MEDICINE I m p r ov i n g E d u c a t i o n a n d Processes Through Video Review How do physicians debrief on life-and-death cases that require high-stakes decisionmaking without hesitation and time-sensitive, coordinated care with a team of caregivers? This is the question that emergency medicine physician and residency alumnus Woody Green, M.D., and team set out to answer, using a hightech solution. With the addition of new Avigilon panoramic cameras to record video and sound, staff in the Dell Seton Medical Center Emergency Department are now able to review cases that present to any of the six resuscitation bays. This resource allows physicians to debrief complex cases and learn best practices focusing on effective communication and team direction, optimized placement of lifesaving equipment and personnel, and the ability to coach individuals on procedures that are infrequently performed.
In the past, these cases were discussed with anecdotal feedback and imperfect recall of the timing and events. Now, the team is able to conduct multidisciplinary reviews of these cases that capture exact timing, actions, interactions and techniques that are used to highlight successes and identify opportunities to improve care for future patients. Medical students and residents are able to review and discuss teaching points to gain understanding and insight into the management of these complex cases. Emergency Department staff are also in the process of creating additional research projects to measure the value of this implementation. They are excited to have this as they work to improve patient care, provide the highest quality education and develop a cohesive multidisciplinary team approach to patient care.
Woody Green, M.D., and Chris Wyatt, M.D. (front), along with Dell Seton Medical Center Emergency Department staff in the resuscitation bay.
19 | ANNUAL REPORT 2022-2023
DIVISIONS
PEDIATRIC CARDIOVASCULAR & THORACIC SURGERY First Pediatric Partial Heart Transplant in Texas In a historic first for Texas, an 11-month-old boy received a partial heart transplant. This is the seventh known operation in the world. The landmark surgery was performed on June 23, 2023, at the Texas Center for Pediatric and Congenital Heart Disease at Dell Children’s, in partnership with UT Health Austin, the clinical practice of Dell Medical School. In a partial heart transplant, valves are procured from a donor heart that was not suitable for full transplantation. The goal is to allow the harvested living valves to grow with the pediatric patient over time, potentially increasing life expectancy. “Our team is excited about this procedure to potentially change the paradigm of valve surgery in pediatric heart disease. This lifesaving surgery can make use of a donated heart that would otherwise not be transplantable,” said Carlos Mery, M.D., MPH, surgical director of the heart transplant program at Dell Children’s and an associate professor in the departments of Pediatrics and Surgery and Perioperative Care at Dell Med. The 11-hour surgery was performed on 11-monthold Elias Robinson-Rodriquez. Elias was born with a congenital heart defect condition called transposition of the great arteries, which obstructs the part of the heart that pumps blood to the body. Despite prior surgery on the valve, the valve between the lower-left heart chamber and the body’s main artery (aorta) was narrowed and didn’t open fully. This reduced or blocked blood flow from the heart to the aorta and to the rest of the body. Following
Eleven-month-old Elias Robinson-Rodriquez after the partial heart transplant performed by Dell Children’s heart transplant team, led by Chesney Castleberry, M.D., and Carlos Mery, M.D., MPH.
the surgery, Elias is showing remarkable improvement and his outlook remains strong. This was the third open heart surgery for Elias. “Our ability to perform this surgery is a major step in Dell Children’s effort to provide innovative, life-changing care for the most complex cardiac cases in the region,” said Charles Fraser Jr., M.D., chief of pediatric and congenital heart surgery at the Texas Center for Pediatric and Congenital Heart Disease and professor in the departments of Pediatrics and Surgery and Perioperative Care at Dell Med. “This groundbreaking surgery provides hope for thousands of babies with congenital heart defects and amplifies the way we can use the gift of organ donation to save more lives.”
20
DIVISIONS
ELECTIVE GENERAL SURGERY As a core teaching service for residents and medical students, the “bread and butter” elective general surgery cases are staffed by two of the departments most experienced surgeons, John Uecker, M.D., FACS, and Drew Fielder, M.D., FACS, who perform open, laparoscopic and robotic cases ranging from inguinal hernias to complex general surgery cases. In addition, Carlos V.R. Brown, M.D., has dedicated part of his practice to developing a hernia clinic to continue to meet the needs of our growing community and residency. Digestive Health, a clinical partnership between UT Health Austin and Ascension Seton, continues to grow and make a nationwide impact. It is a truly integrated clinic and disease-based approach to patient care, where specialists in gastroenterology and surgery function as dyads to provide the best possible care. Nearly half of the surgical patients seen in the clinic come from over three hours away and with a healthy cohort of international patients.
21 | ANNUAL REPORT 2022-2023
The center treats everything from esophageal to colorectal disorders. Surgeons in the center include Tripp Buckley, M.D., FACS, and Elisa Furay, M.D., who focus on the esophagus and stomach, as well as Joga Ivatury, M.D., MHA, who leads colorectal surgery. Despite a busy clinical practice, all of the surgeons have robust research and education programs, which integrate residents, medical students and UT undergraduate students. In 2024, Digestive Health will expand to a second hospital, building out a comprehensive gastroparesis program and laying the groundwork for an academic metabolic disease program (bariatrics) and Foregut Surgery Fellowship.
DIVISIONS
ORTHOPAEDIC SURGERY Building a Research Program As surgeons and faculty members who seek to improve their practice and guidance on tough cases, quality research studies to reference is important, which can be a challenge to produce. But the pediatric orthopaedic service line has successfully produced impactful research for the last three years. Under the vision and guidance of Matt Ellington, M.D., he and research coordinator Niamh McMahon have organized ongoing projects to further build out the research program. Brian Kaufman, M.D., was awarded two grants to study the effect of perioperative IV steroid administration on postoperative pain and the efficacy of perioperative yoga at reducing pain in surgical adolescent idiopathic scoliosis patients. Kirsten Ross, M.D., joined the first multicenter study group investigating the
safety and efficacy of robotic navigation in pediatric spinal deformity surgery. Ellington presented at the Pediatric Orthopaedic Society of North America’s annual national meeting this year in Nashville, Tennessee, on long leg cast versus hinged knee brace immobilization after surgical treatment of tibial tubercle fractures. Hilton Gottschalk, M.D., presented at the American Academy of Pediatrics in October on fingertip injuries and standardizing treatment pathways at a national level. Nineteen studies have been approved by the institutional review board since October 2022. Over the last year, the pediatric orthopaedics team have had 10 residents contributing to these research projects as well as multiple medical students and undergraduates. Their service line has published 10 papers over the last two years, and they are just getting started.
Hilton Gottschalk, M.D., Mathew Ellington, M.D., Kathleen Rickert, M.D., Kirsten Ross, M.D., and Brian Kaufman, M.D., at the annual national meeting in Nashville, Tennessee. 22
DIVISIONS
Value-Based Health Care Positively Impacts Patient Outcomes and Provider Well-Being For the first time, the Musculoskeletal Institute was able to show the impact of integrated care offered via in-house providers not traditionally included in orthopaedic practices. Not only does it achieve improved outcomes and better health for patients, it also results in more joy and higher retention among providers, all at a cost roughly 25% lower than traditional fee-for-service, nonintegrated models of care. The Department of Surgery and Perioperative Care initially developed an overview of how valuebased care was implemented in integrated practice units in the Musculoskeletal Institute for visitors from U.S. Health Human Services in 2016. Since then, the department has responded to continued requests of “how we do it” by developing a two-day Immersion Program to introduce participants from across the health care spectrum to the theory and practice of value-based health care. This program is offered at least twice a year, and attendance by participants from across the nation and around the world continues to increase. Presentations include foundational background on value-based care by Kevin Bozic, M.D., MBA, and Elizabeth Teisberg, Ph.D., of the Value Institute for Health and Care. In addition, participants hear from David Ring, M.D., Ph.D., on the impact of mental health on musculoskeletal outcomes. Prakash Jayakumar, M.D., Ph.D., presents on the importance of using data and analytics on patient reported outcomes to improve the delivery of care and patient outcomes as well as on the use of AI to enable personalized medicine and valuebased health care. Additional presentations and an in-depth tour of the Musculoskeletal Institute
23 | ANNUAL REPORT 2022-2023
clinic with Karl Koenig, M.D., demonstrate the mechanics of fostering close communication and trust between providers as well as the importance of working closely with patients to achieve desired outcomes.
The Musculoskeletal Institute’s success in implementing a value-based model of care with proven results are inspiring to providers, health care administrators and representatives from payor entities. It shows that a culture where care is effective, costs are attributed to proven interventions and providers can focus on actual care delivery — not only in Central Texas but across the nation. Learn more about the program by submitting inquiries to dellmedsurgery@austin.utexas.edu.
DIVISIONS
PEDIATRIC SURGERY Dell Children’s Trauma and Injury Research Center Dell Children’s Pediatric Trauma and Injury Research Center, under the direction of Karla Lawson, Ph.D, MPH, celebrated its 15th year of nationally celebrated leadership. The center is responsible for the dissemination of scientific findings through hundreds of manuscripts, countless national presentations, curriculum development and book chapters. The research center was key in the development of the ATOMAC research collaborative (ArizonaTexas-Oklahoma-Memphis-Arkansas Consortium) that specializes in pediatric trauma clinical care research and guideline development. The ATOMAC group has published over 20 pivotal scientific manuscripts in the field of pediatric surgery. The group has developed clinical guidelines utilized throughout the nation by pediatric trauma centers including those that direct the clinical management of blunt cerebrovascular injury and solid organ injury. The center also focuses on pediatric-specific trauma issues, including child abuse prevention, detection and treatment; pediatric drowning risk and prevention; youth suicide; and adolescent risky alcohol and drug use.
KARLA LAWSON, PH.D., MPH
A highlight of their work includes the development of maps to show incidences of child abuse and neglect in Travis County overlaid with maps indicating needed community services and ATOMAC’s partnerships. The center’s work in prevention and treatment of adolescent risky alcohol and drug use has a national scope and includes screening and treatment delivery for substance use disorders in the emergency room and well as the conduct of research in the delivery of these programs and their programmatic outcomes.
Pediatric Urology Has Made Exc i t i n g Pr o g re s s W i t h a New Transitional Clinic and Oncofertility Program Mary “Katie” Wang, M.D., and E. Charles Osterberg III, M.D., created the Transitional Clinic to care for patients with complex urologic history from childhood to adulthood. These patients include those with congenital abnormalities such as neurogenic bladder, hypospadias, posterior urethral valves, cloaca and bladder exstrophy. Some of these patients have already had complex urologic surgery that requires lifelong follow-up, while others are awaiting surgery to reach a goal of moving toward independence. Fertility preservation in prepubescent male patients with cancer has not been an option until now. The team joined the University of Pittsburgh in a multicenter study to preserve testicular tissue in boys undergoing fertility-threatening chemotherapy or radiation to treat childhood cancer so they can restore fertility or use the preserved tissue with in vitro fertilization in the future.
24
DIVISIONS
Dell Children’s Craniofacial and Pediatric Plastic Surgery Program The craniofacial and pediatric plastic program grew with the addition of three providers: ClaudeJean Langevin, M.D., Jeffrey Cone, M.D., and Sarah Frommer, M.D., Ph.D. The increased capacity was needed to take care of Dell Children’s Craniofacial Center’s 450-plus patient families and expand 24/7 coverage to the new Dell Children Medical Center North Campus. Growth has reduced wait times and increased the surgical capacity during peak summer season. In June, the craniofacial team graduated its twelfth fellow, Steven Ovadia, M.D. The Craniofacial Fellowship is a partnership between Dell Medical School and The University of Texas Medical Branch. The program is leading the nation in the treatment of craniosynostosis, which affects 1/4000-5000 children. Fused skull sutures can cause secondary neurocognitive deficits if not treated properly within a specific treatment window.
The center is leading the way with the implementation of cranial springs in areas that have historically required larger, higher-risk procedures. Cranial springs have the dual benefits as being a lower-risk surgery and improve the outcomes for patients and families. Innovation in this area requires a collaborative team consisting of neurosurgery and craniofacial surgery and close attention to detail. The pediatric otorhinolaryngology team created the Microtia Center to care for patients with congenital external ear malformations. Microtia is a complex diagnosis often presenting challenges with hearing loss as well as congenital facial appearance differences.
Newborn earmolding as a nonsurgical treatment for congenital ear deformity.
25 | ANNUAL REPORT 2022-2023
DIVISIONS
SURGICAL ONCOLOGY An alumnus of Dell Medical School’s General Surgery Residency, Samuel “Rhett” Long, M.D., has recently returned to the department as a faculty member in the Division of Surgical Oncology. Following completion of his endocrine surgery fellowship at the University of Michigan, he is one of a few surgeons in Austin whose practice focuses exclusively on endocrine surgery. His recruitment presents a unique opportunity to develop a center capable of delivering quality care to patients and an expanded educational opportunity for residents. Historically, patients in Austin with complex oncologic conditions have been referred to other tertiary academic centers across Texas, which often results in fragmented care and added expense to the patient. With the growth of Dell Med, surgical oncologists have recognized the need to continue expanding access to the highest level of care.
“
We believe that complex subspecialty care requires individuals who are really dedicated, and we are committed to grow the division to meet the needs of our patients.” —DECLAN FLEMING, M.D., FACS
SAMUEL “RHETT” LONG, M.D.
As a specialized endocrine surgeon, Long can provide comprehensive care to Central Texans in a more accessible location. Long term, his overarching goal is to transform Dell Med into one of the preeminent academic centers for patients with endocrine conditions. Establishing a center of high-level care not only benefits patients but also trainees. In the past, residents have had to connect with physicians in the community to gain exposure to certain types of subspecialty care. The growth of the Division of Surgical Oncology ensures that they will have focused instruction on-site and faculty who are committed to their development. “What we hope by giving our residents a concentrated experience in these subspecialty areas is they will develop greater expertise and further facilitate opportunities to pursue additional fellowship training,” said Declan Fleming, M.D., FACS, the division chief of surgical oncology. Tasked with bridging this gap, Long brings his firsthand knowledge and experiences from the residency program that instilled in him a dedication to pursuing academic excellence. “The focus within our residency program is not just training surgeons but training academic surgeons who are going to be leaders in their field,” said Long.
26
DIVISIONS
SURGICAL SUBSPECIALTIES Educational Developments in Urology The department is pleased to announce a new educational development for the urology practice. As of March 2023, residents can participate in the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Urology Residency Program, a combined Army and Air Force training program. The residents will rotate to Dell Seton Medical Center with an opportunity to gain experience in a variety of urologic subspecialties, including general urology, urologic oncology, genitourinary reconstruction, endourology, robotic surgery and laparoscopy. The resident also will have the opportunity to participate in clinical research and to teach medical students. The first residents were Tarah Woodle, M.D., and Lucien McBeth, M.D.
Residents Tarah Woodle, M.D., and Lucien McBeth, M.D., performing a urethroplasty through the SAUSHEC program.
27 | ANNUAL REPORT 2022-2023
DIVISIONS
TRANSPLANT SURGERY First Year of the Adult Abdominal Transplant Center The Adult Abdominal Transplant Center is a clinical partnership between Ascension Seton and UT Health Austin that opened in November 2021 with the goals to double the number of transplants in the region annually and provide opportunities for nondirected (anonymous) kidney donors to make a local impact. Since its launch, the center has grown its clinical and research teams and achieved several milestones toward providing advanced care to kidney failure patients in the Central Texas community:
18
13
300+
kidney transplant surgeries
living donor surgeries
patients
(From opening in November 2021 to July 2023) The entire transplant journey, starting from determining a patient’s candidacy to the recovery following surgery, is a team effort. The center’s multidisciplinary transplant team and the patient themselves all contribute to successful outcomes. “It’s the relationships you develop and the bonds you form with your patients that are critical to transforming the rest of their lives and empowering them to live that life to its fullest,” said Nicole Turgeon, M.D., FACS, transplant director and surgeon in the Abdominal Transplant Center. The Abdominal Transplant Center endeavors to make remarkable strides in transplantation through the education and training of current and future
Nicole Turgeon, M.D., FACS, performing surgery at the Abdominal Transplant Center.
providers; robust representation in the national arena of professional societies and communities of practice; and through investigation devoted to enhancing access to transplantation. The team is actively involved in research devoted to enhancing access to transplantation by mitigating health disparities, incentivizing more efficient utilization of organs and improving the transplantation health care system to ensure a fair and equitable process for all. “What an academic transplant program can provide is not just clinical excellence but building the next generation of transplant professionals and studying ways to address disparities in access to transplantation,” Turgeon said. “What better way to advance the field than starting the program in a large capital city where we can serve the community and accomplish these goals?”
28
29 | ANNUAL REPORT 2022-2023
INITIATIVES
COMMITMENT TO BELONGING, ENGAGEMENT AND IMPACT INTRODUCING TATIANA CARDENAS, M.D., M.S. Tatiana Cardenas, M.D., M.S, stepped into a new role leading the department’s committee on belonging, engagement and impact, which seeks to improve retention and engagement of faculty, staff and learners as well as advance health equity for our patients. Growing up as a first-generation CubanBrazilian born in the United States, Cardenas realized that there were differences in how, when, why and where patients with diverse races and ethnicities — including her family — sought and received medical care. While learning and working in medicine, she knew that her medical education and career would be tied to institutions seeking to break down these disparities, embrace belonging and provide access to health care for anyone who needed it.
contributes with their own positionality and motivations, which has driven them to create an ambitious set of goals for the coming year:
The committee is made up of faculty, staff and learners. Like Cardenas, each committee member
• Sustainably integrate a health equity lens into departmental research.
Committee Goals: • Promote belonging and engagement through targeted recruitment and retention efforts; • Expand and integrate health equity into clinical care; • Advance and support the health equity learning environment for learners, faculty and staff; and
Tatiana Cardenas, M.D., M.S., celebrates Austin Pride with other members of the department and Dell Medical School (2023). 30
RESEARCH
RESEARCH
From left to right, Joga Ivatury, M.D., MHA, Erin Donovan, Ph.D., and René Dailey, Ph.D.
The department continues to focus on its research pillar strategic goal of incorporating a health equity lens into research. This focus is reflected in faculty research programs and publications as well as in the Annual Research Symposium, where a presentation is awarded for best highlighting or addressing a topic around health equity.
Developing an Ostomy Health Communication Guide Joga Ivatury, M.D., MHA, led a collaboration with Erin Donovan, Ph.D., and René Dailey, Ph.D., from UT Austin’s Moody College of Communication to develop a health communication guide for people with an ostomy, an intestinal opening to the skin for body waste. Many people with ostomies face unseen challenges in social interactions. This research was conceived to address this gap in support by identifying salient social situations and communication techniques to address them. Researchers conducted focus groups and interviews of people with ostomies from five countries and of a variety of ages. They found eight major social situations including leaks, traveling,
31 | ANNUAL REPORT 2022-2023
interactions with clinicians, friends and family. From these testimonies and real experiences, the researchers used the findings to develop a health communication guide that provides recommendations for each situation in a problem-solution format and with various levels of disclosure. The research team are currently conducting more focus groups to improve the guide iteratively. Upon completion, the guide will be available on the United Ostomy Associations of America website (ostomy. org), electronically and in print. This research has been presented at interprofessional symposia on campus, the American Society of Colon and Rectal Surgeons’ annual meeting, the American Society of Colon and Rectal Surgeons’ annual meeting and the National Communication Association meeting. This research is supported by the Department of Surgery and Perioperative Care and the Communication for Health, Empathy, and Resilience Grant Program from the Center for Health Communication, a collaboration of Moody College of Communication and Dell Medical School. The researchers are also pursuing extramural funding to advance this work.
RESEARCH
Expanding Access to Transplantation in Central Texas The Dell Seton Abdominal Transplant Clinic, led by transplant director Nicole Turgeon, M.D., opened its doors in November 2021. Three months later, the first kidney transplant was performed, marking an expansion of treatment and health care access to those living with end-stage kidney disease in Central Texas. The new clinic presented a unique opportunity to develop a research program led by Joel Adler, M.D., MPH, to study and address challenges in fair and equitable access to organ transplantation. The clinic and research programs are developing in tandem, with each program informing and improving the other with an integrated mission of transforming health care delivery and improving access to care. When patients are evaluated for kidney transplantation in clinic, they are invited to participate in a parallel mixed-methods study to better understand the social needs and barriers in accessing kidney transplantation in Central Texas. This study, funded by the IC2 Institute at The University of Texas at Austin, employs both quantitative and qualitative methods to better understand what influences access to care and identify strategies for improvement. This project is a collaboration with Sean Upshaw, Ph.D., an expert in qualitative methods and health communication and an assistant professor at Moody College of Communication. Adler and Upshaw’s work was featured in Dell Med’s Mission Critical, a spotlight on interdisciplinary health research collaborations across UT Austin. Adler and Upshaw’s work has recently evolved to include interviews with dialysis patients who have not yet been referred to the transplant center. It has also expanded through support by a grant from the Society for Transplant Social Workers to engage with dialysis social workers, who are the primary referral source for transplant evaluation.
In September 2022, Adler received a K08 career development award from the Agency for Healthcare Quality and Research. This five-year award will support a comprehensive study of utilization, cost-effectiveness, and patient and provider preferences to expanding telehealth care for the rural population with end-stage kidney disease. Additionally, Adler has support from the American Society of Transplant Surgeons to develop novel hospital-level performance metrics of deceased organ donation. Just as the clinical program aims to improve and address the entire patient journey in transplantation, the research program aims to improve care more broadly for all patients with kidney disease. In collaboration with colleagues at Massachusetts General Hospital and Columbia University, the research team has published studies on the new distance-based kidney allocation system and the impact of different insurance coverage for patients on dialysis. The abdominal transplant research team presented at eight conferences in 2022 and at eleven conferences in 2023.
Joel T. Adler, M.D., MPH, and Sean J. Upshaw, Ph.D.
32
RESEARCH
SELECTED PUBLICATIONS “Ambulance Transport Destination in the U.S. Differ by Patient Race and Ethnicity” Pack CE, Partain AT, Crowe RP, Brown LE. Health Aff. 2023 Feb;42(2):237-245.
“Racial and Ethnic Disparity in Prehospital Pain Management for Trauma Patients” Bradford JM, Cardenas T, Edwards A, Norman T, Teixeira PG, Trust MD, DuBose J, Kempema J, Ali S, Brown CVR. J Am Coll Surg. 2023 Mar 1;236(3):461467.
“Prevalence of Delayed or Forgone Care Due to Patient-Clinician Identity Discordance Among U.S. Cancer Survivors” Patel VR, Gupta A, Blaes AH, Winkfield KM, Haynes AB, Qasim Hussaini SM. JAMA Oncol. 2023 May 1;9(5):719-722.
“A Population Health Approach to Transplant Access: Challenging the Status Quo” Patzer RE, Adler JT, Harding JL, Huml A, Kim I, Ladin K, Martins PN, Mohan S, Ross-Driscoll K, Pastan SO. Am J Kidney Dis 2022 Sep;80(3):406415.
33 | ANNUAL REPORT 2022-2023
“The New Distance-Based Kidney Allocation System: Implications for Patients, Transplant Centers and Organ Procurement Organizations” Cron DC, Husain SA, Adler JT. Curr Transplant Rep 2022 Oct 13;1-6.
“Trisomy 18: Disparities of Care and Outcomes in the State of Texas Between 2009 and 2019” Mizrahi M, Well A, Gottlieb E, Stewart E, Lucke A, Fraser C, Mery C, Beckerman Z. Cardiol Young. 2023 Feb 13.
“Diversity and Inclusion in Orthopaedic Surgery From Medical School to Practice: AOA Critical Issues” Lamanna DL, Chen AF, Dyer GSM, Johnson AE, McCarthy CJ. J Bone Joint Surg Am. 2022 Sep 21;104(18):e80.
RESEARCH
Annual Research Symposium The department’s Sixth Annual Research Symposium was held on May 5, 2023. Visiting professor Karen Woo, M.D., Ph.D., presented the keynote, “Optimizing the Patient Experience of Vascular Access Decision-Making.” Woo is a professor of surgery at the David Geffen School of Medicine at UCLA, a vascular surgeon and principal investigator of a National Institutes of Health-funded mixed-methods clinical research group. Woo contributed to the Q&A sessions after the 22 oral presentations from students, residents and faculty members. An additional 14 studies were highlighted during a poster session.
1
2
3
Photo 1: Braidyn Lazenby, M.A., a doctoral student in the Moody College of Communication, presenting on the creation of a communication guide for individuals with an ostomy. Photo 2: Katherine Walsh, M.D. (PGY-2), general surgery resident, presenting “Short Term Outcomes for Patients Undergoing Roux-en-Y Gastric Bypass as Salvage Therapy for End-Stage Reflux Disease With Preservation of Fundoplication.” Photo 3: Winners of the Sixth Annual Research Symposium. Photo 4: Winners Braidyn Lazenby, M.A., and Sally You, M.S., for the Best Student Presentation Award with Associate Professor Joga Ivatury, M.D., MHA.
4 34
35 | ANNUAL REPORT 2022-2023
RESEARCH
6th Annual Research Symposium Award Winners
Health Equity Award Maya Eldin “Structural Racism, Residential Segregation and Exposure to Trauma: The Persistent Impact of Redlining”
Value Award
Best Resident/ Postdoc Presentation (tie) David Cron “Unintended Consequences of a Change to Broader Distribution of Deceased-Donor Kidneys” Elizabeth Duckworth, M.D., MBA “Improved Perioperative Efficiency in Orthopaedic Trauma Decreases Staffing Costs”
Kevin Smith, M.D. “Prehospital Buprenorphine Administration for Opioid Use Disorder: Bridging the Gap”
Best Poster (two awards)
Best Student Presentation (tie)
Qais Zai, M.D. “Factors Associated With Incidence and Recurrence of Lower Back Pain: A Large Population Analysis of the UK Biobank”
Braidyn Lazenby, M.A. “Speaking Stoma: Creating a Communication Guide for Individuals With an Ostomy”
Pegah Taheri “Hospitalist Co-Management of Urethroplasty Patients in an Academic Center: Implementation of a Standardized Postoperative Care Model”
Sally You “‘I Didn’t Know Where to Find Help’: A Mixed Methods Evaluation of Rectal Cancer Survivors in Texas”
36
HAPPENINGS
HAPPENINGS Thomas B. Coopwood Service Award
The Thomas B. Coopwood Service Award honors one or more Department of Surgery and Perioperative Care faculty members who have demonstrated a commitment to the department’s mission in transforming the health and lives of the diverse communities we serve through innovation in surgical care, research and education.
From left to right: Kevin Bozic, M.D., MBA., Art Markman, Ph.D., and Coopwood Award winner Garrett Scales, M.D.
37 | ANNUAL REPORT 2022-2023
Fro m l ef t to r i g h t : Kristofor Olson, M.D., Ph.D., guest speaker Sachin Jain, M.D., MBA, Kimberly Brown, M.D., and Kevin Bozic M.D., MBA.
Combined Grand Rounds
From left to right: Kimberly Brown, M.D., Sheila Dubin and Kevin Bozic, M.D., MBA. Guest speaker Sachin Jain, M.D., presenting on June 30, 2022.
Following the grand rounds presentation on Sept. 30, 2023, the education team led its first “Resident as Teachers” session, providing an opportunity for senior residents to review a case with junior residents.
Kevin Bozic, M.D., MBA, with guest speaker Amol Navathe, M.D., Ph.D.
Guest speaker Amol Navathe, M.D., Ph.D., presenting on March 30, 2023. 38
WHAT’S NEXT
The international Value-Based Health Care (VBHC) Event Prize awarded to Prakash Jayakumar, M.D., Ph.D., and Ariel Hortert in April 2023.
PHILANTHROPY FOR IMPACT Prakash Jayakumar, M.D., Ph.D., and Ariel Hortert won the Value-Based Health Care (VBHC) Event Prize 2023 in April. The VBHC Prize is a prestigious recognition from a renowned international jury and rewards inspiring initiatives that aim to redefine health care. This event is organized by the VBHC Center Europe, a leading platform based in the Netherlands, and comprised of ambassadors and an academic council that supports the endeavors of those who aim to share knowledge and connections in implementing value-based health care models across the health care community.
The prize recognized the value-based care model implemented at UT Health Austin’s Musculoskeletal Institute and the novel approaches the team has taken to create a transformative integrated practice unit (IPU) that focuses on the patient in a wholeperson approach.
39 | ANNUAL REPORT 2022-2023
T h e i n t e r n a t i o n a l j u r y re c o g n i ze d t h e Musculoskeletal Institute’s efforts to integrate patient-reported outcomes measures, cost transparency and realized cost savings, and use of technology in delivering high-quality care to patients. The team is honored to be recognized for their unique and impactful model of care here in Austin
and continue to celebrate the hard work of the research team and the Musculoskeletal Institute IPU staff and providers. The efforts of this research were supported substantially by the financial gift provided by Eric and Shanna Bass, which has been used to develop a parallel-site study between UT Health Austin and UT Health Science Center at San Antonio on the costs and outcomes of patient care since 2021.
To support this work and enable future impact, consider a gift:
giving.utexas.edu/surgery21
Senior Editor:
Editorial Team:
Graphic Design:
Melanie Montoya
Dory Thompson
Rachel Carper
Lauren Uhler Seth Mejia
Photographer:
Jeremy Marshall
Shannon Southerland
40
DEPARTMENT OF SURGERY AND PERIOPERATIVE CARE DELL MEDICAL SCHOOL AT THE UNIVERSITY OF TEXAS AT AUSTIN 1601 Trinity St., Bldg. B Austin, Texas 78712 512-495-5089 dellmed.utexas.edu @DellMedSchool