Leadership

This summer, I hope everyone found find time to escape the record-breaking heat while spending quality time with family and friends. Recently, while driving to the beach with my family and thinking about what to write for this column, I was surfing the satellite radio channels and was inspired by the title of the 1986 Janet Jackson song, “What Have You Done for Me Lately?” My mission for my day at the beach was clear: Update STS members on the Society’s exciting accomplishments, ongoing projects, and future plans that will directly benefit each one.

Strengthening the STS National Database

In the last President’s Column, I talked about the power of the STS Database and its impact on the specialty. Combined, the four registries of the STS National Database ─ adult cardiac surgery, general thoracic surgery, congenital heart surgery, and STS-Intermacs ─ have accurate, patient-level data on nearly 10 million cardiothoracic surgery operations. STS data along with research trials have been used to develop numerous clinical practice guidelines. Risk calculators are available to help assess the suitability for surgery in patients. Over the last three decades, risk-adjusted data has improved the safety of care, and 30-day outcomes of countless patients.

We now have the ability and opportunity to link our vast data with the National Death Index and with Medicare claims data to demonstrate long-term efficacy, comparative effectiveness, and value-based care compared with other interventional treatments. Over the next six months, we will publish sentinel papers with long-term outcomes on hundreds of thousands of patients demonstrating the efficacy of surgery on specific topics of adult cardiac surgery, general thoracic surgery, congenital heart surgery, and mechanical circulatory support devices. The first sentinel manuscript, which includes more than one million coronary artery bypass grafting patients from our database, demonstrates the long-term survival benefit of multi-arterial grafting and has been submitted to a high-impact journal.

That said, the STS Database is not perfect. Our users have helped to identify gaps and shortcomings as the Database has evolved from its original purpose to provide individual surgeons with tools to benchmark their program’s quality assessment and performance improvement.

Members have asked if the purpose of the database has changed to one of research for the benefit of some academic surgeons rather than serving as a patient care and quality assurance tool for all surgeons. Some members have noted that data collection has become too labor intensive because of the many data elements. Others have complained about the added expense due to abstractors, data coordinators, and third-party vendors needed to manage the data. There continue to be questions about the risk modeling and the relevance of the reported index cases given the rapidly evolving surgical practices related to the increase in transcatheter, endovascular, and endoscopic procedures, and novel drug therapies. 

STS has been listening to this valuable member input, and we have made several changes to decrease the burden, lower the costs, and improve the efficiency of data reporting and return. We recently changed the data warehousing from Duke Clinical Research Institute (DCRI) to IQVIA. We moved most of the data analytics from DCRI to the STS Research Center, which will improve the efficiency and near real-time reporting, analysis, and return of program data. More than 10% of programs are using direct data entry to IQVIA, which allows these programs to bypass the need (and the cost) for third-party data vendors.

Moreover, we are modifying our data dashboard to improve its intuitive appearance and make it more user-friendly. Our goal is to encourage further engagement among surgeons and data coordinators and our STS staff are available to help train more people in direct data entry.

The STS Next Generation Risk Calculator

The STS recently launched a next-generation Operative Risk Calculator to assess the risk of adult cardiac surgery operations. This improved bedside patient care tool includes current risk model adjustment calibrated every three months to ensure up-to-date risk assessment for patients. In addition to the risk of mortality, the risk calculator also provides procedure-specific risk of individual complications associated with index operations (CABG, AVR, MVR, MV repair including one specifically for repair of primary MR, AVR-CABG, MVR-CABG, and MV repair-CABG), as well as the soon to be reported multi-valve and aortic procedures. 

The new risk calculator includes recently added risk factors, such as liver disease, concomitant tricuspid valve procedure, NYHA class, and others not previously included. In addition to providing the calculated risks of individual complications and mortality, the risk calculator also updates and records the impact of each specific risk factor responsible for the composite risk scores to facilitate patient discussions, pre-operative optimization, and medical record charting. A summary page can be easily copied into the electronic medical record. The user-friendly risk calculator is viewable on an intuitively easy-to-use single computer screen and is available on most mobile devices.

With all the new changes, one constant remains: STS’s commitment to ensure that the database exists for all CT surgeons, not just selected large academic centers. The STS database captures 98% of all cardiac surgery operations performed in the United States, allowing every program of every size to benchmark data with the outcomes of “like institutions,” as well as the entire STS cohort.

We have been collecting and analyzing data on the evolving practice of cardiac surgery and will soon be reporting outcomes of multiple-valve operations with and without coronary artery surgery, as well as proximal aortic surgery, including aortic root procedures.

2024 Strategy and Planning

The STS Board of Directors, Council Chairs, and senior staff recently completed a strategic planning process. In this post-COVID world, much has changed in our profession, our specialty, and our membership. A new strategic plan is essential to reaffirm our mission and to set the STS’s top priorities and objectives for the next five years.

As you know, the STS is committed to championing the value and impact of the specialty through quality and research initiatives, advocacy, and strategic partnership. We also are steadfast in our commitment to advance the health, well-being, and inclusion of all CT surgeons from medical school through retirement. But we can’t do it alone. We must do it together.

As part of the 2024 planning process, STS commissioned a survey to collect member feedback, ideas, and insights that will help us explore new ways to enhance membership value, advocate for the specialty and deliver quality educational experiences.

Based on your feedback, we have initiated efforts to address concerns regarding inclusion, selection of STS leaders, and surgeon compensation disparities.

We hired an external consultant to evaluate STS’s DEI policies. I created two new Presidential Task Forces: The Nominating Committee Advisory Task Force to review and improve the current process for identifying, mentoring, and nominating senior STS leaders; and The Surgeon Compensation Task Force to create an annual cardiothoracic surgeon survey to help us better understand workplace-related compensation issues and negotiation matters. The regional, subspecialty, and practice-type specific salary/benefits data will be available to better equip cardiothoracic surgeons to advocate for themselves during contracting and salary negotiations.

STS's Reach Is Extraordinary

STS is everywhere we need it to be to help advance this specialty. The Annals of Thoracic Surgery is the most widely read CT surgery journal in the world. The Thoracic Surgery Foundation, STS’s philanthropic arm, has awarded $1 million in educational, research, and outreach grants in the past year. STS Advocacy is making unprecedented progress to represent your voice in Washington, DC.

As president of the STS, I recently was invited to testify on the value of medical registries at the U.S. House of Representatives Subcommittee on Health regarding Medicare coverage pathways for innovative drugs, medical devices, and technology. Of all the witnesses testifying at this hearing, the STS was one of only two medical specialty societies invited. The impact of our database and the effectiveness of our advocacy efforts literally give the STS a seat at the table in Washington, DC.

After spending the afternoon at the beach, my family and I packed up the car and started to drive back to our hotel. It was a great day at the beach. As luck would have it, the 1974 Bachman-Turner Overdrive song “You Ain’t Seen Nothin’ Yet” came on the radio as we pulled out of the beach parking lot. In one day, two classic rock song titles have proven to be an inspiration to help me write this article. What an exciting time to be a CT surgeon and a member of the STS!

Note: Check out the print magazine mailed directly to you for more informative and inspirational news and stories. Not a member? Join today.

The world of cardiothoracic surgery lost an iconic role model and champion for the profession with the passing of Sean C. Grondin, MD, MPH, FRCSC, The Society of Thoracic Surgeons’ 2021 President. 

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A master surgeon and medical educator, Dr. Grondin, 56, passed suddenly in November after inspiring hundreds of surgeons throughout their careers, raising the quality of the profession, and saving the lives of countless patients.  

An academic surgeon, Dr. Grondin took very seriously the responsibility of inspiring and supporting his colleagues to be better surgeons and researchers, and to improve the profession as a whole. For the past 20 years, he was highly regarded as a “surgeon’s surgeon” and leader at Alberta Health Services and Professor of Surgery at the University of Calgary Cumming School of Medicine in Alberta, Canada.  

“Never ever was it all about Sean,” said his long-time colleague and friend Susan Moffatt-Bruce, MD, PhD, chief executive officer at the Royal College of Physicians and Surgeons of Canada. “He had a heart of gold—there is just absolutely no doubt about that.”  

Focus on What Mattered Most

Dr. Grondin’s priorities were his family, good relationships with others, and constant drive for top quality in all aspects of cardiothoracic surgery, Dr. Moffatt-Bruce said.  
He brought friendship, collegiality, and opportunity to his fellow surgeons, not just by talking, but by opening doors. His word and intentional actions were influential, and he used them to help others earn committee appointments, visiting professorships, fellowship opportunities, and other avenues for development that would enhance knowledge and skills. 

“When I would go to a meeting, perhaps what I looked most forward to was seeing Sean. If I was down about something, he lifted me up, he helped put problems in perspective,” said Douglas E. Wood, MD, chair of the Department of Surgery at the University of Washington and past STS president. “As a close friend, he fulfilled what was most important—he was loyal, non-judgmental, present, and a source of comfort and inspiration.” 

Dr. Grondin, the first Canadian general thoracic surgeon to become STS President, called it “a highlight of my career.” With good decision making and intuition about surgeons’ needs at a difficult time, he guided the Society through the COVID-19 pandemic. Dr. Grondin was also a strong proponent of tracking patient outcomes to improve surgical quality. During his time as STS President, he enabled further development of the STS National Database™ to bring accountability for patient outcomes and identify areas for improvement.    

A Canadian Who Touched the World 

Dr. Grondin was born in Edmonton, Alberta, Canada, where he spent most of his youth and adult life, but his perspective grew globally.

He developed a broader view of who received surgical care, who did not, how patients everywhere fared following surgery, and what could be done to correct racial and socioeconomic care disparities. This viewpoint drew him to earn an MPH in clinical effectiveness from Harvard University in 1999 and helped him advance equities in cardiothoracic surgery. 

Dr. Grondin attended medical school and completed a general surgery residency at Dalhousie University in Halifax, Nova Scotia, Canada. He completed a thoracic surgery residency at the University of Toronto, a thoracic oncology fellowship at the Brigham and Women’s Hospital in Boston, Massachusetts, and a second fellowship in minimally invasive thoracic surgery at the University of Pittsburgh in Pennsylvania.  

After his fellowships, he practiced at Northwestern University Evanston Hospital in Illinois before returning to his native Canada at Foothills Medical Center, where he headed the clinical and academic sides of the Department of Surgery from 2016 to 2020.  

Dr. Grondin received many awards and honors, including the Royal College of Physicians and Surgeons of Canada “Mentor of the Year,” and multiple visiting professorships throughout the world. In 2016, he earned the highly competitive James IV Association of Surgeons Canadian Traveling Fellowship and used this opportunity to exchange knowledge with thoracic surgeons in China, Australia, England, and Scotland.  

He was a Regent at the American College of Surgeons and incoming president of the Western Surgical Association, and he had served as a leader in every Canadian thoracic surgical association, including past president of the Canadian Association of Thoracic Surgeons. 

Working Hard for Patients, Family 

Throughout all his accomplishments and in his humble demeanor, Dr. Grondin would say, “I am not the smartest person in the room.  I just work hard.” 

He did the same for his patients, and they cherished him. “I thank God for this man every day and that he graced me with his surgical skills. He is the best surgeon and those who are fortunate to be his patient have the second best shot of their life,” one patient wrote. 

He passed his work ethic on to—and was tremendously proud of—his grown children, Kate and Ben. An avid outdoorsman, soccer and hockey player, and labradoodle owner, Dr. Grondin extended his passions well beyond the OR. He credited his wife, Cathy, for being the glue that held everything together and making his life complete. 

“His legacy lives on in every surgeon he has helped to shape, and as such, the pursuit of excellence in cardiothoracic surgery continues,” Dr. Moffatt-Bruce said.