Department of Anesthesiology 2012 Annual Report

department of

anesthesiology 2012 annual report p r o f i l e s i n c l i n i c a l , e d u c at i o n a l and research excellence

2012 Annual Report

contents 1

A MESSAGE FROM THE DIRECTOR

2012 HIGHLIGHTS & STRATEGIC ACCOMPLISHMENTS

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Advancing Safety Through Clinical Initiatives, Quality Assessment and Performance Improvement

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Commitment to Exceptional Pain Management Care

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Patient Profile: Faith Selchick, RN

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Leading the Way in Anesthesia Education

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Profile in Teaching: Swetha Pakala, MD

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Investigator Profile: Stavros Memtsoudis, MD, PhD

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Advancing the Field through Clinical Research

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STAFF IN THE SPOTLIGHT

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DEPARTMENT GROWTH

2012 NOTABLE ACHIEVEMENTS

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Awards and Special Recognition

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Leadership Positions and Appointments

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Editorial Appointments

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Grants

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Staff Publications & Accomplishments

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2012 Selected Publications

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PROFESSIONAL AND ADMINISTRATIVE STAFF

DEPARTMENT OF ANESTHESIOLOGY

mission statement

“To achieve an international leadership role by providing the highest quality anesthetic care and pain management for patients undergoing orthopedic surgery, to advance the science of regional anesthesia, pain management, and orthopedic critical care through clinical and translational research, and to promote educational opportunities to all students of regional anesthesiology and pain medicine.”

department of anesthesiology

director a message from the

I

n 2012, the Department of Anesthesiology continued to make significant advances in clinical, educational, and research programs, helping to maintain our position as the premier department in the world for the practice of regional anesthesia and pain medicine for orthopedics. These GREGORY A. LIGUORI, MD advances are a direct result of Anesthesiologist-in-Chief the efforts of our extraordinary and Director group of physicians, clinicians, administrators and support staff, who have a clear understanding of the Department’s mission and work tirelessly to achieve our primary goal of providing the highest quality clinical care for our patients.

The Department has grown significantly over the past year, in stride with the growth of HSS as a whole. I am proud to report that along with this expansion, the quality of our patient care continues to improve every year. The testimonials throughout this report highlight the great work of our clinicians, researchers, and educators.

We continue to advance quality of care, focusing on providing an optimal anesthetic experience by minimizing side effects and complications. Our physician investigators, assisted by a dedicated research team, study the role of

anesthetics in the development of surgical complications such as blood loss, clotting, and infections, to promote the utilization of the safest anesthetic techniques.

As leaders in the field, our physicians share their regional anesthesia expertise via local, national, and international platforms. In 2012, our doctors traveled the globe, participating in medical missions and training programs in Africa, Asia, South America and the Middle East.

The comprehensive acute, recuperative and chronic pain services provided by our Pain Management Division were expanded via the recruitment of two additional boardcertified physicians, one of whom rounds full-time on the HSS inpatient population. Additionally, we maintained our focus on specialty physician teams, and in 2013 our orthopedic critical care program, in partnership with Perioperative Medicine and Orthopedic Surgery, will open the only orthopedic critical care unit in the world. No other Anesthesiology Department in the country can boast this level of focus and care for orthopedic patients.

I hope you enjoy reading about these and other Anesthesiology Department accomplishments in our 2012 Annual Report.

Gregory A. Liguori, MD Anesthesiologist-in-Chief and Director

2012 Annual Report

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2012

highlights &

strategic accomplishments

❯ ADVANCING SAFETY THROUGH CLINICAL INITIATIVES, QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT In 2012, the anesthesiologists of Hospital for Special Surgery performed 37,785 operating room anesthetics, 85 percent using regional anesthesia techniques. Vast experience in regional anesthesia makes the Department of Anesthesiology at HSS the premier Department in the world for the practice of regional anesthesia for orthopedics. As a leader in the field, HSS anesthesiologists perform ongoing evaluation of current clinical standards, policies and initiatives with the goal of improving safety and providing the highest quality anesthetic care.

In 2012, the Department’s Quality Assessment and Performance Improvement (QA/PI) staff monitored over 1,000 cases for physician compliance in performing pre-anesthetic site verification, labeling medication syringes, and use of patient identifiers in the holding area.

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Under the direction of Andy Lee, MD, QA/PI Director, and Maureen Stanton, RN, QA/PI Manager, the QA/PI Committee continued its review of guidelines and policies, developing evidence-based practice improvements to elevate quality to the highest level. Committee members participated in interdisciplinary conferences which provided thought-provoking conversation, educational opportunities and allowed the development of effective guidelines to improve patient safety. In 2012, the Committee developed a monthly newsletter to disseminate information discussed at interdisciplinary meetings to the Department’s attending anesthesiologists.

The newsletter provides physicians with current clinical information tailored to their practice, including synopses of meeting discussions and supportive literature, trends in anesthetic procedures at HSS, physician documentation compliance rates and a featured policy.

The Department continues to expand specialty

highlights & strategic accomplishments

DR. BEATHE DEMONSTRATED COMPASSION AND UNDERSTANDING. HE TOOK THE TIME TO GET TO KNOW ME AND BE AS HELPFUL AND ENLIGHTENING AS HE COULD TO ALLAY MY ANXIETIES. HE IS A VERY SPECIAL PHYSICIAN.

—EXCERPT FROM A 2012 PRESS GANEY PATIENT SURVEY

physician teams to provide patients with the highest level of care specific to their individual needs. In 2012, the Department focused on critical care specialty services to address an ongoing rise in the co-morbidity index for total hip and total knee replacement patients.

Led by Stavros Memtsoudis, MD, PhD, Director of Critical Care Services, Michael Urban, MD, PhD, PACU Director, and Michael Nurok, MBChB, PhD, SDU Director, the Department’s expert team of critical care trained physicians, nurse practitioners and physician assistants provided care for over 19,000 patients in the PACU and SDU. In November, to accommodate increased patient volume due to operating room expansion, a new 13-bed SDU opened on the hospital’s 5th floor. A 4-bed orthopedic critical care unit, the first of

its kind, will open adjacent to the SDU in 2013 and admit the highest acuity patients.

A total of 415 bilateral total knee arthroplasty (BTKA) procedures were performed at HSS in 2012. As the number of BTKA procedures increases, controversy continues to surround various aspects of the practice. A number of published studies suggest that same stage BTKA is associated with increased risk for morbidity and mortality compared to unilateral TKA, yet definitive prospective studies are lacking. While the safety of BTKA has been debated for many years and guidelines were developed at HSS to improve patient outcomes, until recently no national consensus existed to aid physicians and their patients in their decision-making process as to whether, or in what manner, to proceed with same stage BTKA. 37,785

31,143

33,192

34,779

total or anesthetics performed

2009–2012

40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000

2009

2010

2011

2012

Left: Mary Maher, CRNA

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highlights & strategic accomplishments

Above: Pain Management physicians Jeffrey Ngeow, MD, Vladimir Kramskiy, MD, David Wang, MD, Semih Gungor, MD, Christine Peterson, MD, Seth Waldman, MD, Dan Richman, MD and Robert Griffin, MD. Right: Our dedicated Pain Management nursing and office staff

After years of extensive research, Dr. Memtsoudis and a team of orthopedic surgeons, epidemiologists and biostatisticians produced an extensive body of literature regarding risk factors and mechanisms leading to adverse outcomes after bilateral knee arthroplasty. Following the principles of translational science research, the team sought to transform their collective clinical and scientific knowledge into actionable, evidence-based guidelines to be used by clinicians nationwide.

In September 2012, after an extensive consensus process that included a systematic evaluation of pertinent literature, writing of position papers and a thorough peer review, forty experts representing various specialties at sixteen institutions were invited to participate in a

Bilateral Total Knee Arthroplasty Consensus Conference in New York City. Orthopedic surgeons, cardiologists, critical care specialists, internists, pulmonologists and anesthesiologists with expertise in the selection and management of BTKA patients attended the two-day meeting and finalized recommendations for this patient population. A summary statement was drafted and submitted for publication; extensive dissemination of the results will follow via presentations at various subspecialty meetings.

employee of the month Congratulations to Kate Collins, Pain Management Nurse Practitioner, who was selected as the HSS Employee of the Month in November 2012. Kate has been a member of the Anesthesiology Department since July 2010. A competitive athlete and outdoor enthusiast, Kate was selected for her compassion and commitment to provide our patients with the highest level of clinical care.

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highlights & strategic accomplishments patient profile ❯ COMMITMENT TO EXCEPTIONAL PAIN MANAGEMENT CARE “I felt like part of the team that cared for me. My pain management care was excellent! All options were provided and explained, and all my needs were addressed, emotional, physical and social.”

—2012 Press Ganey Patient Satisfaction Survey Comment The Department’s Pain Management Division is committed to enhancing the mobility of patients affected by musculoskeletal pain and improving their quality of life. The Division’s highly trained physicians and clinical staff, directed by Seth Waldman, MD, Michael Gordon, MD, Vladimir Kramskiy, MD, Christine Peterson, MD, and Barbara Wukovits, RN, treat pain from its acute stages to more complex and chronic conditions. In 2012, our pain management teams treated over 29,000 patients.

As evidence of their skill, pain control scores reported in Press Ganey patient satisfaction surveys remained in the 99th percentile throughout the year.

In February, the Pain Management Center and interventional pain management physician offices moved to the new 75th Street campus. The Special Procedures Unit (SPU) was relocated as well, providing patients with greater convenience and a more integrated experience.

In 2012, pain management physicians performed over 3,000 interventional procedures in the SPU, including lumbar sympathetic blocks, epidural steroid injections, facet injections and radiofrequency denervation.

Robert Griffin, MD, PhD, joined the interventional

Seth Waldman, MD, and Donna Lawrence, NP

❮❮ Faith Selchick, RN Faith Selchick is a 27-year-old nurse who works in a chemotherapy infusion clinic at Yale-New Haven Hospital. On June 15, 2002, she was the passenger in a motor vehicle collision, an event that changed her life forever. Faith suffered trauma to her right knee, tearing both the medial and lateral meniscus.

After enduring two surgeries at another institution in an attempt to repair and subsequently remove the tears in her knee, Faith’s pain was becoming increasingly severe. She endured multiple nerve blocks, cortisone injections, daily aggressive physical therapy and countless medications and narcotics to no avail. Faith was unable to attend school and was forced to give up running, her passion in life.

Living in a world of severe pain, at 18, Faith came to Hospital for Special Surgery to meet with Seth Waldman, MD. Dr. Waldman confirmed a diagnosis of complex regional pain syndrome (CRPS) in her bilateral lower extremities.

Dr. Waldman began a multi-modal treatment plan, which included a variety of medications and nerve blocks. An inpatient Ketamine infusion gave Faith relief from the magnitude of CRPS for the first time, a treatment she continues today. According to Faith, “Dr. Waldman took me under his care and instilled hope in me. For the first time since CRPS entered my life, I felt optimistic that I would recover and regain my life. He forever changed my world.”

The ongoing care and expertise of Dr. Waldman has allowed Faith to resume a full life and fulfill her dreams to the highest potential. She completed a bachelor’s degree in psychology, enrolled in Duke University’s accelerated BSN program and, graduating at the top of her class, earned a RN, BSN degree. In August 2012, Faith enrolled at Yale University in a full time adult oncology nurse practitioner program, with the ultimate goal of obtaining a Doctor of Nursing Practice degree.

“To speak of my medical team and recognize their greatness is difficult because I do not know where to begin," she says. “Donna Lawrence, Nurse Practitioner for the Pain Medicine Division is one of my favorite providers. Dr. Seth Waldman is my angel and I am so thankful for him.

It is because of Dr. Waldman that I have been able to go after my goals and achieve them. He has never allowed me to give up, even when my pain was at its worst. He never gave up on me, and most importantly, he believed in me from the very beginning. He genuinely cares about his patients, and the compassion is evident in his face. He is a very special person and Hospital for Special Surgery is fortunate to have him."

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highlights & strategic accomplishments

profile in teaching

❮❮ Swetha Pakala, MD Dr. Swetha Pakala’s experiences in global health have included both short-term surgical missions and sustainable health efforts. Along with multidisciplinary teams of surgeons and other practitioners, Dr. Pakala participated in an Operation Rainbow mission to Ecuador in 2012, where the teams performed orthopedic surgery on over 80 patients in one week.

Although valuable, Dr. Pakala believes that medical missions are limited in their sustainability, and local infrastructures must be used to build medical workforces to make a meaningful and lasting impact. As such, her goal is to “teach teachers to teach” so that improved care continues in the absence of a medical mission.

Dr. Pakala travels the world teaching providers to safely use regional anesthesia, focusing on utilizing local resources to improve the safety profile of surgery. She has been integral to anesthesia teaching programs throughout Ethiopia, Malawi, Kenya and Uganda, and in 2012 she was selected as a member of the Health Volunteers Overseas Anesthesia Steering Committee of North America. Ultimately, Dr. Pakala hopes to develop lasting collaborations with physicians in under-resourced communities globally, believing that, as leaders in our field, our physicians’ impact in both service and teaching missions will be profound.

pain management staff and assumed the medical directorship of the ambulatory care pain clinic in November 2012. Over 400 patients were treated in the clinic, a weekly program providing outreach and pain control to an underserved patient population.

To improve the clinical management of chronic pain inpatients, the Department recruited a Director of Inpatient Pain Services. Christine Peterson, MD, board

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certified in internal medicine and pain and palliative medicine, joined the team in this newly created role.

Dr. Peterson conducts inpatient rounds and provides consults and follow-up visits to patients suffering from a myriad of complex pain conditions. Working collaboratively with pain management physicians, nurses and an interdisciplinary team, Dr. Peterson provides HSS patients with the highest level of specialized pain management care.

The Pain Management Division developed and revised several publications in 2012 to provide the most up-todate information to our patients and colleagues. The Ambulatory Surgery Post-Operative Pain Management Discharge Instructions booklet was distributed to educate patients regarding the use of analgesics post surgery, and the Clinicians Guide to Pain Management Services at Hospital for Special Surgery was revised to include the most recent recommendations for treating inpatient pain conditions. The Pain Management Opioid Options list was created to assist surgeons in providing optimal pain relief for patients undergoing unilateral knee surgery, and guidelines for a pre-operative pain management referral were drafted, outlining the types of patients that will benefit from a pre-operative pain consult and the process for obtaining one.

❯ LEADING THE WAY IN ANESTHESIA EDUCATION “The month I spent at HSS will remain one of my fondest memories of residency. The incredible learning environment, the warm support staff and the fantastic clinician educators made the month an unparalleled educational experience. I learned skills that I will carry with me for the rest of my career.”

—Jim Rothschild, MD, 2012 CA-3 resident The Department of Anesthesiology fosters an educational environment in which the highest level of academic excellence is established. Under the leadership of David Lee, MD, Medical Director, Education, Jonathan Beathe, MD, Director, Training Programs, and Mary Hargett, Administrative Director, Education, the Department strives to provide exceptional specialized training to the next generation of regional anesthesia providers.

highlights & strategic accomplishments

Left and below: 2012 Annual Symposium workshop and lecture

As leaders in the field of regional anesthesia, the physicians in the Department of Anesthesiology share workshops were a program highlight, enabling enhanced their knowledge on a local, national and international interaction among participants and the opportunity for platform by teaching regional anesthesia techniques to comprehensive hands-on training. residents and fellows, presenting at local and national The Sixth Annual Program on Pain Awareness, conferences and participating in teaching missions in entitled, “Pain Management in 2012: Issues, Challenges underserved populations throughout the world. and Treatments” was held in September and was th The Department’s 16 Annual Symposium, designed to address some of the challenging obstacles “Controversies and Fundamentals in Regional Anesthesia”, facing both the pain management patient and care was held in April 2012 and featured guest faculty from provider. Over 70 attendees participated in a day of Johns Hopkins Medicine. Over 200 attendees learned interactive discussion with a multidisciplinary faculty. about topics including The forum provided the value of intrapresentations on articular injections, care disparities, the possibility of 2012 gender differences regional anesthesia in response to pain, contributing to ❮❮ Chris Edmonds, MD, was chosen poly-pharmacy and lower cancer as 2011-2012 Teacher of the Year by the substance abuse, recurrence and 2012 graduating fellows. Dr. Edmonds and concluded with was also the recipient of this award the use of epidural an excellent case in 2004. analgesia to improve discussion segment. patient outcomes.

Educating ❯❯ Stephen Harris, MD, was chosen as With a ratio of one residents and 2012 HSS Teacher of the Year by the instructor per two fellows is an graduating anesthesiology residents of to three students, Weill Cornell Medical College. important focus the regional block of the Department,

teachers of the year

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highlights & strategic accomplishments

I LOVED MY ANESTHESIOLOGIST. HE WAS SO REASSURING AND I WENT INTO SURGERY WITH COMPLETE CONFIDENCE IN HIM.

—EXCERPT FROM A 2012 PRESS GANEY PATIENT SURVEY

and Carrie Guheen, MD, continues the Department’s mission to be the most trusted educator through teaching the next generation of regional anesthesiologists. In 2012, Dr. Guheen trained residents at the national American Society of Regional Anesthesia and Pain Medicine meeting in San Diego and national American Society of Anesthesiologists meeting in Washington, D.C. She presented a lecture to participants and taught basic regional anesthesia techniques, use of the ultrasound for nerve blocks, and common applications of regional

anesthesia. Dr. Guheen also precepted the Regional Anesthesia Resident Ultrasound Workshop, using 20 live patient models to demonstrate ultrasound techniques for nerve blocks including upper extremity, lower extremity, neuraxial blockade and TAP blocks.

On the international front, the World Health Organization states that “health is a human right” and every human should be entitled to a healthy life and adequate healthcare. Unfortunately, huge disparities in health remain, as low income countries carry a disproportionate burden of disease.

Given the global shortage of anesthesia providers, limited training and scarce resources, HSS anesthesiologists routinely participate in international educational endeavors to improve the safety of anesthetic care globally.

In January 2012, John Muller, MD, and regional anesthesia fellow Justo Left: Stavros Memtsoudis, MD, with Research Assistants Dan Yoo and James Bae. Below: Barbara Wukovits, RN, at the Annual Program on Pain Awareness

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highlights & strategic accomplishments

patient accolades Gonzalez, MD, participated in a medical mission to treat underserved patients in the Dominican Republic. This mission, conducted at Creighton University’s Institute for Latin American Concern (ILAC) in Santiago, provided necessary orthopedic procedures to 47 patients over a four-day period. More than 50 percent of the procedures involved regional anesthetics, including peripheral nerve blocks and neuraxial techniques. During the mission, Dr. Muller and Dr. Gonzalez also provided perioperative education in regional anesthesia to local providers.

Philip Wagner, MD, spent ten days in Israel teaching regional anesthesia and pain management in October 2012. He participated in a combined anesthesia/ orthopedics program at Assaf Harofeh Hospital near Tel Aviv and Hadassah Hospital in Jerusalem, where he lectured and performed hands-on operating room training.

International Research Fellowship In 2012, the Department began an exciting new partnership with Paracelsus Medical University and Salzburg University Hospital in Austria. In a collaborative research endeavor, residents from the hospital participate in a one year research fellowship at HSS. After two years of residency, Ottokar Stundner, MD, PhD, joined the research team in January 2012, becoming the first participant in this new program. Dr. Stundner had a very successful, productive and educational year, coauthoring six papers published in high-impact journals and presenting twelve abstracts at domestic and international congresses. His primary fields of work were clinical studies in the peri- and post-operative period and projects in outcomes research and epidemiology.

According to Dr. Stundner, “The research fellowship served as a unique opportunity to broaden my knowledge and perspective, as well as a great way to gain experience in top-class research. Best of all, it allowed me to work together with some of the most scientifically and clinically experienced anesthesiologists in the world.

The mentorship I received at HSS was not only an ideal primer for a scientific career, but also a valuable personal experience of collaboration and team spirit.”

2012

Each year we receive hundreds of accolades from patients praising the excellence of our physicians and staff. 2012 Press Ganey Patient Satisfaction Survey comments include: ❯❯ “ The morning of my surgery went smoothly and everyone I encountered was kind and professional. My anesthesiologist, Dr. DiMeo, had a total “take charge” approach, and I knew I was in good hands.” ❯❯ “ This was by far the best anesthesia experience I’ve ever had.” ❯❯ “ My anesthesiologist was outstanding. He understood issues that arose in my prior surgery and made excellent adjustments, absolutely perfect.” ❯❯ “ Dr. Quinn was amazing - he explained all anesthesia plans and pain levels perfectly.” ❯❯ “ Dr. Ngeow is out of this world! His whole staff is unusually excellent – bravo!” ❯❯ “ I want to commend Dr. Turteltaub. She was very careful to fully understand a disability I have that is very rare, researched it and made an important decision based on that information. All doctors should be as thorough and thoughtful as she is.” ❯❯ “ Dr. Ho was fantastic in explaining the anesthesia to me prior to surgery. He really put me at ease and calmed my nerves.” ❯❯ “ Dr. Guheen was my anesthesiologist and my angel. I love her and she took excellent care of me.” ❯❯ “ Dr. Richman’s expertise is the best. I have the utmost confidence in his skills.” ❯❯ “ Dr. Vladimir Kramskiy is one of the finest doctors I have ever had. He is a great communicator who patiently answers all my questions and concerns while looking right into my eyes.” ❯❯ “ I would like to extend personal thanks to my anesthesiologist, Dr. Swamidoss, for both his bedside manner & his medical skills. He calmed me down prior to the procedure, he clearly explained my anesthesia options & helped me make an informed choice with which I was more than satisfied. Because of his nerve block, I required NO pain meds after discharge.” ❯❯ “ Dr. Maalouf came to my holding room pre-surgery to talk about my special concerns. He listened carefully and gave me his undivided attention and care. I felt that I was in superb hands.”

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highlights & strategic accomplishments

investigator profile

❮❮ Stavros Memtsoudis, MD, PhD Stavros Memtsoudis, MD, PhD, conducts clinical trials research and is the principal investigator of multiple studies evaluating patient outcomes and anesthesiology practices in total joint replacement and complex spine patients. In 2012, he conducted eight clinical studies, published twenty-three papers and thirteen abstracts, and was honored with two prestigious awards for his prolific work.

A key element to the success of the Department’s Research Division is the multi-disciplinary approach of collaboration with HSS colleagues.

Recognizing that the high volume of patients at HSS is ideally suited to help answer important questions that are beyond the reach of other institutions, Dr. Memtsoudis spearheaded an interdisciplinary collaboration in the “Peri-Operative ISchemic Evaluation” (POISE-2) clinical trial in 2012. Both the POISE-1 and POISE-2 studies were initiated by the Population Health Research Institute (PHRI), McMaster University, Canada.

POISE-2 was designed to determine whether peri-operative low-dose clonidine and low-dose aspirin prevent all-cause mortality and nonfatal myocardial infarction without excessive risk of major bleeding or clinically impor-

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tant hypotension in patients undergoing non-cardiac surgery.

Aware that major heart problems during or after orthopedic surgeries represent a large scale health problem and encouraged by the data published in the POISE-1 study, Dr. Memtsoudis obtained support from Research Administration and the Department of Medicine in a joint collaboration on the POISE-2 trial. Dr. Memtsoudis and Dr. Linda Russell are co-principal investigators and a research coordinator in the Department of Medicine facilitates the study.

Dr. Memtsoudis began collaborating with Madhu Mazumdar, PhD, Chief of the Division of Biostatistics and Epidemiology in the Department of Public Health at Weill Cornell Medical College in 2007, and together they established a translational research team of orthopedic surgeons, anesthesiologists, biostatisticians and epidemiologists. The translational science team, most recognized for their work regarding the safety of bilateral total knee replacement surgery, found that the procedure carries a three-fold adjusted risk for in-hospital mortality and that staggering the procedure across several days produces even greater risk. They published thirteen papers on the topic, including a manuscript in Journal of American Medical Associa-

tion, and their findings influenced new guidelines for bilateral TKA at HSS and beyond. In recognition of their significant research contributions, the members of this collaboration were presented with the prestigious Team Science Award from the American Federation for Medical Research, Association for Clinical Research Training, Association for Patient Oriented Research and Society for Clinical and Translational Science in April 2012.

After preparing a proposal outlining his five year commitment to research at HSS, Dr. Memtsoudis received the Anna Maria and Stephen Kellen Foundation’s Clinician Scientist Career Development Award in July 2012. The program awards funds to clinicians with a well-defined plan for research activities integrated with clinical responsibilities, with a goal of creating a group of clinician scientists who will establish research careers and become future leaders in academic orthopedics, rheumatology and musculoskeletal specialties.

Dr. Memtsoudis stated, “This award is a big personal honor. It will allow me to pursue a career dedicated to research while maintaining my practice as a clinician, which in today’s environment is becoming increasingly difficult.

For that, I am incredibly grateful.”

highlights & strategic accomplishments

Annual Interdisciplinary Distinguished Professor in Anesthesiology Edward Mariano, MD, Chief of Anesthesiology and Perioperative Care Service at the VA Palo Alto Health Care System in California, presented Grand Rounds in December 2012 as the second participating anesthesiologist in Hospital for Special Surgery’s Annual Distinguished Professor Lecture Series. In his lecture, entitled, “Pay for Performance in Pain Management is Here: How Do You Define Quality and Add Value?”, Dr. Mariano provided an overview of value-based purchasing and suggested effective strategies to provide consistent high-quality pain management care for postsurgical patients. During his visit, Dr. Mariano also moderated a Visiting Professor Journal Club for Anesthesiology Department staff, toured clinical areas to view procedures and share best practice information, and met with an interdisciplinary group of the HSS leadership team to further discuss his Grand Rounds presentation.

❯ ADVANCING THE FIELD THROUGH CLINICAL RESEARCH Clinical research endeavors are fundamental to the Department’s mission of advancing the field of regional anesthesia. Our goal is to improve the patient experience by gaining a better understanding of how peri-operative

anesthetics affect patient outcomes. Guided by Jacques Ya Deau, MD, PhD, Director of Clinical Research and Carey Ford, Clinical Research Manager, the twelve members of the Department’s dedicated research team assist our physician investigators with study designs including randomized controlled trials, comparative effectiveness, pilots and medical databases. Publication of research in prominent peer-reviewed journals allows the research team to actively contribute to advancements in the international anesthesia community. To this end, the Department has an enduring commitment to support physician investigators and conduct high quality research.

In 2012, 30 full-length manuscripts were published and 23 abstracts were presented at national anesthesia conferences.

Continued Success for the Department’s First Research Fellow After completing an anesthesiology research fellowship, Anna Maria Bombardieri, MD, PhD, began a clinical fellowship at HSS in 2012. During this time, she continued her research and published three additional papers. Upon completion of the clinical fellowship, Dr. Bombardieri received the Department’s Nigel Sharrock Award for Excellence in Academic Research. Additionally, in November 2012 the Hospital honored Dr. Bombardieri with the Charles L. Christian Award for Excellence in Musculoskeletal Research for her work on cerebral blood flow velocity.

Right: Research team members Jodie Curren, Shane Reid and Marcus DiLallo. Below: Anna Maria Bombardieri, MD, PhD, receiving the Charles L. Christian Award from Thomas Sculco, MD and Charles Christian, MD

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staff in the

spotlight We would not be the leaders we are today without the efforts of our dedicated support team. As we acknowledge their role in our successes, we invite you to learn more about three members of our exceptional team:

❯❯ Kelly Culot

❯❯ Raymond Daniel

Physician Assistant, PACU-SDU

Senior Anesthesia Technician

Role: I work with my colleagues to facilitate post-surgical management of our patients in the recovery room, consulting with physicians and hospital staff on a case-by-case basis to meet the diverse medical needs of our patients. We use a variety of techniques and practices for controlling pain, while making patient safety our number one priority. My responsibilities include: planning for timely effective treatment, educating patients and families about their postoperative condition, and ensuring patient safety and quality care during and after their stay at our hospital.

A member of the HSS family since: October 2004 Why I love my job: I love my job for many reasons, but the one thing that stands out the most is the people I have the privilege to work with every day. Our commitment to providing patients with the best possible care in all circumstances is what makes the HSS community such a special place to work.

Goals: The emphasis our hospital and each department places on continued professional growth for all employees helps me continue to develop and improve my skills as a physician assistant for the Department of Anesthesiology.

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Role: I maintain anesthesia equipment and supplies in operating rooms and other clinical areas, provide technical support to the Department’s physicians and clinical support staff and work with Materials Management staff and other members of the technical support team to avoid potential supply inadequacies and address any deficiencies. Along with the Department’s other technical staff members, I ensure that our anesthesiologists have everything they need to make the operating rooms run as efficiently as possible.

A member of the HSS family since: March 1998 Why I love my job: I truly enjoy being a member of the anesthesiology staff and HSS family; I am proud to be part of a team that is integral in providing the best care to our patients.

Goals: I am interested in improving my performance through ongoing training and education, and I am grateful that the department enables my continued learning by providing me with the opportunity to attend conferences and avail of other educational opportunities.

❯❯ Sarah Kennedy

QA/PI Supervisor Role: My responsibilities include tracking and maintaining compliance for state and federal regulations, maintaining physician and CRNA profiles, managing an anesthesia literature database, collecting and analyzing departmental QA data and maintaining quarterly reports. In addition, I implement QA educational initiatives including orientation for incoming residents and writing our monthly QA newsletter.

A member of the HSS family since: August 2009 Why I love my job: My co-workers in the Anesthesiology Department are incredibly intelligent and hardworking, as well as being one of the most fun groups of people I know. Being around such dynamic personalities is motivating and keeps me engaged.

Goals: In 2012, I accomplished my goal of receiving a master’s degree.

I would love to continue in my career path at HSS and plan to support that by obtaining certifications in healthcare quality and healthcare administration.

department

growth The Department of Anesthesiology proudly announced the addition of four outstanding physicians to our team in 2012: Adam Booser, MD Assistant Attending Anesthesiologist After graduating from the University of Kansas School of Medicine, Dr. Booser completed an anesthesiology residency at Weill-Cornell Medical Center and fellowship in pediatric anesthesiology at Children’s Hospital of Denver. Dr. Booser is board-certified in anesthesiology and worked as a pediatric anesthesiologist at Children’s Mercy Hospitals and Clinics in Kansas City, MO, prior to joining the HSS staff.

Robert S. Griffin, MD, PhD Director, Ambulatory Pain Medicine Program Dr. Griffin, double board-certified in anesthesiology and pain medicine, received his medical degree from Harvard Medical School and his PhD in neuroscience from Harvard University. He recently completed a residency in anesthesia and a fellowship in pain medicine at Massachusetts General Hospital. Dr. Griffin has conducted research on the relationship between genetics and pain, and is interested in translational and clinical pain research.

Swetha Pakala, MD Assistant Attending Anesthesiologist Dr. Pakala completed medical school and residency training at the University of California, San Francisco, and joined our attending staff after graduating from HSS’ Regional Anesthesia and Acute Pain Medicine Fellowship.

During her fellowship she received the Attending Anesthesiologists’ Award for Clinical Excellence, and was later awarded a traveling fellowship by Health Volunteers Overseas in collaboration with the Society for Education in Anesthesia. Dr. Pakala is board-certified in anesthesiology.

Christine Peterson, MD Director, Inpatient Pain Medicine Services Board-certified in internal medicine and pain and palliative medicine, Dr. Peterson received her medical degree from SUNY, Stony Brook, completed an internal medicine residency at Lenox Hill Hospital and graduated from the Memorial Sloan-Kettering pain and palliative care fellowship program. Prior to joining the pain management team, Dr. Peterson worked at Hospice of New York, where she served as the Bronx Regional Medical Director and Medical Director of St. Barnabas Hospice Inpatient Unit.

❯❯ In addition, fourteen new staff members joined our talented team in 2012. The department welcomed: Nancy Blissett LPN/Administrative Assistant for Dr. Kramskiy

Victoria Emem Office Manager for Dr. Griffin

Eric Chen Research Assistant

Wesley Hicken Physician Assistant, PACUSDU

Marcus DiLallo Research Assistant

Alvin Joseph QA/PI Assistant Halsey Julien, CRNA

Kaitlyn LaFerrara, CRNA Mario Nova Physician Assistant, PACU-SDU Grace Parreno, NP Pain Management

Heather Reel Research Assistant Matthew Rosenberg Finance Manager Latha Swamy, MS Research Coordinator

Janey Quinn Physician Assistant, PACU-SDU

2012 Annual Report

13

2012

notable ACHIEVEMENTS

AWARDS AND SPECIAL RECOGNITION Chris R. Edmonds, MD Fellows’ “Teacher of the Year” Award, 2011-2012 Stephen N. Harris, MD Cornell Anesthesiology Residents’ “Teacher of the Year” Award, 2011- 2012 Spencer S. Liu, MD Team Science Award for Translational Research, awarded by the American Federation for Medical Research, Association for Clinical Research Training, Association for PatientOriented Research and Society for Clinical and Translational Science Stavros G. Memtsoudis, MD, PhD Anna Maria and Stephen Kellen Clinician Scientist Career Development Award Team Science Award for Translational Research, awarded by the American Federation for Medical Research, Association for Clinical Research

14

department of anesthesiology

Training, Association for PatientOriented Research and Society for Clinical and Translational Science Nigel E. Sharrock, MBChB Team Science Award for Translational Research, awarded by the American Federation for Medical Research, Association for Clinical Research Training, Association for PatientOriented Research and Society for Clinical and Translational Science

LEADERSHIP POSITIONS AND APPOINTMENTS James D. Beckman, MD Instructor, Anatomy Course, New York Presbyterian Hospital, New York, NY Jonathan C. Beathe, MD Member, ASA Advisory Council Douglas S. T. Green, MD Instructor, Bio-Ethics Course, New York Presbyterian Hospital, New York, NY

Carrie R. Guheen, MD Instructor, Anatomy Course, New York Presbyterian Hospital, New York, NY Invited Speaker, American Society of Regional Anesthesia National Meeting, San Diego, CA Richard L. Kahn, MD Instructor, Anatomy Course, New York Presbyterian Hospital, New York, NY David L. Lee, MD Member, Medical School Admissions Committee, Weill Cornell Medical College Instructor, Anatomy Course, New York Presbyterian Hospital, New York, NY Spencer S. Liu, MD Examiner, American Board of Anesthesiology Chair, Committee for ASRA AQI Clinical Registry Stavros G. Memtsoudis, MD, PhD Director, Bilateral Knee Arthroplasty Symposium, New York, NY Member, American Society of

notable achievements

Anesthesiologists’ Committee on Database Research Member, New York State Society of Anesthesiologists’ Committee on Critical Care Medicine Member, Society of Anesthesia and Sleep Medicine Newsletter Committee Member, Society of Anesthesia and Sleep Medicine Research Committee Invited Speaker, Society of Anesthesiology and Sleep Medicine Meeting 2012, Washington DC Invited Speaker, American Society of Anesthesiologists Meeting 2012, Washington DC Visiting Professor, Grand Rounds, Paracelsus Medical University, Salzburg, Austria Visiting Professor, Grand Rounds, Weill Cornell Medical College Department of Public Health, New York, NY Jeffrey Y.F. Ngeow, MD Director At Large, New York Society of Interventional Pain Physicians Advisory Board Member, New York Society of Interventional Pain Practice Member, Review Committee for Grant Application, Cornell Clinical and Translational Science Center Member, Pain Committee, New York State Society of Anesthesiologists Honorary Member, Chinese American Society of Anesthesiologists Invited Speaker, International Conference on Chinese Medicine, Kuala Lumpur Michael Nurok, MB ChB, PhD Member, American Society of Anesthesiologists Committee on Ethics Member, Quality & Safety Committee, Society of Critical Care Medicine Member, Anesthesiology Section Advisory Board, Society of Critical Care Medicine Visiting Professor, Grand Rounds, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA Invited Speaker, American Association of Orthopedic Surgery Annual Meeting, San Francisco, CA Invited Speaker, NYPH Pulmonary Fellows Lecture Invited Speaker, American Society of Anesthesiologists 2012 Annual Meeting, Washington, DC Invited Speaker, University of Paris – Nanterre, Paris, France Opening Speaker, University of Paris – Diderot, Paris, France

Swetha R. Pakala, MD Member, Health Volunteers Overseas Anesthesia Steering Committee

Medicine Section Editor, Pain Medicine, Anesthesia & Analgesia

Lauren H. Turteltaub, MD Instructor, Anatomy Course, New York Presbyterian Hospital, New York, NY

Daniel B. Maalouf, MD, MPH Scientific Reviewer, Journal of Clinical Anesthesiology

Michael Urban, MD, PhD Invited Speaker, Society for Perioperative Assessment and Quality Improvement Meeting, Miami, FL

Stavros G. Memtsoudis, MD, PhD Scientific Reviewer, Anesthesiology Scientific Reviewer, Anesthesia and Analgesia Scientific Reviewer, Annals of Internal Medicine Scientific Reviewer, Annals of Thoracic Surgery Scientific Reviewer, Cleveland Clinic Journal of Medicine Scientific Reviewer, Clinical Anatomy Scientific Reviewer, Critical Care Scientific Reviewer, HSS Journal Scientific Reviewer, Journal of Clinical Anesthesiology Scientific Reviewer, Journal of Clinical Epidemiology Scientific Reviewer, Journal of Clinical Orthopedics and Related Research Scientific Reviewer, Journal of Critical Care Medicine Scientific Reviewer, Journal of Thoracic and Cardiovascular Surgery Scientific Reviewer, Regional Anesthesia and Pain Medicine

William F. Urmey, MD Board of Directors, American Society of Regional Anesthesia and Pain Medicine Chair, Distinguished Service Award Committee, American Society of Regional Anesthesia and Pain Medicine Invited Speaker, American Society of Regional Anesthesia National Meeting, San Diego, CA Seth A. Waldman, MD Secretary, New York State Society of Interventional Pain Physicians Visiting Professor, Neurological Surgery Grand Rounds, Weill Cornell Medical College, New York, NY Philip J. Wagner MD Visiting Professor, Postoperative & Interventional Pain Management Symposium, Sackler School of Medicine / Assaf Harofeh Medical Center, Tel Aviv, Israel Visiting Professor, Hadassah Hospital & Medical Center, Department of Anesthesiology, Jerusalem, Israel Jacques T. Ya Deau, MD, PhD Invited Speaker, American Society of Regional Anesthesia National Meeting, San Diego, CA

EDITORIAL APPOINTMENTS Jonathan C. Beathe, MD Scientific Reviewer, Journal of Clinical Anesthesiology Scientific Reviewer, Journal of Clinical Orthopedics and Related Research Kethy M. Jules-Elysee, MD Editorial Board, HSS Journal Gregory A. Liguori, MD Editor, Anesthesia and Analgesia Associate Editor, Regional Anesthesia and Pain Medicine Spencer S. Liu, MD Editor, Regional Anesthesia & Pain

Michael Nurok, MBChB, PhD Anesthesiology Section Advisory Board, Society of Critical Care Medicine Scientific Reviewer, Cochrane Review Group Scientific Reviewer, Critical Care Scientific Reviewer, Critical Care Medicine Scientific Reviewer, Journal of Critical Care Scientific Reviewer, Current Opinion in Anesthesiology Scientific Reviewer, Anthropology & Medicine Scientific Reviewer, Millbank Quarterly Scientific Reviewer, Social Science and Medicine Scientific Reviewer, Sociology of Health and Illness William F. Urmey, MD Scientific Reviewer, Anesthesiology Scientific Reviewer, Regional Anesthesia & Pain Medicine Seth A. Waldman, MD Scientific Reviewer, The Medical Letter Jacques T. Ya Deau, MD, PhD Associate Editor, Regional Anesthesia and Pain Medicine

2012 Annual Report

15

notable achievements

Editorial Board, HSS Journal Scientific Reviewer, Anesthesia and Analgesia

GRANTS “Analgesia after Total Hip Arthroplasty: Peri-Articular Injection vs. Epidural.”

Adult Reconstruction and Joint Replacement (ARJR) Research & Innovation Committee Research Grants December 13, 2011 – December 31, 2012 Principal Investigator: Kethy JulesElysee, MD The HSS Anesthesia/ARJR Research Collaboration (HAARC, a group of anesthesiologist and surgeon investigators) designed this collaborative study to assess two different multimodal pain management regimens. This study aims to determine if the peri-articular injection treatment reduces the time until patients are ready for discharge, reduces opioid utilization, and improves patient quality of recovery and satisfaction compared with the patient controlled epidural analgesia regimen. The study is anticipated to complete enrollment in early 2013.

“Comparative Effectiveness of Interventions for Chronic Pain Management.”

National Institute of Health RC2 Award November 2009 – August 31, 2012 Principal Investigator: Charles Inturrisi, PharmD; Weill Cornell Medical College

Co-Investigators: Semih Gungor, MD and Seth A. Waldman, MD The goals of this project are to establish a retrospective chronic pain data registry for patients of 4 New York City academic hospital-based pain clinics that employ interdisciplinary pain management treatments; use Practice Based Evidence (PBE) methodology to create a comprehensive, prospective chronic pain data registry, using the retrospective registry as a foundation; and use both registries to identify specific pain management interventions that are most effective for specific patient types with chronic pain.

“Chronic Pain Management Costs in a Multi-Institutional Patient Registry.”

Clinical and Translational Science Center (CTSC) Pilot Award June 1, 2010 – May 31, 2012 Principal Investigator: Bruce R. Schackman, PhD, Weill Cornell Medical College Co-Investigators: Semih Gungor, MD and Seth A. Waldman, MD In collaboration with Dr. Inturrisi’s NIH sponsored chronic pain registry, this project will collect cost information from a subset of patients across the four institutions.

“Implementation of Electronic Medical Records to Initiate a Chronic Pain Registry.”

Clinical and Translational Science Center (CTSC) Pilot Award

June 1, 2010 – May 31, 2012 Principal Investigator: Seth A. Waldman, MD Conversion of paper based office charts to electronic format enabling participation in the NIH sponsored chronic pain registry lead by Dr. Inturrisi. Registry will include detailed patient characteristics (including severity of illness) and assessments, treatments, interventions and outcomes data that have been standardized across four participating pain clinics during the first year of the project.

2012 SELECTED PUBLICATIONS Original Articles Bekker A, Haile M, Kline R, Didehvar S, Babu R, Martiniuk F, Urban M. The Effect of Intraoperative Infusion of Dexmedetomidine on the Quality of Recovery After Major Spinal Surgery. J Neurosurg Anesthesiol. 2012 Jul 19.

[Epub ahead of print] Bombardieri AM, Beckman J, Shaw P, Girardi FP, Ma Y, Memtsoudis SG. Comparative Utility of Centrally versus Peripherally Transduced Venous Pressure Monitoring in the Perioperative Period in Spine Surgery Patients. 2012 Nov; 24(7):542-8. Epub 2012 Sep 20.

Della Valle AG, Chiu YL, Ma Y, Mazumdar M, Memtsoudis SG. The metabolic syndrome in patients undergoing knee and hip arthroplasty:

staff publications and accomplishments 2012 ❯❯ The Research Division held its first annual Research Awards Ceremony in December. Eric Chen received the Heart of Excellence Award for consistently demonstrating engagement, spirited enthusiasm, eagerness to help those around him and willingness to learn. Amanda Goon received the Excellence in Research Professionalism Award for demonstrating

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exceptional performance in enrollment duties, data collection, protocol development, manuscript preparation and data analysis. ❯❯ The HSS Anesthesiology Department is the subject of the cover article, written by Mary Hargett, in the Fall 2012 edition of SPHERE, the New York State Society of Anesthesiologists’ quarterly publication. ❯❯ Sarah Kennedy received

department of anesthesiology

a Masters in Science degree in Environmental Health Medicine from NYU in May 2012.

Her thesis, entitled “Chained to a Stranger”, investigated occupational hazards of anesthesiologists. ❯❯ Junior Rigby was the subject of an article in the Summer 2012 issue of “The Sensor”, a publication of the American Society of Anesthesia Technologists and Technicians.

❯❯ In April, Barbara Wukovits, RN, participated in the Pain Management Expert Panel for the American Nurses Credentialing Center, helping to develop and review current practice in pain management for use in a certification examination. Barbara also participated in a Research Special Interest Group Panel during the National Association of Orthopedic Nursing’s Annual Meeting in New Orleans, LA.

Trends and Outcomes in the United States.

J Arthroplasty. 2012 Jun 5. [Epub ahead of print] Gritsenko K, Marcello D, Liguori GA, Jules-Elysée KM, Memtsoudis SG. Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses. Br J Anaesth. 2012 Mar;108(3):485-90. Epub 2011 Dec 16.

Jules-Elysée KM, Wilfred SE, Memtsoudis SG, Kim DH, YaDeau JT, Urban MK, Lichardi ML, McLawhorn AS, Sculco TP. Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective double-blind, randomized controlled trial. J Bone Joint Surg Am. 2012 Oct 24 [Epub ahead of print] Kirksey MA, Issack PS, Edmonds CR, Souweidane MM, Lee A, Perlman S, Zayas VM, Boachie-Adjei O. Fatal Cerebral Swelling Associated with Scoliosis Surgery in Two Patients with Neuromuscular Scoliosis and Congenital Hydrocephalus. JBJS Case Connector, 2012 May 23;2(2):e23 1-5.

Kirksey MA, Chiu YL, Ma Y, Gonzalez Della Valle A, Poultsides L, Gerner P, Memtsoudis SG. Trends in in-hospital major morbidity and mortality after total joint arthroplasty: USA 1998-2008.

Anesth Analg 2012 Aug;115(2):321-7.

Epub 2012 May 31.

Krych AJ, Richman D, Drakos M, Barnes R, Cammisa F, Warren RF. Epidural Steroid Injection for Lumbar Disc Herniation in NFL Athletes. Medicine & Science in Sports & Exercise. 2012 Feb;44(2):193-8.

Kuo C, Chiu YL, Edwards A, Mazumdar M, Memtsoudis SG. Regional anesthesia for children undergoing orthopedic ambulatory surgeries in the United States, 19962006. HSS Journal ®, 2012, Volume 8, Number 2, Pages 133-136.

Liu SS, Bae JJ, Bieltz M, Ma Y, Memtsoudis SG. Association of perioperative use of nonsteroidal antiinflammatory drugs with postoperative myocardial infarction after total joint replacement. Reg Anesth Pain Med. 2012 Jan;37(1):45-50.

Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, Perros S, Pope AJ, Poultsides L, Della Valle CJ, Shin NS, McCartney CJ, Ma Y, Shah

M, Wood MJ, Manion SC, Sculco TP. A Cross-Sectional Survey on Prevalence and Risk Factors for Persistent Postsurgical Pain 1 Year After Total Hip and Knee Replacement. Reg Anesth Pain Med. 2012 Jul-Aug;37(4):415-22.

Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, Perros S, Pope AJ, Poultsides L, Valle CJ, Shin NS, McCartney CJ, Ma Y, Shah M, Wood MJ, Manion SC, Sculco TP. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop. 2012 Nov;36(11):2261-7.

Maalouf D, Liu SS, Movahedi R, Goytizolo E, Memtsoudis SG, Yadeau JT, Gordon MA, Urban M, Ma Y, Wukovits B, Marcello D, Reid S, Cook A. Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery. J Clin Anesth. 2012 Feb;24(1):44-50.

Memtsoudis SG, Bombardieri AM, Ma Y, Girardi F. The effect of low versus high tidal volume ventilation on inflammatory markers in healthy individuals undergoing posterior spine fusion in the prone position: a randomized controlled trial. J

Clin Anesth. 2012 Jun;24(4):263-9. Epub 2011 Oct 15.

Memtsoudis SG, Bombardieri AM, Ma Y, Walz JM, Chiu YL, Mazumdar M. Mortality of patients with respiratory insufficiency and adult respiratory distress syndrome after surgery: the obesity paradox. J Intensive Care Med. 2012 Sep;27(5):306-11. Epub 2011 Jul 21.

Memtsoudis SG, Dy CJ, Ma Y, Chiu YL, Della Valle AG, Mazumdar M. InHospital Patient Falls After Total Joint Arthroplasty: Incidence, Demographics, and Risk Factors in the United States. J Arthroplasty. 2012 Jun;27(6):823-8.e1.

Epub 2011 Nov 23.

Memtsoudis SG, Liu SS. Bispectral Index versus Minimum Alveolar Concentration for Prevention of Intraoperative Awareness: Does a Practical Controlled Trial Provide CERtainty? Anesthesiology. 2012 Oct;117(4):693-5.

Memtsoudis SG, Ma Y, Swamidoss CP, Edwards AM, Mazumdar M, Liguori GA. Factors influencing unexpected disposition after orthopedic ambulatory surgery. J Clin Anesth. 2012 Mar;24(2):89-95. Epub 2012 Feb 4.

2012 Annual Report

17

notable achievements

Memtsoudis SG, Mantilla CB, Parvizi J, Stundner O, Mazumdar M. Have Bilateral Total Knee Arthroplasties Become Safer?: A Population-Based Trend Analysis. Clin Orthop Relat Res. 2012 Sep 25. [Epub ahead of print]

Vulcano E, Gesell M, Esposito A, Ma Y, Memtsoudis SG, Della Valle AG. Multimodal thromboprophylaxis with preferential use of aspirin for elective hip and knee arthroplasty. Int Orthop. 2012 Jun 12. [Epub ahead of print]

Memtsoudis SG, Pumberger M, Ma Y, Chiu YL, Fritsch G, Gerner P, Poultsides L, Della Valle AG. Epidemiology and risk factors for perioperative mortality after total hip and knee arthroplasty. J Orthop Res 2012 Apr 19. [Epub ahead of print]

Yadeau JT, Paroli L, Kahn RL, JulesElysée KM, Lasala VR, Liu SS, Lin E, Powell K, Buschiazzo VL, Wukovits B, Roberts MM, Levine DS. Addition of pregabalin to multimodal analgesic therapy following ankle surgery: a randomized double-blind, placebocontrolled trial. Reg Anesth Pain Med. 2012 May 2012;37(3):302-7.

Memtsoudis SG, Sun X, Chiu YL, Nurok M, Stundner O, Pastores SM, Mazumdar M. The utilization of critical care services among patients undergoing total hip and knee arthroplasty: epidemiology and risk factors.

Anesthesiology. 2012 Jul;117(1):107-16.

Passias PG, Ma Y, Chiu YL, Mazumdar M, Girardi FP, Memtsoudis SG. Comparative Safety of Simultaneous and Staged Anterior and Posterior Spinal Surgery. Spine (Phila Pa 1976). 2012 Feb 1;37(3):247-55.

Poultsides LA, Ma Y, Della Valle AG, Chiu YL, Sculco TP, Memtsoudis SG. In-hospital Surgical Site Infections after Primary Hip and Knee Arthroplasty – Incidence and Risk Factors. J Arthroplasty 2012 Nov 8 [Epub ahead of print] Stundner O, Chiu YL, Sun X, Mazumdar M, Fleischut P, Poultsides L, Gerner P, Memtsoudis SG. Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty. Reg Anesth Pain Med. 2012 Nov-Dec;37(6):638-44.

Stundner O, Kirksey MA, Chiu YL, Mazumdar M, Poultsides L, Gerner P, Memtsoudis SG. Demographics and Perioperative Outcome in Patients with Depression and Anxiety Undergoing Total Joint Arthroplasty: A Population-Based Study. Psychosomatics. 2012 Nov 27 [Epub ahead of print] Stundner O, Memtsoudis SG. Regional anesthesia and analgesia in critically ill patients: a systematic review. Reg Anesth Pain Med. 2012 Sep;37(5):537-44.

Stundner O, Taher F, Abhijit P, Memtsoudis SG. Pulmonary Complications after Spine Surgery. World Journal of Orthopedics. 2012 October 18; 3(10): 156-161.

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department of anesthesiology

YaDeau JT, Tedore T, Goytizolo EA, Kim DH, Green DST, Westrick A, Fan R, Rade MC, Ranawat AS, Coleman SH, Kelly BT. Lumbar Plexus Blockade Reduces Pain after Hip Arthroscopy: A Prospective Randomized Controlled Trial.

Anesth Analg. 2012 Jul 19. [Epub ahead of print] Abstracts and Presentations Bae JJ, Gungor S, Buschiazzo V, Ford C, Gristsenko K, Storm H, Christos PJ. Electrical Skin Conductance Monitoring as an Assessment of Postoperative Pain Scores. 6th World Congress – World Institute of Pain (WIP), Miami Beach, FL, February 2012.

Bae JJ, Gungor S, Buschiazzo V, Ford C, Gritsenko K, Storm H, Christos PJ. The Effect of Acute Pain and Emotional Stressors on Skin Conductance Indices.

37th Annual American Society of Regional Anesthesia (ASRA) Meeting and Workshops, March 2012, San Diego, CA. Conwell C, Magid S, Ma Y, Urban M. The Incidence of Atrial Fibrillation After Orthopedic Surgery. Perioperative Medicine Summit March 2012, Miami, FL. Haskins S, Kahn R, Shaw PM, Reid S. Postoperative Pain Control and Block Satisfaction following Brachial Plexus Block for Ambulatory Shoulder Surgery.

37th Annual American Society of Regional Anesthesia (ASRA) Meeting and Workshops, March 2012, San Diego, CA. Kim D, YaDeau JT, Lin Y, Maalouf D, Kahn R, Goytizolo E, Manohar A, Patt M, Marcello D. Saphenous (Adductor Canal) Nerve Block vs. Femoral Nerve Block for Total Knee Arthroplasty: A Novel Approach for Postoperative Analgesia. 37th Annual American Society

of Regional Anesthesia (ASRA) Meeting and Workshops, March 2012, San Diego, CA. [2012 ASRA Resident Travel Award Winner, selected for oral presentation] Krych AJ, Mark Drakos M, Birmingham P, Richman D, Weiss LJ, Barnes RP, Cammisa F, Warren RF. Return to Play After Epidural Steroid Injection for Lumbar Disc Herniation in Professional American Football Athletes. American Orthopaedic Society for Sports Medicine (AOSSM) Specialty Day February 2012, San Francisco, CA. Krych AJ, Mark Drakos M, Birmingham P, Richman D, Weiss LJ, Barnes RP, Cammisa F, Warren RF. Return to Play after Epidural Steroid Injection for Lumbar Disc Herniation in Professional Football Athletes. American Academy of Orthopaedic Surgeons (AAOS) February 2012 Annual Meeting, San Francisco, CA. Liu SS, Buvanendran A, Rathmell JP, McCartney CJ, Bae JJ. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement.

American Society of Anesthesiologists (ASA) Annual Meeting, October 2012, Washington DC. [Selected for oral presentation]

notable achievements

October 2012, Washington DC. Stundner O, Gerner P, Chiu YL, Sun X, Memtsoudis SG. Non-Invasive Ventilation in Sleep Apnea Patients Undergoing Spine Surgery. Society of Anesthesia and Sleep Medicine (SASM), October 2012, Washington DC. Stundner O, Kirksey MA, Chiu YL, Mazumdar M, Poultsides L, Gerner P, Memtsoudis SG. Perioperative outcomes in patients with anxiety and depression undergoing orthopedic surgery. 37th Annual American Society of Regional Anesthesia (ASRA) Meeting and Workshops, March 2012, San Diego, CA. Stundner O, Rasul R, Chiu YL, Fleischut P, Mazumdar M, Memtsoudis SG. Perioperative Outcomes of Patients with Sleep Apnea Undergoing Hip and Knee Arthroplasty, 66th Meeting of the Postgraduate Assembly in Anesthesiology (PGA) 2012, New York City, NY

Memtsoudis SG, Stundner O, Gerner P, Chiu YL, Fleischut P. Sleep Apnea and Perioperative Outcomes in Spine Surgical Patients: A Population Based Study. Society of Anesthesia and Sleep Medicine (SASM), October 2012, Washington DC. Memtsoudis SG, Stundner O, Sun X, Chiu YL, Walz JM, Gerner P, Liu S, Sharrock N. Perioperative Komplikationen unter Verwendung von Neuraxial- vs. Allgemeinanästhesie bei orthopädischen Patienten (Perioperative outcomes after neuraxial versus general anesthesia in orthopedic patients), 2012 Conference of the German Society of Anesthesiology (DAC), Leipzig, Germany.

Anesthesia Research Society (IARS) May 2012 Annual Meeting, Boston MA. Stundner O, Gaber L, Chiu YL, Sun X, Mazumdar M, Memtsoudis SG. Tracheostomy After Cervical Spine Fusion Surgery Incidence, Risk Factors and Outcome. Society of Critical Care Anesthetists (SOCCA), October 2012, Washington DC. Stundner O, Chiu YL, Sun X, Ma Y, Fleischut P, Memtsoudis SG. The Utilization of Critical Care Services Among Patients Undergoing Spine Fusion Surgery. Society of Critical Care Anesthetists (SOCCA), October 2012, Washington DC.

Memtsoudis SG, Sun X, Chiu YL, Stundner O, Liu SS, Banerjee S, Mazumdar M, Sharrock NE. Type of Anesthesia and Perioperative Outcomes after Orthopedic Surgery. 37th Annual American Society of Regional Anesthesia (ASRA) Meeting and Workshops, March 2012, San Diego, CA.

Stundner O, Chiu YL, Sun X, Mazumdar M, Fleischut P, Poultsides L, Gerner P, Memtsoudis SG. Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee Arthroplasty. American Society of Anesthesiologists (ASA) Annual Meeting, October 2012, Washington DC.

Motaghedi R, Bae JJ, Shaw PM, Memtsoudis SG, Liu SS. Association of BMI with postoperative pain and quality of recovery after total hip replacement: Role of insulin resistance. International

Stundner O, Danninger T, Memtsoudis SG. Hemodynamic effects of increasing airway resistance in spontaneously breathing, healthy volunteers. Society of Anesthesia and Sleep Medicine (SASM),

Su E, Bombardieri AM, Go G, Sculco T, Sharrock NE. Cerebral Blood Flow Velocity is Preserved during Total Hip Arthroplasty under Hypotensive Epidural Anesthesia. American Academy of Orthopaedic Surgeons (AAOS) February 2012 Annual Meeting, San Francisco, CA. Westrich GH, Padgett DE, Mayman DJ, Ranawat AS, Alexiades MM, Ranawat CS, Su EP, YaDeau J. Prospective Randomized Knee Arthroplasty TrialEpidural/Femoral Blockade versus Periarticular Injection. American Academy of Orthopaedic Surgeons (AAOS) February 2012 Annual Meeting, San Francisco, CA. Yoo D, Stundner O, Jules-Elysée KM, Della Valle AG, Sculco TP, Boettner F, Memtsoudis SG. The Impact of Ischemic Preconditioning on Postoperative Pain After Total Knee Arthroplasty.

American Society of Anesthesiologists (ASA) Annual Meeting, October 2012, Washington DC. Yoo D, Stundner O, MD, Sun X, Chiu YL, Nurok M, Memtsoudis SG. Utilization of higher levels of care among total joint arthroplasty recipients. 37th Annual American Society of Regional Anesthesia (ASRA) Meeting and Workshops, March 2012, San Diego, CA.

2012 Annual Report

19

professional

staff &

ANESTHESIOLOGIST-IN-CHIEF AND DIRECTOR Gregory A. Liguori, MD ATTENDING ANESTHESIOLOGISTS Spencer S. Liu, MD Stavros G. Memtsoudis, MD, PhD Medical Director, Critical Care Services Nigel E. Sharrock, MBChB ASSOCIATE ATTENDING ANESTHESIOLOGISTS Stephen N. Harris, MD Jeffrey Y.F. Ngeow, MD Michael Nurok, MBChB, PhD Medical Director, SDU Cephas P. Swamidoss, MD, MPH Michael K. Urban, MD, PhD Medical Director, PACU William F. Urmey, MD Jacques T. Ya Deau, MD, PhD Medical Director, Clinical Research Victor M. Zayas, MD Director, Pediatric Anesthesia ASSISTANT ATTENDING ANESTHESIOLOGISTS Jonathan C. Beathe, MD Director, Training Programs James D. Beckman, MD Devan D. Bhagat, MD Adam Booser, MD Bradford E. Carson, MD Mary F. Chisholm, MD Kathryn DelPizzo, MD Christopher A. DiMeo, MD Medical Director, Clinical Initiatives Naomi Dong, MD Chris R. Edmonds, MD

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department of anesthesiology

administrative

Sean Garvin, MD Michael A. Gordon, MD Medical Director, Acute and Recuperative Pain Medicine Services Enrique A. Goytizolo, MD Douglas S.T. Green, MD Robert S. Griffin, MD, PhD Director, Ambulatory Pain Medicine Carrie R. Guheen, MD Semih Gungor, MD Director, Chronic Pain Research Michael C. Ho, MD Kethy M. Jules-Elysee, MD Director, Pre-Anesthesia Screening Richard L. Kahn, MD Medical Director, Ambulatory Surgery David H. Kim, MD Richard S. King, MD Vincent R. LaSala, MD Andrew C. Lee, MD Medical Director, Quality Assessment and Performance Improvement David L. Lee, MD Medical Director, Education Yi Lin, MD, PhD Daniel B. Maalouf, MD, MPH John G. Muller, MD Joseph A. Oxendine, MD Swetha R. Pakala, MD Leonardo Paroli, MD, PhD Thomas J. Quinn, MD, MBA Daniel I. Richman, MD James J. Roch, MD Lauren H. Turteltaub, MD Assistant Director, Training Programs Philip J. Wagner, MD Director, Web Seth A. Waldman, MD Medical Director, Chronic Pain Medicine

David Y. Wang, MD, MS, MPH Medical Director, Chronic Pain Education ASSISTANT ATTENDING PHYSICIANS Christine Peterson, MD Director, Inpatient Pain Services Vladimir N. Kramskiy, MD Medical Director, Ambulatory Recuperative Pain Medicine 2011-2012 FELLOWS IN REGIONAL ANESTHESIOLOGY AND ACUTE PAIN MEDICINE Emilio G. Andrade, MD Anna Maria Bombardieri, MD, PhD Shawna M. Dorman, MD Justo K. Gonzalez, MD Mandip S. Kalsi, MD Kristy M. Labib, MD Milica Markovic, MD Swetha Pakala, MD Minda Patt, MD 2012-2013 FELLOWS IN REGIONAL ANESTHESIOLOGY AND ACUTE PAIN MEDICINE Guilherme Holck, MD Thomas Caggiano, MD Katherine Chuy, MD Stephen Haskins, MD Christen-Jennifer Lee, MD Sephalie Patel, MD Kevan Stanton, MD 2012-2013 RESEARCH FELLOW Ottokar Stundner, MD

professional & administrative staff ADMINISTRATION Bobby Stack, MS Administrative Director Susan Cardamone, MBA Associate Director Ilene Bacine Coordinator, Finance Mary J. Hargett Administrative Director, Education Alvin Joseph QA/PI Assistant Sarah Kennedy, MS QA/PI Supervisor Dana Libov Administrative Coordinator Matthew Rosenberg Manager, Finance Ellen Segal Staff Secretary Pamela Shaw Administrative Coordinator Maureen Stanton, RN Manager, QA/PI Sheryl Stebel Administrative Assistant to Dr. Liguori NURSE ANESTHETISTS Donna Hasil, CRNA Chief CRNA Elizabeth Caliwara, CRNA Halsey Julien, CRNA Claire Karlick, CRNA Kaitlyn LaFerrara, CRNA Sara Listokin, CRNA Mary Maher, CRNA Lisa Nigro, CRNA Sesle Olsen, CRNA Paul Scott, CRNA Wendy Smart-Lazare, CRNA PACU-SDU Christy Loughlin, PA-C PA Service Manager, PACU Cheryl Conwell, DNP, ANP-BC Kelly Culot, PA-C Wesley Hicken, PA-C Michael Lichardi, PA-C Michele Mangini-Vendel, DNP, ANCPBC, CCRN Mario Nova, PA-C

Janey Quinn, PA-C Geraldine Tomakin-Pilla, RN, MA, ANP-BC Kenneth Van Ora, PA-C PAIN MANAGEMENT Barbara Wukovits, RN, BSNC Director, Pain Services Aris Azar, RN Nancy Blissett, LPN Dr. Kramskiy Kaitlin Collins, MS, RN, ANP Victoria Emem Office Manager, Dr. Griffin Elizabeth Garden Office Manager, Dr. Kramskiy Alexandra Jacobs, RN, BSN, MA Dr. Richman Mary Kelly, RN, BC, ONC Evening Nurse Coordinator Donna Lawrence, NP Diane Leistman, RN Dr. Waldman Bingjing Liu Administrative Assistant, Dr. Wang Neiza Lugo Registrar / Billing Cyndi Ma Secretary, Dr. Ngeow Lilia Macias Secretary, Dr. Richman Andrea Martin, LPN Dr. Gungor Deepa Mathew, RN, MS, ANP, GNP Eileen Moynihan, RN, MA, BSN, ONC Susan Ngeow, CPA Office Manager, Dr. Ngeow Grace Parreno, NP Brian Phillips, MS, RN, FNP Assistant Director, RPM Sandra Simpson, LPN Office Manager, Dr. Wang Evette Staff Office Manager, Dr. Richman Elvi Taveras Office Manager, Dr. Gungor Bonnie Urquhart Pain Services Coordinator and Office Manager, Dr. Waldman Sherrene Wan Secretary, Dr. Ngeow

RESEARCH Carey Ford, CCRC Manager, Research James Bae, MS Research Assistant Valeria Buschiazzo Senior Research Assistant Eric Chen Research Assistant Jodie Curren, RN, BSN, ACRN Research Nurse Marcus DiLallo Research Assistant George Go Senior Research Assistant Amanda Goon Research Assistant Isabelle Kao Research Volunteer Heather Reel Research Assistant Shane Reid, MS Research Assistant Latha Swamy, MS Coordinator, Research Daniel Yoo, MS Research Assistant ANESTHESIA TECHNICIANS Junior Rigby Chief Anesthesia Technician Garrick Austin Grell Barnes Raymond Daniels Raul Latchman Hector Pineda

2012 Annual Report

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Department of Anesthesiology Hospital for Special Surgery 535 East 70th Street New York, NY 10021 www.hss.edu The 2012 Annual Report of the Department of Anesthesiology is produced by Hospital for Special Surgery's Department of Anesthesiology and Education & Academic Affairs.

Managing Editor Susan Cardamone, MBA Editor Bobby Stack, MS Contributors Carey Ford, CCRC Mary J. Hargett, BS Sarah Kennedy, MS Maureen Stanton, RN Barbara Wukovits, RN Design Christina Fisher, MFA Photography George Go Brad Hess About Hospital for Special Surgery Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopaedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopaedics, No. 3 in rheumatology and No. 16 in neurology by U.S. News and World Report. HSS has also received Magnet Recognition for Excellence in Nursing Service from American Nurses Credentialing Center and has one of the lowest infection rates in the country. For the last three years HSS has received the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopaedic and rheumatologic patient care at NewYork-Presbyterian Hospital/ Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The Hospital’s research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases.

Š 2013 Hospital for Special Sugery.

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department of anesthesiology