News & Media

STS News, Winter 2019 -- Four new e-learning modules are available as part of the Society’s effort to create relevant online continuing education materials for cardiothoracic surgeons and their teams. The topics were chosen after a careful review of continuing medical education (CME) requirements from each state medical board in the United States. Certain states mandate that physicians complete CME in specific topic areas, so STS leaders took those mandates into account and also considered which subjects would most directly impact cardiothoracic surgeons and their patients—now and in the future. These modules, on surgical ethics, shared decision-making, breaking bad news, and cultural competencies, can be accessed via the STS Learning Center (sts.org/learningcenter). Each will take approximately 30 minutes to complete, and users will be eligible for either CME credit or a certificate of participation. The surgical ethics module presents several scenarios that may not have straightforward answers. Surgical Ethics A wide variety of clinical situations present ethical difficulties in surgery. The surgical ethics module addresses four questions related to uses and abuses of technology: Should a patient be given an unindicated transcatheter aortic valve replacement before an impending loss of insurance?  Does an iatrogenic injury require that an otherwise futile procedure be done? Can a surgeon refuse to operate on an intravenous drug-abusing patient with recurrent aortic prosthesis infection? Is an experienced surgeon performing a robotic lobectomy for the first time ethically obligated to include his/her limited experience in the informed consent discussion? “The e-learning module on surgical ethics helps surgeons analyze a variety of difficult situations in which more than one option may seem reasonable, or in which there is disagreement between the surgeon and patient or family on how to proceed,” said one of the module developers, Robert M. Sade, MD, former Chair of the STS Committee on Standards and Ethics and the 2012 recipient of the Society’s Distinguished Service Award. “The e-learning module on surgical ethics helps surgeons analyze a variety of difficult situations in which more than one option may seem reasonable.” Robert M. Sade, MD Shared Decision-Making The shared decision-making module helps cardiothoracic surgeons understand the importance of involving patients when making decisions about treatment options. “Surgeons need education to overcome misconceptions about shared decision-making; there are several inhibitors to its adoption,” said James R. Edgerton, MD, a member of the Society’s Clinical Practice and Member Engagement Council Operating Board who helped create the module. “Surgeons may believe that the practice will lead to incorrect decisions or that they don’t have the time for it. Further, they simply may not be familiar with the process. But a patient’s active participation is a key factor in establishing a strong physician-patient relationship and may improve outcomes.” The module looks at three scenarios that may be challenging, especially for a surgeon who is new at shared decision-making: A 45-year-old diabetic woman with complex coronary disease is afraid of pain from a sternotomy and wants a minimally invasive procedure combined with medical therapy, which the surgeon feels is a poor decision. A 50-year-old man diagnosed with a stage I non–small-cell carcinoma in his lung chooses to forgo the surgeon’s recommended treatment because he’s worried about losing his job if he takes too much time off from work. An 87-year-old man who experienced a postoperative stroke has become ventilator- and dialysis-dependent; the surgeon recommends that his wife withdraw aggressive care, but she is unable to make the decision. The module also explores factors that impact a patient’s ability to participate in shared decision-making, including age, socioeconomic status, and disease status. Surgeons will be given tools and techniques to aid patients in the process. The e-learning modules challenge users to apply the information they’ve learned. Breaking Bad News The breaking bad news module provides guidance on discussing end-of-life care with patients and their families. It outlines a complicated situation in which a patient’s advanced directive gave medical power of attorney to his wife, who had been institutionalized for several years with dementia. Surgeons will be provided with specific steps to take and language to use when they encounter similarly challenging situations in the future. Cultural Competencies The cultural competencies module examines how surgeons can deliver care that addresses not only patients’ medical needs, but also their social and cultural needs. It addresses topics such as sensitivity to religion, gender differences, distrust of the health system, and language barriers. “As cardiothoracic surgeons, we need to have a better understanding of our patients’ expectations based on their beliefs so that optimal care is delivered,” said Subroto Paul, MD, MPH, one of the module developers. To purchase the modules, visit sts.org/learningcenter. If you have questions, contact the STS Education Department.

Take Part in the 2018 TSF/STS Surgeon Match Challenge For the third year in a row, STS has pledged to match surgeon contributions to The Thoracic Surgery Foundation (TSF), which means your donation will have double the impact—up to $100,000! For example, if you donate $5,000, the Society will match the contribution and $10,000 would be available to fund cardiothoracic surgery research initiatives. In addition, STS supports TSF’s administrative expenses, assuring that every dollar you donate goes directly to support TSF-sponsored research programs, and all donations to TSF are tax deductible to the extent provided by the law. The 2018 Surgeon Match Challenge will end on December 31—so rise to the challenge and make your contribution today by visiting thoracicsurgeryfoundation.org/donate. STS Heads to Milan for EACTS Meeting The Society had an important presence at the European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting in Milan, Italy, in October. Several surgeon leaders gave presentations during the meeting, and staff promoted the benefits of STS membership at a booth in the Exhibit Hall. STS President Keith S. Naunheim, MD met with colleagues from around the world, including newly elected EACTS President Ruggero De Paulis, MD (left). Submit Your Proposal for STS Funding The Society recently revised its spending policy formula, with a goal of making more money available for reinvestment in the specialty (see the Summer issue of STS News). As a result, more than $1.1 million will be available in 2019 for cardiothoracic surgery projects, programs, and affiliated organizations (apart from regular STS operations). STS members are invited to submit proposals for 2019 spending policy funding consideration by emailing a letter to STS Finance Committee Chair Mark S. Allen, MD via Keith Bura. Proposals should be no more than 900 words and include the amount of the request, a detailed description of how and when the funds would be used, and an explanation of how the proposed funding would constitute a reinvestment in the specialty. The deadline for submissions is November 15, 2018. STS Leaders Join European and Chinese Colleagues at CSTCVS Meeting Several STS surgeon leaders, including President Keith S. Naunheim, MD, Past President Joseph E. Bavaria, MD, Canadian Director Sean C. Grondin, MD, MPH, Ram Kumar Subramanyan, MD, PhD, and James S. Tweddell, MD, joined their counterparts from the European Association for Cardio-Thoracic Surgery at the Chinese Society for Thoracic and Cardiovascular Surgery’s Annual Meeting in Shenyang, China, this October. All presented during the meeting, and Drs. Naunheim and Bavaria gave keynote lectures on lung volume reduction and the STS/ACC TVT Registry, respectively. One of the Society’s strategic plan goals is to foster collaboration and connection worldwide. Participating in international cardiothoracic surgery meetings is an important part of this initiative. Mathisen Delivers Keynote Address STS Historian and Past President Douglas J. Mathisen, MD gave the prestigious Royal College Gallie Lecture at the Canadian Surgery Forum in St. John’s, Newfoundland, on September 15. The forum was organized by the Canadian Association of Thoracic Surgeons and several other societies. His talk was titled “Surgeon Scientist in an Era of Declining Revenue, RVUs, and Work Hours.” Society Co-Sponsors General Thoracic Conference in China Several STS members joined colleagues from the European Association for Cardio-Thoracic Surgery, the European Society of Thoracic Surgeons, and the Shanghai Medical Association at the “5th Oriental Congress of Thoracic Surgery” in Shanghai, China, in September. John D. Mitchell, MD (sixth from left), Ara A. Vaporciyan, MD (seventh from left), Valerie W. Rusch, MD (sixth from right), and STS Past President Douglas J. Mathisen, MD (fourth from right) represented the Society and gave presentations on topics such as the management of tracheal stenosis, neoadjuvant therapy for stage III cancer, and extended resection for thymic malignancy. Sylvia M. Laudun, DNP, MBA, RN won the best poster award. View Photos from AQO 2018 and Purchase Online Meeting Access More than 400 data managers and surgeons participating in the STS National Database recently gathered in Hollywood for Advances in Quality and Outcomes: A Data Managers Meeting, September 26-28. Speakers addressed all aspects of data collection, including the recently launched spec upgrade for the General Thoracic Surgery Database, the spec upgrade planned for the Congenital Heart Surgery Database, and hot topics related to the Adult Cardiac Surgery and Intermacs Databases. See more photos from the meeting at sts.org/2018AQOphotos. If you or your data manager weren’t able to attend AQO, experience the exceptional content delivered during the meeting by purchasing AQO Online. This year’s online product features unlimited on-demand viewing and—new for 2018—the ability to earn CE or CEU credit. Visit sts.org/AQOOnline to place your order. Note: Meeting attendees will be given free online access to the sessions for which they were registered. Complexities of CVT Critical Care Explored The multifaceted nature of cardiovascular and thoracic critical care cases—including their unique physiology, array of procedures, and potential complications—was the focus of the 15th Annual Multidisciplinary Cardiovascular and Thoracic Critical Care Conference, held October 4-6 in Washington, DC. More than 200 cardiothoracic surgeons, cardiologists, anesthesiologists, nurses, pulmonologists, and other medical professionals learned about new concepts, management protocols, and clinical experiences from a multidisciplinary faculty. In addition, STS Past President Richard L. Prager, MD delivered a special keynote address on “The End of Average.” View more photos at sts.org/2018criticalcarephotos.

STS News, Fall 2018 -- The Centers for Medicare & Medicaid Services is reevaluating the scientific evidence supporting volume requirements for hospitals and heart team members who perform transcatheter aortic valve replacement (TAVR) procedures. The current TAVR National Coverage Determination (NCD), which was released in 2012, requires that hospital programs and heart team members perform a certain number of surgical aortic valve replacements and percutaneous coronary interventions in order to begin or maintain a TAVR program. On July 25, a Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) panel met in Washington, DC, to hear recommendations regarding procedural volume requirements. Among the presenters were Joseph E. Bavaria, MD, David M. Shahian, MD, and Thoralf M. Sundt, MD. During the presentation, Dr. Bavaria stressed that programmatic TAVR volume requirements are essential: “Quality cannot be reliably determined at low-volume centers—good or bad. That is the conundrum.” The MEDCAC panel will now advise CMS as the agency prepares a new TAVR NCD due for release in June 2019. In addition, CMS will consider written comments, including those in a joint letter from STS, the American Association for Thoracic Surgery (AATS), the American College of Cardiology (ACC), and the Society for Cardiovascular Angiography and Interventions (SCAI). Prior to the MEDCAC meeting, the four societies published an expert consensus document on TAVR in each of their respective peer-reviewed journals, including The Annals of Thoracic Surgery. The writing committee for the “2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement” was co-chaired by Dr. Bavaria and Carl L. Tommaso, MD. The document updates a 2012 version and identifies criteria for performing TAVR procedures safely, while optimizing patient outcomes. A related editorial, “TAVR 2.0: Collaborating to Measure, Assure, and Advance Quality,” by Dr. Shahian and colleagues, also was published in The Annals. Read the multisociety comment letter, the expert consensus document, the editorial, and slide decks from the MEDCAC meeting below. Multisociety Comment Letter 2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement TAVR 2.0: Collaborating to Measure, Assure, and Advance Quality Joseph Bavaria slide deck David Shahian slide deck Thoralf Sundt slide deck Meet Your Lawmakers at Home One of the best times to connect with your legislators is when they’re at home in their districts. Take advantage of their proximity and schedule time to advocate for cardiothoracic surgery. Read about the different opportunities available to you below, and then contact Madeleine Stirling, Government Relations Coordinator, to get the ball rolling. Facility Tour Site visits are a great way to provide your legislators with firsthand knowledge about the challenges you face delivering high-quality patient care. Once scrubbed in, it’s impossible for them to ignore your message as you proceed to show them around your facility. This is the most hands-on way to make an impression on your elected officials. Time Commitment: 1 hour or more Fundraising Event  Members of Congress rely on contributions, both big and small, to run their campaigns and continue working for you. If you believe your representative is doing a great job, a huge way to show your support is to participate in or host a political event. Depending on the circumstances of your district, STS staff may be able to arrange your participation. Time Commitment: 1 hour District Office Meeting A one-on-one meeting at your legislator’s local office is an excellent way to bring important issues to the forefront. STS can help you schedule the meeting and can thoroughly prepare you with relevant materials. Time Commitment: 30 minutes Town Hall If your schedule makes daytime meetings difficult, attending a town hall might be perfect for you. Town halls, which are often held in the evening, allow constituents to gather in a public space and speak with their Senators and Representatives. The presence of a physician is always welcome, and your perspective is sure to be respected. STS staff can help you prepare a question and reasonable argument in advance. Time Commitment: variable Phone Call  If you can’t make it out to a district office but really want to educate your member of Congress on your priorities, a phone call may fit the bill. Just like a meeting, STS staff will handle scheduling and briefing materials so that you’re prepared. Time Commitment: 20 minutes  

Keith S. Naunheim, MD, President STS News, Fall 2018 -- On occasion, a graduating resident or STS member will ask me if membership in the Society is really “worth the money.” It’s true that $750 is more than just pocket change, and it can cover the purchase of many cool things: 1. A summer-weight suit from Brooks Brothers (winter-weight will run another $300) 2. Drinks and dinner for six at a fine steakhouse (with an inexpensive California varietal) 3. Three opening day box seats at Fenway, Wrigley, or Dodger Stadium (get ready for $12 beers) 4. One year of Active Member dues in The Society of Thoracic Surgeons Many, if not most, cardiothoracic surgeons would splurge for the first three items listed above without a second thought; yet some question the value of that last item and balk at the idea of paying those annual dues. The common question is “What the heck does that get me?”. Yeah, we all know that your dues get you a subscription to The Annals of Thoracic Surgery (currently $509 alone for non-members), an opportunity for substantial savings on participation in the STS National Database, free quality measure reporting to CMS that prevents reimbursement penalties, complimentary subscriptions to STS News and other newsletters, as well as discounted registration rates for the Annual Meeting and other educational programs. Yet some wonder if that is enough, and the question is still asked: “Am I getting real value for my annual dues?”. As the current President and former Secretary, I have been on the “inside” for many years, so some would accuse me of bias and being a “homer.” Still, while I have no doubt that we get the full bang for our bucks, I also am certain there are those who remain skeptical. To them, I would suggest: Come to the STS offices in Chicago (21st floor at Erie and Saint Clair). Spend a day watching 65 people working at hundreds of tasks, all of which are designed to make your practice more successful. The ongoing education you require to stay at the forefront of care is among their highest priorities. Go ahead and shadow STS staff for the week before the Annual Meeting to appreciate the thousands of hours of effort devoted to providing you a streamlined and integrated educational experience, along with unparalleled networking opportunities. Watch throughout the year as they help provide both live and electronic education for all of us in structural heart disease, coronary revascularization, mechanical circulatory assistance, critical care, and thoracic oncology—just to name a few. If we don’t continue to learn and evolve, we will be left in the dust. They make that learning possible. Go to Washington, DC, to participate in an STS Legislative Fly-In. Get educated about how government really works—not only the fantasies we were taught in high school civics class, but also the reality of Realpolitik Congressional legislation. Watch our staff and volunteer leaders attend meetings with Congressional staffers, as well as officials from CMS, the FDA, and the NIH. They are working to defend the best interests of you and your patients, whether it is regarding continued funding for cardiothoracic research, coverage for lung cancer screening, or the negotiation of fair reimbursement for new procedures. Thousands of hours of staff and volunteer time are spent each year pursuing these objectives on your behalf. It’s the best damn bargain you’ll get all year. Accompany STS volunteer leaders (there are more than 400, many donating hundreds of volunteer hours annually) to Medicare headquarters for a day and watch them fight on your behalf against the increasing regulatory burden. Listen as they argue against contrived, inexact quality measures like MIPS or Meaningful Use and instead convince CMS to utilize real, objective, clinical data from our own Database to make determinations regarding the quality of care.  Attend a joint meeting between volunteer leaders of STS and international sister societies from Asia, Europe, and Latin America (there are more than a dozen such meetings annually). Find out how we are all collaborating internationally to address the standardization of technology such as valve sizing, the optimization of ongoing education, and the delivery of care both in our own countries and to the world’s underserved populations. Review the effort and output of the 200 cardiothoracic surgeons whose research has been supported by The Thoracic Surgery Foundation, the Society’s charitable arm. Those research efforts range from blood cardioplegia and hypothermic arrest to percutaneous valve implantation, arrhythmia surgery, and minimally invasive surgery of all types. What you do all day and every day is at least partially the product of research funded by our Society. This is where we forge the tools needed to ensure our continued relevance in health care. The reality is that the $750 you pay for dues each year goes to support the efforts of a complex organization that solely exists to serve you and your patients; and thanks to careful financial management and the Society’s success in generating non-dues revenue, that dues number has not gone up since 2002. That money supports ongoing research to keep our specialty relevant. It ensures education and training opportunities throughout the year to keep surgeons, perfusionists, and nurses current. It supports our societal efforts to prevent unfair pay adjustments and to minimize burdensome regulations. And through the Database, surgeons and hospitals receive accurate, specific clinical outcomes allowing for effective quality assessment and improvement. Without your dues supporting these efforts, our modern-day surgical practices likely would not exist—and neither would our careers. So how do I answer the “Is it worth it?” question? It’s the best damn bargain you’ll get all year.

STS News, Fall 2018 -- Cardiothoracic surgeon Daniel J. Boffa, MD is the recipient of the 2018 STS/ACS Health Policy Scholarship, a joint offering from STS and the American College of Surgeons that enables a member surgeon to attend the intensive Executive Leadership Program in Health Policy and Management at Brandeis University near Boston. During the weeklong course this past June, Dr. Boffa joined surgeons from a variety of specialties for a week of lectures and small group discussions on health care policy, health care finance, leadership, operations management, and conflict negotiation. “I learned something from every session. The hospital finance session was the most shockingly high-yield,” said Dr. Boffa, who is Director of Clinical Affairs for Yale Medicine’s thoracic surgery program and a Professor of Thoracic Surgery at Yale University School of Medicine in New Haven, Connecticut. “I came into the topic with very little experience (or interest), but knew it was important. I am now much more comfortable with hospital spreadsheets.” He also learned about the mechanics of persuasion, particularly in those frustrating situations where there seems to be a preponderance of uncontested data supporting a decision, yet the opposing side persists in supporting movement in the opposite direction. “What I was missing was that my resistant audience was making critical assumptions and accepting them as facts, making the data seem less convincing,” Dr. Boffa said. “Only when you get your counterparts to recognize the distinction between assumptions and facts can you unlock them from their position.” “I learned something from every session. The hospital finance session was the most shockingly high-yield. ... I am now much more comfortable with hospital spreadsheets.” Daniel J. Boffa, MD As a scholarship recipient, Dr. Boffa will be appointed to serve a 3-year term on the STS/AATS Workforce on Health Policy, Reform, and Advocacy, starting in January 2019. Applications for the 2019 scholarship will be accepted later this year. Applicants must be members of both STS and ACS and between the ages of 30 and 55. Application materials, which include a curriculum vitae and a one-page essay discussing why the candidate wishes to receive the scholarship, are due by February 1, 2019. The scholarship will help cover the costs of tuition, travel, and accommodations during the course. The Thoracic Surgery Foundation (TSF) also offers scholarships that partially cover the cost of attending the course. Applications for TSF’s Alley-Sheridan Scholarship will open December 1 and are due by February 15, 2019. For more information on the STS/ACS scholarship, visit sts.org/healthpolicyscholarship or contact Grahame Rush, Associate Executive Director. For more information on the TSF scholarship, visit thoracicsurgeryfoundation.org/awards or contact Priscilla Kennedy, TSF Executive Director.

Robert A. Wynbrandt, Executive Director & General Counsel STS News, Fall 2018 -- Late one afternoon in 1989, a team of lawyers descended on the executive offices of the American Library Association to make a pitch for the ALA’s “business” in response to a recently issued Request for Proposals. Details of the experience are somewhat fuzzy 29 years later, but two things stand out: (a) the youngest member of the team was mostly preoccupied with keeping his lunch down, as he was more nervous about making a good showing in front of his senior partners – especially a newly recruited senior partner participating in the pitch – than he was about impressing the ALA management team; and (b) said newly recruited senior partner, Paul Gebhard, used an expression that day that was unfamiliar to his gastrointestinally challenged younger partner, but remains memorable decades later. Specifically, Paul tried to convey to the prospective client a special quality he perceived among his new colleagues in the firm’s Association Practice Group that would serve the Association well if it were to retain the firm, stating that they practiced law “with a fire in the belly.” (In hindsight, Paul’s use of that term bordered on omniscient, given the younger lawyer’s nervous stomach. One other factoid about Paul that may be of interest to readers of STS News is that he was the individual credited with having coined a term – in a 1957 brief written on behalf of his longstanding client, the American College of Surgeons – that became quite famous within the surgical community: “informed consent.”) Based on 22 years of work that exposed me to the operations of more than 200 associations before I was employed by The Society of Thoracic Surgeons, I can report with confidence that cardiothoracic surgeons and their teams possess a fire in the belly, both on matters of patient care and on matters of engagement with their medical special society. Recent cases in point with respect to the latter: earlier this year, more than 1,100 abstracts were submitted for consideration in connection with the upcoming 55th STS Annual Meeting, when only 137 could be accepted for oral presentation (see page 14 for important information regarding the opportunity to submit “late-breaking abstracts”); 74 self-nominations were submitted in September for consideration of appointment to STS governance positions, in a context where we are fortunate to be able to accommodate 20 self-nominees in a typical year; and our charitable arm, The Thoracic Surgery Foundation, received 203 applications for its various awards in calendar year 2018, when associated funding will only support a total of approximately 60 awards. And if it’s true that STS members tend to come equipped with a fire in the belly, then it’s also the case that a constant stream of STS surgeon leaders has emerged, year after year since 1964, with a five-alarm fire. Of course not all leaders express their passion for the specialty and this organization in the same way. For every Bob Replogle and Joe Bavaria (both among the more “demonstrative” in the pantheon of STS leaders) there is a Fred Grover or a Mark Allen who gets the job done more quietly; the common denominator is the fire. And our job on the staff is to match that fire in our respective areas of expertise and execution so that the organization can successfully achieve its mission of enhancing the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.  View this image in full size (zoom in to see a dedication to the Society's Past Presidents on the left and the STS Core Values on the right) STS President Keith Naunheim is one of those individuals who appeared on the STS scene, in 1989 as a member of what was then called the “Ad Hoc Committee for Cardiothoracic Surgical Practice Guidelines,” with a roaring fire in the belly. That fire later spread to the entire range of Society activities, most notably in the realms of coding, reimbursement, and broader matters of health care policy. Keith brought some of that fire with him to a special “unveiling” ceremony with the staff on September 28, as we dedicated a new Presidents Wall at our headquarters office in Chicago (see photo). After first paying homage to the 53 STS Presidents who preceded him, he turned his attention to the staff and acknowledged its critical contributions to STS success, identifying specific individuals by name as examples: a terrific way to fan the flames and motivate the team. (As all successful leaders know, recognition is a powerful accelerant.) Keith’s appearance in our office for that unveiling ceremony coincided with the Society’s Annual Meeting program planning session held the following day, with approximately 30 volunteer leaders and staff in attendance and setting the table for the call to action that follows. Under the leadership of Annual Meeting Workforce Chair Rick Lee, STS volunteer leaders and staff have joined forces to create an innovative and exciting STS 55th Annual Meeting program (see page 1). And if Keith’s 2010 STSA Presidential Address is any indication, his presentation alone on Monday morning will be worth the price of admission. Registration is now open, so make your plans to join us in San Diego; it will be the hottest event of the year!

STS News, Fall 2018 -- In the last 10 years, much light has been shed on the function of high-reliability organizations. Most of the research has centered around groups in aviation, the military, and first responders. In this article, Dr. Paul Levy highlights useful ideas applicable in the cardiothoracic surgery arena. Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management Paul S. Levy, MD, MBA, Chief of Surgical Services and Physician Operational Lead, Physician/Administrator Dyad NEA Baptist Memorial Hospital, Jonesboro, Ark. If you want to go fast, go alone. If you want to go far, go together. – African Proverb Having very challenging surgical cases is nothing new for cardiothoracic surgeons. We recently had one such case. I say “we” because most surgeons understand that surgery is a team sport. Teamwork is at the core of high performance and consistency. Good teams function as a whole—its members helping out where needed and stepping up when required. In our specialty, this behavior can save lives. But how are high-functioning teams put together? What role does leadership play in fostering teamwork? Answers to these key questions may depend on market size, program size, and administrative support, but never upon mere chance. The Importance of Leadership Team building is predicated upon a common vision. High-fidelity teams possess members that understand the vision, work in a collaborative manner, hold each other accountable, and share a relationship of trust. Leadership is the linchpin to team building. High-fidelity teams possess members that understand the vision, work in a collaborative manner, hold each other accountable, and share a relationship of trust. A strong leader encourages point-of-service stakeholder input and adaptation—a “can do” attitude. Ideal heart team members are self-starters, innovators, quick thinkers, and possess thick skin. A traditional command and control leadership style can stifle these important attributes. Strong leaders must be able to clearly articulate important team goals and identify educational gaps in teammates that are preventing them from accomplishing these goals. After filling educational gaps, leaders must trust their people and processes. Creating an environment promoting team camaraderie is the job of a surgeon leader and cannot be delegated to a manager. High-functioning and reliable teams have to feel that their leaders stand shoulder to shoulder with them. How to Strengthen Your Team Building a strong heart team has been a priority at our institution. The importance of teammate engagement has led to some impressive and sustainable dividends. Over the past 5 years, we have not only experienced decreased heart team staff turnover, but we also have cut our production costs significantly while increasing overall case volume. Additionally, our STS performance quality metrics have improved. How did we do it? We gave each team member a voice and showed them that we cared. Monthly heart team “get-togethers” serve to fill educational gaps and promote camaraderie. We begin each meeting with personal life catch-ups and then follow with talks regarding pertinent surgical topics, discuss the surgical “whats and whys” using videos, identify different surgical instruments, discuss anatomy, and end with an inspirational team-building video. This is our formula, and it works. I encourage you to give it a try at your institution. Alone or together, fast or far—it’s your choice. To view previous practice management columns, visit sts.org/practicemanagement.

STS News, Fall 2018 -- Three years into an R01 grant, researchers have made a number of discoveries that will help cardiothoracic surgeons improve patient outcomes after lung cancer surgery. In 2015, the Agency for Healthcare Research and Quality awarded STS nearly $1 million to study lung cancer survival, surgical approach, and resource use. The research team, led by Felix G. Fernandez, MD, MSc, from Emory University in Atlanta, has completed work on the first two aims; results from the third aim are expected in July 2019. “This research has leveraged two complementary national datasets to produce a unique cross-linked data infrastructure of individual patient clinical characteristics and longitudinal outcomes that could not otherwise be replicated,” said Dr. Fernandez. “Results from these studies have identified those patients at risk for poor long-term survival following lung cancer surgery and helped determine the optimal surgical strategies and associated costs in such patients.” Long-Term Survival The grant’s first aim was to develop a risk model for long-term survival following lung cancer resection. To accomplish this, the researchers linked data from the STS General Thoracic Surgery Database (GTSD) with Medicare claims data, which allowed for long-term follow-up on approximately 26,000 patients aged 65 or older who had undergone lung cancer resection. “The GTSD, as great as it is, is limited to 30-day clinical outcomes,” Dr. Fernandez said. “What really matters to patients, besides the safety of the surgery, is how long they are likely to live after surgery.” Following the data linkage, the researchers found that although mortality was 2.2% at 30 days, it increased to 2.6% at 90 days. In addition, 90-day mortality for sublobar and lobar resection was at least double that of the GTSD-reported mortality and also was higher for bilobectomy and pneumonectomy. “Results from these studies have identified those patients at risk for poor long-term survival following lung cancer surgery.” Felix G. Fernandez, MD, MSc Building upon these findings, the researchers then created a long-term survival model, which determined that cancer stage and a patient’s age are strong predictors of survival following lung cancer resection. This model also adjusts for other clinical variables in estimating predicted long-term survival. Results from this study can inform clinical practice by helping lung cancer patients understand their expected survival following surgery based on their unique characteristics. Other discoveries included: A center’s short-term outcomes didn’t necessarily correlate with its long-term results. Delirium, blood transfusion, reintubation, and pneumonia had a negative impact on survival 3-18 months after surgery, while sepsis and blood transfusion were associated with a greater risk of mortality after 18 months. Perioperative lobectomy outcomes for GTSD participants were superior to outcomes from non-GTSD participants. Surgical Approach and Resection Extent With work from the first aim completed, the team then started examining survival based on surgical approach, as well as the extent of lung resection in lung cancer patients.  Performing a comparative effectiveness analysis, the researchers found that minimally invasive surgical techniques for lung cancer resection did not lead to worse outcomes. “There had been prior data suggesting that perhaps a minimally invasive approach was inferior in terms of lymph node staging compared to a thoracotomy and that this could potentially adversely impact long-term survival,” Dr. Fernandez said. “This comparative effectiveness analysis, however, showed no difference in the two approaches.” Results from a similar study on outcomes for segmentectomy versus lobectomy for early stage lung cancer will be presented at the STS 55th Annual Meeting in January. Resource Use and Costs For the final aim of the project, the research team will compare resource use and costs according to surgical approach and extent of resection, but Dr. Fernandez said that there’s still a major query that needs to be addressed in future research. “We want to know how our care impacts patient quality of life through patient-reported outcomes,” he said. “That’s a big interest of mine and a potential future topic for a follow-up grant. We know how long patients live, what their complications are, and what the costs are. But what we really don’t know is what impact the therapies have on their quality of life.” For more information on this grant or other STS-led research projects, contact Robert Habib, Director of the STS Research Center.