STS News, Spring 2019 — More than 4,300 people, including 2,317 cardiothoracic surgeons and allied health care professionals, gathered in San Diego, January 27-29, for the STS 55th Annual Meeting. To view meeting photos, program content, and daily editions of the STS Meeting Bulletin, visit sts.org/annual-meeting-archive.
Naunheim Points to Resilience as Key to Survival
Cardiothoracic surgery has faced adversity for several decades. The specialty has been hit by reduced reimbursement, lower patient volume, and a shrinking workforce. Instead of getting angry, cardiothoracic surgeons became resilient. They worked to influence federal policy, used data to change practice patterns, improved medical guidelines, and began to change the face of the specialty, said Keith S. Naunheim, MD during his Presidential Address at the STS 55th Annual Meeting.
He described how the change began in the mid-1990s when Robert Replogle, MD was STS President and CMS proposed a 45% reimbursement cut to move nurse practitioners, physician assistants, and surgical assistants out of surgical practices and into hospitals. “He resolved to address this in a strong but constructive fashion,” Dr. Naunheim said. “He restrained his anger, reassessed the situation, and responded to the threat. These days, the word for that kind of reaction is resilience—the capacity to recover quickly from difficulties with the ability to spring back or rebound. Resilience means you bend but you do not break. And STS does just that.”
Dr. Naunheim’s address was titled “Anger Management 101: Why Am I Angry? Let Me Count the Ways.” In retrospect, he said, it should have been called “Resilience 101: How Can We Fight Back Against Those SOBs?”
For Dr. Replogle, fighting back meant a $1,000 special assessment from each STS member. The Society put together an aggressive, $6 million lobbying campaign in Washington, DC. The campaign resulted in a $1.6 billion reimbursement increase over 10 years for cardiothoracic surgeons compared to the original proposals, a 26:1 return on investment. Another hit to the specialty came in the 1990s when balloon dilation and coronary stent implantation were introduced, and interventional cardiologists began to insert stents broadly. Percutaneous coronary intervention became the go-to therapy for coronary circulation issues. PCI rates soared; CABG numbers fell.
“The wide application to PCI in the absence of evidence appeared inappropriate, and it fell to us, the cardiothoracic surgery community, to affirmatively address this misguided practice,” Dr. Naunheim said. STS and the American College of Cardiology (ACC) used data from both organization’s databases to compare long-term outcomes of CABG and PCI. The ASCERT Trial, published in 2012, demonstrated long-term survival benefits for CABG in multiple subgroups.
"I am convinced that we can and will meet those future challenges and prevail."
The Society also led the creation of appropriate use guidelines for PCI in cooperation with ACC, the Society of Cardiovascular Angiography and Interventions, the American Association for Thoracic Surgery, and the American Heart Association. By 2015, the chance of PCI being appropriately used rose from 30% to nearly 50%, while the inappropriate use of PCI fell by half and CABG volume increased.
“The good guys are winning,” Dr. Naunheim said.
Good women are winning, too, as more women become cardiothoracic surgeons. To help spur this growth of women cardiothoracic surgeons, STS leaders again collaborated with others to promote and strengthen the specialty. This time it was with a focus on the development of transcatheter aortic valve replacement, minimally invasive surgery, and robotics, all attractive, cutting-edge procedures for young surgeons. And the Society worked with Women in Thoracic Surgery to develop and present role models for female medical students and residents.
“We’ve come a long way, but there is still much improvement possible,” Dr. Naunheim said. “Our specialty has been and continues to be under assault from multiple directions, and we have to respond on every front. I am convinced that we can and will meet those future challenges and prevail.”
This article was adapted from the Tuesday edition of the 2019 STS Meeting Bulletin.
The entire Presidential Address is available as a video at sts.org/naunheimaddress.
(left to right) Robert S.D. Higgins, MD, MSHA, Dr. Rusch, Dr. Naunheim, and A. Pieter Kappetein, MD, PhD
Award Winners Honored
The recent STS Annual Meeting offered the opportunity to recognize those who are making an impact on the organization and the specialty. The following were honored by the Society in San Diego:
Distinguished Service Awards
Distinguished Service Awards recognize those who have made significant and far-reaching contributions to the Society. The 2019 recipients were James M. Levett, MD and Douglas E. Wood, MD.
Earl Bakken Scientific Achievement Award
The Earl Bakken Scientific Achievement Award was presented to Valerie W. Rusch, MD, who is one of the world’s top experts on the management of lung cancer and mesothelioma. The Bakken Award honors individuals who have made outstanding scientific contributions that have enhanced the practice of cardiothoracic surgery and patients’ quality of life.
President's Award
The President’s Award was presented to Tara Semenkovich, MD, MPHS from Washington University School of Medicine in St. Louis for her paper, “Adjuvant Treatment for Node-Positive Esophageal Cancer After Induction Therapy and Surgery Improves Survival: A Multisite Study.” Selected by the STS President, this award recognizes an outstanding scientific abstract by a lead author who is either a resident or a surgeon 5 years or less in practice.
Poster Awards
Adult Cardiac Surgery:
STS Overall Composite Scores: A Better Measure of High-Quality Cardiac Surgery (Julia Coughlin, MD)
Congenital Heart Surgery:
More Than 25 Years of Experience With the Ross Procedure in Children: A Single-Center Experience (Elisabeth Martin, MD, MPH, FRCSC)
Critical Care:
Platelet Nadir Following Cardiopulmonary Bypass Is Independently Associated With Postoperative Mortality, Infection, Acute Kidney Injury, and Prolonged Intensive Care Unit Stay (Benjamin Griffin, MD)
General Thoracic Surgery:
A Tumor-Specific Staging System for Neuroendocrine Tumors of the Lung Needs to Incorporate Histological Grade: An Analysis of the National Cancer Database (Anee Sophia Jackson, MD)
Quality Improvement:
Outcomes of Nonelective Coronary Artery Bypass Grafting Performed on Weekends (Jared P. Beller, MD)
Access STS 55th Annual Meeting Online
STS Annual Meeting Online provides access to more than 100 hours of recorded sessions. Access to Annual Meeting Online was included with Annual Meeting registration. Non-attendees can purchase the online product at sts.org/AMonline.
| 2,317 | Professional Registrants |
| 130+ | Oral Scientific Abstracts |
| 90+ | Educational Sessions |
| 150 | Exhibiting Companies and Organizations |
| 58 | Countries Represented by Registrants |