Department of Surgery 2020 Annual Report

Department of Surgery 2020 ANNUAL REPORT

DEPARTMENT OF SURGERY by the numbers 56 168 12 active clinical faculty trials non-ACGME-accredited surgical fellowships 152 37 26,670 interns and residents fellows operations performed 188 12 5 active grants clinical divisions ACGME-accredited surgical fellowships 5 147,112 office visits ACGME-accredited surgical residency programs $40,501,132 research spending

A Letter from the Chair Over the past year, the Department of Surgery has continued to build on our proud history of clinical and academic achievement. This year presented us with an unforeseen and unique challenge as we navigated the COVID-19 pandemic. Our department played a critical role in responding to this unprecedented crisis. 2020 was the exception to the oft-quoted concept that during crises, we donʼt rise to the occasion, we sink to our level of training. We use this idea frequently to justify our rigorous clinical training and careful preparations for the operating room. However, no one forecast the challenges that we faced in 2020, which affected how we work, how we live, how our children go to school, how we shop for our food. No aspect of our lives was untouched, and there was no blueprint, no plan B or C or D to guide us. We werenʼt trained to respond to this crisis; there was no simulation exercise, no role to step into. However, we did rise to the occasion, over and over again. Everyone found or invented ways to help, and it was inspiring to watch. I am very proud of the varied ways that every member of the department found to contribute when society needed us most. In other news, we saw our faculty continue to grow as we welcomed 17 new members to our group, and we also named new department leaders this academic year. C. Keith Ozaki, MD, was appointed vice chair of the department; Douglas S. Smink, MD, MPH, was named chief of surgery at Brigham and Womenʼs Faulkner Hospital; Jennifer Shin, MD, SM, was appointed associate chair for Faculty Development; and two new division chiefs were announced. Chandrajit P. Raut, MD, MSc, was named chief of Surgical Oncology and Ali Tavakkoli, MD, was named chief of General and Gastrointestinal Surgery. Our department continues to be on the cutting edge of surgical research with new grant funding to study head and neck cancer resistance to immunotherapy drugs; surgical decision- making for persons living with dementia, their family caregivers and their providers; the impact of aging on inflammation via the dissemination of senescent cells; the management of preeclampsia and reduction of vasoconstriction and hypertension in pregnancy; and how trauma affects immune cell subsets and cell mediated immune responses. Our annual report highlights just some of the many examples of our ongoing commitment to excellence in clinical care, research and surgical education. Thank you for taking the time to read our report. We look forward to connecting with you again soon. GERARD M. DOHERTY, MD Moseley Professor of Surgery, Harvard Medical School Surgeon-in-Chief, Brigham Health & Dana-Farber Cancer Institute Crowley Family Distinguished Chair, Department of Surgery, Brigham and Womenʼs Hospital BWH DOS 3

Faculty DEPARTMENT OF SURGERY The Brigham attracts internationally renowned surgeons who create pioneering breakthroughs that make a difference for patients today, as well as for generations to come. We are committed to delivering world-class, collaborative patient care with a profound human touch, while advancing scientific research and training the surgical innovators of tomorrow. BREAST SURGERY CARDIAC SURGERY TARI A. KING, MD PREM S. SHEKAR, MD, MBA Chief • Division of Breast Surgery Interim Chief • Division of Anne E. Dyson Professor of Surgery in Cardiac Surgery the Field of Women’s Cancers Associate Professor of Surgery Sary F. Aranki, MD Thanh U. Barbie, MD Faina Nakhlis, MD Associate Professor of Surgery Assistant Professor of Surgery Assistant Professor of Surgery Tsuyoshi Kaneko, MD Assistant Professor of Surgery Katherina Zabicki Calvillo, MD Suniti Nimbkar, MD Dan Loberman, MD Instructor in Surgery Assistant Professor of Surgery Instructor in Surgery Daniel E. Rinewalt, MD Laura S. Dominici, MD Esther Rhei, MD Member of the Faculty of Surgery Assistant Professor of Surgery Assistant Professor of Surgery Ashraf A. Sabe, MD Member of the Faculty of Surgery Christina A. Minami, MD, MFA, MS Anna Weiss, MD Assistant Professor of Surgery Assistant Professor of Surgery Elizabeth Mittendorf, MD, PhD Robert and Karen Hale Distinguished Chair in Surgical Oncology Professor of Surgery 4 BWH DOS

GENERAL AND GASTROINTESTINAL SURGERY ALI TAVAKKOLI, MD Chief • Division of General and Gastrointestinal Surgery Associate Professor of Surgery Colon and Metabolic and Minimally Invasive Rectal Surgery Bariatric Surgery Surgery (MIS) & General Surgeons RONALD BLEDAY, MD SCOTT A. SHIKORA, MD Section Chief • Colon Section Chief • Metabolic Stanley W. Ashley, MD and Rectal Surgery and Bariatric Surgery Frank Sawyer Professor of Surgery Associate Professor of Surgery Professor of Surgery David C. Brooks, MD Christian H. Corwin, MD Neil D. Ghushe, MD Associate Professor of Surgery Instructor in Surgery Instructor in Surgery John J. Froio, MD Joel E. Goldberg, MD Malcolm K. Robinson, MD Instructor in Surgery Assistant Professor of Surgery Associate Professor of Surgery Pardon R. Kenney, MD, MMSc Jennifer L. Irani, MD Eric G. Sheu, MD, PhD Senior Lecturer on Surgery Assistant Professor of Surgery Assistant Professor of Surgery Erika L. Rangel, MD, MS Nelya Melnitchouk, MD, MSc David Spector, MD Assistant Professor of Surgery Assistant Professor of Surgery Instructor in Surgery Andrew Resnick, MD Melissa M. Murphy, MD, MPH Thomas C. Tsai, MD, MPH Member of the Faculty of Surgery Instructor in Surgery Assistant Professor of Surgery Brent T. Shoji, MD James Yoo, MD Ashley H. Vernon, MD Assistant Professor of Surgery Member of the Faculty of Surgery Assistant Professor of Surgery Douglas S. Smink, MD, MPH Paul B. Davidson, PhD Associate Professor of Surgery Instructor in Psychiatry Edward E. Whang, MD Mark Gorman, PhD Associate Professor of Surgery Instructor in Psychiatry BWH DOS 5

ORAL MEDICINE OTOLARYNGOLOGY– PLASTIC AND HEAD AND NECK SURGERY RECONSTRUCTIVE SURGERY NATHANIEL S. TREISTER, DMD, DMSc RAVINDRA UPPALURI, MD, PhD ANDREA L. PUSIC, MD, MHS Chief • Division of Oral Medicine Chief • Division of Chief • Division of Plastic Associate Professor of Oral Otolaryngology–Head and Neck and Reconstructive Surgery Medicine, Infection, and Immunity Surgery Joseph E. Murray Professor BWH Distinguished Chair in of Surgery Herve Y. Sroussi, DMD, PhD Otolaryngology Assistant Professor of Oral Associate Professor of Otolaryngology Shailesh Agarwal, MD Medicine, Infection, and Immunity Member of the Faculty of Surgery Donald J. Annino, MD, DMD Sook-Bin Woo, DMD, MMSc Assistant Professor of Otolaryngology Justin Broyles, MD Associate Professor of Oral Medicine, Member of the Faculty of Surgery Infection, and Immunity Regan Bergmark, MD Instructor in Otolaryngology Matthew J. Carty, MD Associate Professor of Surgery Thomas L. Carroll, MD Assistant Professor of Otolaryngology Benjamin P. Christian, MD Instructor in Surgery Carleton E. Corrales, MD Instructor in Otolaryngology Yoon S. Chun, MD Associate Professor of Surgery Laura A. Goguen, MD Associate Professor of Otolaryngology Jessica Erdmann-Sager, MD Assistant Professor of Surgery Alice Z. Maxfield, MD Instructor in Otolaryngology Lydia A. Helliwell, MD Instructor in Surgery Anju K. Patel, MD Instructor in Otolaryngology Dennis P. Orgill, MD, PhD Professor of Surgery Anthony A. Prince, MD Instructor in Otolaryngology Bohdan Pomahac, MD Roberta and Stephen R. Weiner Eleni Rettig, MD Distinguished Chair in Surgery Instructor in Otolaryngology Professor of Surgery Rachel E. Roditi, MD Christian E. Sampson, MD Instructor in Otolaryngology Assistant Professor of Surgery Jennifer J. Shin, MD, SM Indranil Sinha, MD Associate Professor of Otolaryngology Assistant Professor of Surgery Simon G. Talbot, MD Associate Professor of Surgery

SURGICAL ONCOLOGY THORACIC SURGERY CHANDRAJIT P. RAUT, MD, MSc RAPHAEL BUENO, MD Chief • Division of Surgical Chief • Division of Thoracic Oncology Surgery BWH Distinguished Chair in Fredric G. Levin Distinguished Chair in Surgical Oncology Thoracic Surgery and Lung Cancer Professor of Surgery Research Professor of Surgery Monica M. Bertagnolli, MD Richard E. Wilson Professor of Surgery Antonio Coppolino, III, MD, MSc in the Field of Surgical Oncology Instructor in Surgery Thomas E. Clancy, MD Christopher T. Ducko, MD Assistant Professor of Surgery Assistant Professor of Surgery Mark Fairweather, MD Michael T. Jaklitsch, MD Assistant Professor of Surgery Professor of Surgery Jiping Wang, MD, PhD Abraham Lebenthal, MD, MHA Associate Professor of Surgery Instructor in Surgery Charles H. Yoon, MD, PhD Hari R. Mallidi, MD Assistant Professor of Surgery Associate Professor of Surgery Endocrine Surgery M. Blair Marshall, MD Michael A. Bell Family Distinguished Nancy L. Cho, MD Chair in Healthcare Innovation Assistant Professor of Surgery Associate Professor of Surgery Gerard M. Doherty, MD Ciaran McNamee, MD, MSc Moseley Professor of Surgery Assistant Professor of Surgery Atul A. Gawande, MD, MPH Steven J. Mentzer, MD Cynthia and John F. Fish Professor of Surgery Distinguished Chair in Surgery Samuel O. Thier Professor of Namrata Patil, MD, MPH Surgery Instructor in Surgery Matthew A. Nehs, MD Matthew M. Rochefort, MD Assistant Professor of Surgery Instructor in Surgery Scott J. Swanson, MD Professor of Surgery Hisashi Tsukada, MD, PhD Assistant Professor of Surgery Jon O. Wee, MD Assistant Professor of Surgery Brian Whang, MD Instructor in Surgery Abby A. White, DO Assistant Professor of Surgery Daniel C. Wiener, MD Assistant Professor of Surgery BWH DOS 7

TRANSPLANT SURGERY TRAUMA, BURN AND UROLOGY SURGICAL CRITICAL CARE STEFAN G. TULLIUS, MD, PhD ALI SALIM, MD ADAM S. KIBEL, MD Chief • Division of Transplant Chief • Division of Trauma, Burn Chief • Division of Urology Surgery and Surgical Critical Care Elliott Carr Cutler Professor Professor of Surgery Professor of Surgery of Surgery Joel T. Adler, MD, MPH Reza Askari, MD Elodi J. Dielubanza, MD Assistant Professor of Surgery Assistant Professor of Surgery Instructor in Surgery Sayeed K. Malek, MD Gustavo J. Bauzá, MD George Haleblian, MD Assistant Professor of Surgery Instructor in Surgery Assistant Professor of Surgery Christopher J. Burns, MD Martin Kathrins, MD Instructor in Surgery Assistant Professor of Surgery Cristina Carpio, MD Arthur F. Little, MD Instructor in Surgery Michael J. Malone, MD Zara R. Cooper, MD, MSc Instructor in Surgery Associate Professor of Surgery Michael W. McDonald, MD David W. Fink, MD Assistant Professor of Surgery Instructor in Surgery Michael P. O’Leary, MD, MPH Joaquim M. Havens, MD Professor of Surgery Assistant Professor of Surgery Daniel A. Wollin, MD Anupama Mehta, MD Member of the Faculty of Surgery Stephanie L. Nitzschke, MD, MS Urologic Oncology Instructor in Surgery STEVEN L. CHANG, MD, MS Robert Riviello, MD, MPH Section Chief • Urologic Steven C. and Carmella R. Kletjian Oncology Foundation Distinguished Chair in Assistant Professor of Surgery Global Surgery Associate Professor of Surgery Matthew Mossanen, MD, MPH Assistant Professor of Surgery Naomi Shimizu, MD Instructor in Surgery Mark A. Preston, MD, MPH Assistant Professor of Surgery Graeme S. Steele, MD Assistant Professor of Surgery Quoc-Dien Trinh, MD Associate Professor of Surgery

VASCULAR AND RESEARCH Steven Piantadosi, MD, PhD ENDOVASCULAR SURGERY Senior Investigator Matthew Brian Couger, PhD Member of the Faculty of Surgery MICHAEL BELKIN, MD Lead Investigator Chief • Division of Vascular and William G. Richards, PhD Endovascular Surgery Assunta De Rienzo, PhD Lead Investigator Professor of Surgery Lead Investigator Assistant Professor of Surgery Assistant Professor of Surgery Garima Dosi, MD Gilbert Welch, MD, MPH Tanujit Dey, PhD Senior Investigator Edwin C. Gravereaux, MD Lead Investigator Instructor in Surgery Member of the Faculty of Surgery Joel S. Weissman, PhD Senior Investigator Edward M. Kwasnik, MD Ann Marie Egloff, PhD, MPH Professor of Surgery Assistant Professor of Surgery Lead Investigator Member of the Faculty of Surgery Jeremy M. Wolfe, PhD Edward J. Marcaccio, Jr., MD Senior Investigator Assistant Professor of Surgery Li Jia, PhD Professor of Ophthalmology Lead Investigator Matthew T. Menard, MD Assistant Professor of Surgery Feng Yao, PhD Associate Professor of Surgery Lead Investigator Raouf A. Khalil, MD, PhD Associate Professor of Surgery Louis L. Nguyen, MD, MPH, MBA Lead Investigator Associate Professor of Surgery Associate Professor of Surgery C. Keith Ozaki, MD James A. Lederer, PhD John A. Mannick Professor of Surgery Lead Investigator Professor of Surgery Associate Professor of Surgery Marcus E. Semel, MD, MPH AFFILIATED FACULTY EMERITUS Instructor in Surgery South Shore Hospital Francis D. Moore Jr., MD Francis D. Moore Professor of Surgery, Frederick Millham, MD Emeritus Chair of Surgery, South Shore Hospital Anthony D. Whittemore, MD Veteran’s Affairs (VA) Boston Professor of Surgery, Emeritus Healthcare System Michael J. Zinner, MD GENERAL SURGERY Moseley Professor of Surgery, Kamal Itani, MD Emeritus Chief of Surgery, VA Boston Healthcare System Jason S. Gold, MD Gentian Kristo, MD Ann Smith MD, MPH CARDIAC SURGERY Miguel Haime, MD Jacquelyn A. Quin, MD Marco Zenati, MD PLASTIC SURGERY Shahe Fereshetian, MD UROLOGY B. Price Kerfoot, MD Juan Garisto, MD VASCULAR SURGERY Michelle C. Martin, MD Joseph Raffetto, MD RESEARCH Vivian Cristofaro, PhD Aldebaran Hofer, MD, PhD Maryrose P. Sullivan, PhD

NEW VICE CHAIR NEW DIVISION AND SECTION CHIEFS C. KEITH OZAKI, MD CHANDRAJIT P. RAUT, MD, MSC ALI TAVAKKOLI, MD Vice Chair • Department of Surgery Chief • Division of Surgical Oncology Chief • Division of General and Dr. Ozaki is a vascular surgeon, vice chair Gastrointestinal Surgery of the Department of Surgery and the Director • Center for Sarcoma and John A. Mannick Professor of Surgery Bone Oncology, Dana-Farber Cancer Co-Director • Center for Weight at Brigham and Women’s Hospital. He Institute Management and Metabolic Surgery is a professor of surgery at Harvard Dr. Raut is a graduate of Stanford Dr. Tavakkoli is a minimally invasive and Medical School. University (BA/BS), the University of bariatric surgeon. He is co-director of Oxford (MSc) and Harvard Medical the Center for Weight Management and He earned his medical degree from Duke School (MD). He completed a residency in Metabolic Surgery and director of the University School of Medicine, completed general surgery at Massachusetts General minimally invasive surgery fellowship at the a general surgery residency through the Hospital followed by a fellowship in Brigham. He is an associate professor of Deaconess/Harvard Surgical Service (now surgical oncology at MD Anderson Cancer surgery at Harvard Medical School. Beth Israel Deaconess Medical Center) and Center. Dr. Raut is a committed clinician then graduated from the vascular surgery who specializes in the multidisciplinary care He received his medical degree from the fellowship at the University of Michigan of patients with soft tissue sarcoma. He is London Hospital Medical College in the Health System. He serves as director of also a prolific researcher and has a multi-PI UK, where he became a fellow of the Royal Vascular Surgery Research at the Brigham R01 grant to evaluate an innovative drug- College of Surgeons of England before and currently leads the Ozaki Vascular eluting film to be placed in the surgical moving to Boston, where he completed Biology Lab within the Division of Vascular bed and reduce tumor local recurrence both a surgical residency and fellowship and Endovascular Surgery. Dr. Ozaki is rates. Additionally, he was co-PI on a multi- in advanced minimally invasive surgery at also the director of Resident Research in institutional phase II clinical trial evaluating the Brigham. the Department of Surgery. In this role, he five years of adjuvant imatinib for primary prepares surgical trainees for their two to gastrointestinal stromal tumor (GIST), Dr. Tavakkoli leads an active NIH- three years of academic enrichment time co-investigator on an international phase funded research group that studies the embedded in their surgical residency. III randomized clinical trial evaluating the mechanisms of diabetes resolution after use of preoperative radiation therapy for gastric bypass surgery, focusing on the Dr. Ozaki’s clinical interests include retroperitoneal sarcomas and a member role of intestinal metabolism and portal complex hemodialysis access and of The Cancer Genome Atlas Sarcoma signaling. His group’s goal is to develop less peripheral vascular occlusive disease. He (TCGA-SARC) working group of the National invasive alternatives to surgery that can has authored over 120 peer-reviewed Institutes of Health/National Cancer replicate the metabolic benefits of surgery publications.  Institute (NIH-NCI). without the risks. Dr. Raut serves as section editor for He is an active member of many sarcoma in the journals Cancer and Annals professional societies, a member of the of Surgical Oncology, associate editor for American College of Surgeons (ACS) Board the journal Sarcoma and editorial board of Governors and president-elect of the member for the journal ACS Case Reports in Massachusetts Chapter of the American Surgery. He has authored over 210 papers College of Surgeons (MCACS). He is an and over 30 book chapters and serves associate editor for Digestive Diseases and as the program director of the Dana- Sciences, serves on the editorial board of Farber/Mass General Brigham Cancer Care the Journal of Gastrointestinal Surgery and Surgical Oncology Fellowship.  has been recognized for his dedication to surgical education with several teaching and mentorship awards throughout his career.  10 BWH DOS

NEW BWFH CHIEF NEW ASSOCIATE CHAIR STEVEN L. CHANG, MD, MS DOUGLAS S. SMINK, MD, MPH JENNIFER SHIN, MD, SM Section Chief • Urologic Oncology, Chief of Surgery • Brigham and Associate Chair • Faculty Division of Urology Women’s Faulkner Hospital Development Dr. Chang is an associate surgeon at Dr. Smink received his medical degree from Dr. Shin is a graduate of Harvard Radcliffe Brigham and Women’s Hospital and Dana- the Perelman School of Medicine at the College and Harvard Medical School. She Farber/Brigham and Women’s Cancer University of Pennsylvania and completed completed her residency and fellowship Center and is an assistant professor of a general surgery residency at the Brigham training in the Harvard Program and surgery at Harvard Medical School. and a minimally invasive surgery fellowship was a fellow of the National Institutes of at Dartmouth-Hitchcock Medical Center. Health (NIH) and Howard Hughes Medical Dr. Chang received his medical degree His clinical interests include abdominal wall Institute. She also holds a master’s in from Columbia University Vagelos College of hernias, foregut surgery and biliary tract epidemiology from the Harvard T.H. Chan Physicians and Surgeons and completed a disease. School of Public Health. urology residency and a urologic oncology fellowship at Stanford University Medical Dr. Smink also serves as the editor-in-chief Dr. Shin has a longstanding interest in Center. During his fellowship training, Dr. of the Journal of Surgical Education and was evidence-based practice and has served Chang earned a Master of Science in health recently selected by the American College as chair of the Outcomes, Research and services research from the Department of Surgeons (ACS) to the Academy of Master Evidence-Based Medicine Leadership of Health Research and Policy at Stanford Surgeon Educators. Group for the American Academy of University School of Medicine. He is board Otolaryngology-Head and Neck Surgery certified in urology. His research focuses on resident (AAO-HNS) Foundation. She also served and faculty education and how to teach as co-chair of the expert panel convened Dr. Chang cares for patients with communication, leadership and decision- by the academy to develop their national urologic cancers, using minimally invasive making to surgeons and surgical teams. clinical consensus statement on pediatric surgical approaches with laparoscopy and He is the co-leader of the Surgical Culture chronic rhinosinusitis. Dr. Shin served robotics. He is particularly interested in Program at the Brigham Center for as vice chair of the clinical practice the management of kidney cancer and has Surgery and Public Health (CSPH) and a guideline on otitis media with effusion, established collaborations with medical co-PI on the NIH R01 Provider Awareness a multidisciplinary effort supported by oncologists at Dana-Farber/Brigham and Cultural Dexterity Toolkit for Surgeons the AAO-HNS, the American Academy of Women’s Cancer Center and interventional (PACTS) grant. He is also the co-director Family Physicians (AAFP) and the American radiologists at Brigham and Women’s of the Surgical Coaching for Operative Academy of Pediatrics (AAP). Hospital to treat patients with kidney Performance Enhancement (SCOPE) tumors, ranging from incidentally detected Program at Ariadne Labs. She also chairs one of the specialty’s small renal masses, to metastatic renal cell seven clinical advisory committees, which carcinoma. Dr. Smink succeeds Pardon Kenney, are cooperative endeavors encompassing MD, who has served as chief of Surgery at the American Board of Otolaryngology, the Dr. Chang’s research focuses on Brigham and Women’s Faulkner Hospital for AAO-HNS and subspecialty societies, such reducing the overall burden of urologic more than 30 years.  as the American Laryngological Association cancers on the health care system. (ALA) and the American Neurotology His clinical specialties include kidney Society (ANS). Dr. Shin also serves as the cancer, prostate cancer, bladder cancer, deputy editor for Otolaryngology-Head and adrenal cancer, testicular cancer and Neck Surgery, one of the main journals in reconstructive kidney surgery.  the field. Her first book, Evidence-Based Otolaryngology (2008), was among the publisher’s most accessed works, with over 55,000 downloads.  BWH DOS 11

NEW FACULTY the eagle genotyping and producing the first genomic assembly for the enigmatic JOEL T. ADLER, MD, MPH JUSTIN BROYLES, MD anaerobic fungi. Transplant Surgery Plastic & Reconstructive Surgery Dr. Adler is a graduate of the University Dr. Broyles received his medical degree Dr. Couger’s research interests include of Wisconsin, where he also received his from the University of Texas at Houston, bioinformatics; computational biology; medical degree. He completed an MPH followed by a residency in integrated high performance computing; big data; at the Harvard T.H. Chan School of Public plastic surgery at Johns Hopkins Hospital/ cellular biology; RNA-seq; machine learning; Health. He completed a general surgery University of Maryland Shock Trauma and software design; whole genome assembly; residency at Massachusetts General a fellowship in reconstructive microsurgery variant discovery; and population genetics. Hospital, followed by a fellowship in at the University of Texas MD Anderson abdominal transplantation at the University Cancer Center. Dr. Couger’s research in bioinformatics of Wisconsin School of Medicine and and genomics includes 46 publications in Public Health. Dr. Broyles brings expertise in head journals such as the ISME Journal, Applied to toe reconstructive microsurgery, with and Environmental Microbiology, Cell Reports, His clinical interests include kidney and a particular interest in oncoplastic and Nature Methods and G3: Genes, Genomes, pancreas transplantation, with an interest microsurgical breast surgery, head and Genetics. in living donation and highly sensitized neck reconstruction, abdominal wall/trunk transplant recipients. His research interests reconstruction and craniofacial trauma. At the Brigham, Dr. Couger will be include population and public health- working on computational oncology and based improvements to improve access to His research interests include strategies other big data projects for the Division transplantation.  to improve efficiency and optimize of Thoracic Surgery, as well as helping resource utilization in reconstructive establish this resource for the Department surgery, approaches to improve the of Surgery.  surgical experience for reconstructive surgery patients and clinical outcomes in oncological reconstruction.  SHAILESH AGARWAL, MD MATTHEW BRIAN COUGER, PHD TANUJIT DEY, PHD Plastic & Reconstructive Surgery Thoracic Surgery Center for Surgery & Public Health Dr. Agarwal is a graduate of the University Dr. Couger is a graduate of Oklahoma Dr. Dey is a graduate of the University of of Michigan and received his medical State University, where he received Kalyani in West Bengal, India and received degree from the University of Chicago his PhD in microbiology and molecular a PhD in statistics from Case Western Pritzker School of Medicine. He completed genetics. Before coming to the Brigham, Reserve University. Most recently, Dr. his residency training in plastic surgery he worked as a bioinformatics specialist Dey was an associate staff member in and an NIH-funded postdoctoral research at the Oklahoma State University High the Department of Quantitative Health fellowship at the University of Michigan and Performance Computing Center. Sciences at the Cleveland Clinic Lerner a fellowship in microsurgical reconstruction Research Institute, where he also served as at University of Chicago. Highlights of his research include the head of the Biostatistics Core. co-creating the extremely popular RNA Dr. Agarwal’s clinical interests include analysis functional annotation software Prior to joining Cleveland Clinic, he spent reconstruction of the breast, lymphatic Trinotate, producing the first murine six years at the College of William & Mary as system, chest wall, trunk/lower extremity genome using 10x genomics sequencing, a tenured associate professor of statistics and head/neck, as well as gender surgery. writing numerous papers on microbial in the Department of Mathematics. Dr. His research is centered on genetic and ecology, designing a 40k marker array for Dey also served as a visiting scholar at epigenetic reprogramming to modify cell the Center for Stochastic and Chaotic function for tissue regeneration.  Processes in Science and Technology and the Department of Mathematics, Applied Mathematics and Statistics at Case Western Reserve University. He serves as associate editor for the Journal of Applied Probability and Statistics and the Journal of Statistical Computation and Simulation. He also 12 BWH DOS

served on the Regional Advisory Board M. BLAIR MARSHALL, MD, FACS Dr. Mehta’s clinical interests include burn the Eastern North American Region (ENAR) Thoracic Surgery surgery and reconstruction, wound healing, of the International Biometrics Society (IBS). Dr. Marshall is a graduate of Brown scar tissue management and burn critical University and received her medical degree care. She also treats pediatric burns and Dr. Dey’s methodological research from Georgetown Medical School, where patients with Stevens-Johnson syndrome interests include Bayesian statistics; she also completed a residency in general (SJS) and toxic epidermal necrolysis (TEN). big data; causal inference; data mining; surgery. Dr. Marshall completed both a Additionally, she has interests in faculty ensembles; environmental spatial statistics; cardiothoracic surgery fellowship and a development and resident wellness high dimensional variable and model general thoracic fellowship at the University initiatives.  selection; longitudinal data analysis; of Pennsylvania. She is board certified by machine learning; mediation analysis; the American Board of Surgery and the CHRISTINA A. MINAMI, MD, MFA, MS reliability theory; and survival analysis.  American Board of Thoracic Surgery. Breast Surgery Dr. Minami is a graduate of Harvard ARTHUR F. LITTLE, MD Most recently, Dr. Marshall was chief of University and received her medical degree Urology Thoracic Surgery at MedStar Georgetown from the David Geffen School of Medicine Dr. Little is a graduate of Princeton University Hospital, where she received at UCLA. She also holds an MS in health University. He received his medical the Outstanding Faculty Teaching Award services and outcomes research from degree from Baylor College of Medicine on multiple occasions. She is currently the Northwestern University and an MFA from and completed his residency training editor of Thoracic Surgery Clinics and the the University of Iowa Writers’ Workshop. at Massachusetts General Hospital and thoracic editor of Operative Techniques in Lahey Hospital & Medical Center. Thoracic Surgery. Dr. Minami completed residency training in general surgery at Northwestern Most recently, Dr. Little was a urologist Her research and clinical interests University Feinberg School of Medicine, at Mystic Valley Urological Associates include minimally invasive and robotic followed by a fellowship in breast surgery and the chief of Urology at Winchester techniques for complex thoracic at Memorial Sloan Kettering Cancer Center. Hospital. He is board certified by the procedures, simulation, surgical education, She is board certified by the American American Board of Urology. surgical videos and patient safety.  Board of Surgery. His research and clinical interests ANUPAMA MEHTA, MD Her clinical interests include breast include general urology, kidney and Trauma, Burn & Surgical Critical Care cancer treatment in the elderly, breast ureteral stones, benign prostatic Dr. Mehta graduated with honors from conservation and extent of axillary surgery. hyperplasia, erectile dysfunction, bladder Rutgers College and obtained her medical Her research interests include health cancer, urinary tract infections and no- degree from the University of Vermont. services and outcomes research in the scalpel vasectomy.  She completed a general surgery arena of geriatric breast oncology, patient- residency at Loyola University Medical centered decision-making and cancer Center and a burns and critical care quality measures.  fellowship at the University of Southern California, Los Angeles. She is board certified in general surgery and surgical critical care. She is also a member of the American Burn Association (ABA) and the American College of Surgeons (ACS). BWH DOS 13

ANDREW RESNICK, MD, MBA ELENI RETTIG, MD He is board certified by the American General & Gastrointestinal Surgery Otolaryngology – Head & Neck Board of Thoracic Surgery. Most recently, Dr. Resnick joined Brigham Health as senior Surgery Dr. Rinewalt was a clinical instructor vice president and chief quality and safety Dr. Rettig is a graduate of Yale University in cardiothoracic transplantation and officer in October 2019. He oversees the and received her medical degree from mechanical circulatory support at planning, administration and monitoring Baylor College of Medicine. She completed Stanford University. of all quality, safety management and residency training in otolaryngology – regulatory requirements, as well as all head and neck surgery at Johns Hopkins His research and clinical interests quality improvement initiatives across University School of Medicine, including a include all aspects of adult cardiac surgery, Brigham Health. two-year otolaryngology research training as well as heart and lung transplantation, program. She then completed a fellowship ventricular assist device placement, In this role, he is responsible for the in advanced head and neck oncologic and extracorporeal membrane oxygenation Brigham’s compliance with all regulatory, reconstructive surgery at Mayo Clinic. (ECMO) and surgical education.  state, federal and Joint Commission requirements, and the development of a Dr. Rettig is board certified by the ASHRAF A. SABE, MD comprehensive quality and performance American Board of Otolaryngology – Head Cardiac Surgery improvement program. He also oversees and Neck Surgery. Her clinical expertise Dr. Sabe graduated with the distinction of Infection Control and Patient and Family includes the surgical treatment of head Alpha Omega Alpha from Case Western Relations. and neck cancers; salivary gland tumors; Reserve University School of Medicine. cutaneous malignancies; thyroid and He completed general surgery residency Prior to joining Brigham Health, Dr. parathyroid tumors; transoral robotic training at Beth Israel Deaconess Medical Resnick was chief medical officer at surgery; and microvascular reconstruction Center and a cardiovascular surgery Froedtert Hospital, where he also served of the head and neck. Her research research fellowship at the Warren Alpert as associate dean of Clinical Affairs Adult interests include human papillomavirus- School of Medicine at Brown University. Practice and associate professor of associated oropharynx cancer; head and He completed a cardiothoracic surgery General Surgery at the Medical College of neck cancer epidemiology; and health- residency at Brigham and Women’s Wisconsin. Prior to that, Dr. Resnick worked related quality of life among head and neck Hospital, followed by a fellowship in at Penn State Health Milton S. Hershey cancer patients.  advanced aortic and endovascular surgery Medical Center as chief quality officer. at Duke University. While there, he led the development of DANIEL E. RINEWALT, MD interprofessional, unit-based quality teams Cardiac Surgery He is board certified by the American to empower frontline staff, as well as clinical Dr. Rinewalt is a graduate of Texas Tech Board of Surgery and the American and operational leaders, to improve patient University and received his medical Board of Thoracic Surgery. Most recently, care quality and safety at the local level. degree from the University of Texas Health Dr. Sabe was a faculty cardiothoracic and He began his career at the University of Science Center at Houston. He completed aortic surgeon at Lahey Hospital & Pennsylvania, where he oversaw many a residency in general surgery at Rush Medical Center. quality improvement activities across the University Medical Center/Cook County organization. Hospital, followed by a cardiothoracic Dr. Sabe’s clinical and research interests surgery residency at Brigham and Women’s include all aspects of adult cardiac surgery, Dr. Resnick graduated from Dartmouth Hospital, where he also completed a with a focus on the treatment of complex College and Yale University School of fellowship in advanced cardiac surgery. aortic and valvular disease, as well as Medicine. He completed a surgical minimally invasive and endovascular residency at the Hospital of the University procedures.  of Pennsylvania and earned a master’s degree in business administration from UPenn’s Wharton School.  14 BWH DOS

THOMAS C. TSAI, MD, MPH Internal Medicine, Journal of the American JAMES YOO, MD General & Gastrointestinal Surgery Medical Association, the New England Journal General & Gastrointestinal Surgery Dr. Tsai is a graduate of Harvard College. of Medicine and the Journal of the National Dr. Yoo is a graduate of Brown University He received his medical degree from Cancer Institute—as well as in op-eds in the and received his medical degree from the Stanford University School of Medicine Los Angeles Times and The New York Times. Icahn School of Medicine at Mount Sinai. He and completed an MPH at the Harvard completed a residency in general surgery T.H. Chan School of Public Health. He Dr. Welch questions the assumption that at Beth Israel Deaconess Medical Center, completed a residency in general surgery at more medical care is always better. His followed by a fellowship in colon and rectal Brigham and Women’s Hospital, followed by research has focused on the assumption surgery at New York-Presbyterian Hospital. a fellowship in minimally invasive bariatric as it relates to diagnosis: The best strategy and advanced GI surgery at Massachusetts to keep people healthy is early diagnosis— Most recently, Dr. Yoo was chief of the General Hospital. He is board certified by and the earlier the better. He has Division of Colon and Rectal Surgery and the American Board of Surgery. delineated the side effects of this strategy: vice chair of the Department of Surgery at Physicians test too often, treat too Tufts Medical Center. Prior to joining Tufts, Dr. Tsai’s clinical interests include the aggressively and tell too many people that he was chief of Colon and Rectal Surgery surgical and endoscopic management of they are sick. Much of his work has focused and co-director of the Colorectal Cancer gastroesophageal reflux disease, bariatric on overdiagnosis in cancer screening, Program at the Ronald Reagan UCLA surgery and complex abdominal wall particularly in the screening for melanoma, Medical Center. reconstruction. His current research uses thyroid, lung, breast and prostate cancer.  Medicare claims and other large national Dr. Yoo is board certified by the American datasets to study the effectiveness and DANIEL A. WOLLIN, MD Board of Surgery and the American Board unintended consequences of health Urology of Colon and Rectal Surgery. He serves as policy interventions on the affordability, Dr. Wollin is a graduate of Williams College associate editor of the Journal of Surgical accessibility and quality of health care in and received his medical degree from Research. the United States.  the University of Chicago Pritzker School of Medicine. He completed a residency His research and clinical interests include GILBERT WELCH, MD, MPH in urology at New York University School inflammatory bowel disease, colon and Center for Surgery & Public Health of Medicine, followed by a fellowship in rectal cancer, minimally invasive surgical Dr. Welch recently joined the Center for endourology, metabolic stone disease, approaches, the tumor microenvironment Surgery and Public Health (CSPH) as a laparoscopic and robotic surgery at and colitis-associated cancer.  senior investigator. He is a general internist Duke University Medical Center. He is who has worked for the U.S. Indian Health currently completing a Master of Science Service, the Department of Veterans Affairs in integrated design and management at and Dartmouth College. Massachusetts Institute of Technology. For over three decades, he has His research and clinical interests include been asking hard questions about his endoscopic surgery, kidney cancer, kidney profession. His arguments are frequently masses/cysts, kidney stones, medical counterintuitive, even heretical, yet have devices, metabolic stone disease, prostate regularly appeared in the country’s most cancer, robotic surgery and ureteral/renal prestigious medical journals— Annals of reconstruction.  BWH DOS 15

The Department of Surgery steps up ın the CcOrıVsIDıs-19 16 BWH DOS

When you think of caring for COVID-19 patients, you probably don’t think of surgeons. But as Brigham and Women’s Hospital began to plan for the surge of COVID-19 patients and the postponement of all elective surgeries, it became clear that the Department of Surgery could play a critical role in responding to this unprecedented crisis. BWH DOS 17

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“We knew staffing and having all residents at that if systems got overwhelmed, we “We created six new teams overall, home to keep a healthy reserve and wouldn’t have enough pulmonary with three staffed as surgical not expose people unnecessarily. “As critical care physicians,” Ali Salim, critical care teams, including it became clear that we would need to MD, chief of Trauma, Burn and surgical intensivists, anesthesiology staff ICUs, we consolidated residency Surgical Critical Care, said. “I intensivists and emergency and staff in partnership with the think in other health systems, department intensivists, along with anesthesia and surgical services and surgical intensivists got involved residents and fellows who played a medical teams for ICU deployment,” at some point. What was probably vital role,” Dr. Salim explained. “We Dr. Scully explained. unique here was that we started converted regular rooms into negative off by creating multidisciplinary pressure ICU rooms. We created a Redeploying Staff teams from surgery, anesthesia, whole tower for COVID patients.” the emergency department and to COVID ICUs pulmonary critical care before the “The learning curve was steep in system could get overwhelmed. We the beginning,” Dr. Salim said. “We “We anticipated that, like the went with all hands on deck, and are used to surgical disease processes medical centers in Seattle, much of between surgery and anesthesia, in the surgical ICU, but COVID is a the non-COVID work would go away we staffed three of the six COVID medical disease requiring intensive and much of our workforce would intensive care units (ICUs).” care. We were not accustomed be available for redeployment,” C. to caring for these patients who Keith Ozaki, MD, vice chair of the “It was a unique time where people were older, had comorbid medical Department of Surgery, who oversaw were scared of the unknown and by conditions and were being treated redeployment of surgical staff to what they were seeing in Italy and for respiratory failure—not the usual address COVID needs, said. New York,” Dr. Salim, who led one population that surgical intensivists of the first surgical ICU teams to run care for.” “We had a principle that we wanted a COVID ICU, said. “But everyone, volunteers,” Dr. Ozaki said. “And regardless of roles, stepped up and “As surgeons, we do manage we never had to force anyone. The was willing to work outside of their pulmonary issues in the surgical volunteer spirit of the department comfort zones to do what needed to ICU,” Stephanie Nitzschke, MD, was impressive.” be done.” program director of the surgical residency program, said. “But those Widespread volunteer enthusiasm “The early transition to an incident are secondary to other problems turned out to be both a blessing command structure on January 28 arising from surgery—things like and a challenge. With so many enabled the deliberate activation bleeding or sepsis. Caring for COVID volunteers, coordinating deployments of various teams and resources at patients was essentially managing a and tracking everyone became an a pace and level of organization primary pulmonary disease.” immediate challenge (more on Digital that we could not have achieved Health’s role in solving this problem otherwise,” Gerard M. Doherty, Even the surgical trainees were below). Because shortages of trauma MD, chair of the Department of tapped to play a role. “Our surgical and critical care specialists were Surgery, said. The Brigham Incident trainees had months of their formal a near certainty, they focused on Command met every day during surgery residency training derailed rapidly getting board-eligible trainees the crisis to organize and oversee by the pandemic,” Rebecca Scully, credentialed to walk into these interdepartmental redeployment. MD, MPH, administrative chief roles. Anyone with trauma and ICU resident in the Department of Surgery, experience was quickly credentialed From Surgeons to explained, “but this provided very to staff the ICU. unique training opportunities. It Medical Intensivists all happened very quickly, as the Everyone was willing to roll up evolution of the pandemic brought their sleeves and take on any role. “We have a robust and talented day-to-day changes in understanding For example, Edwin Gravereaux, MD, surgical critical care group what we needed to do to take care of director of Endovascular Surgery consisting of both surgeons and these patients,” Dr. Scully added. and Interventional Therapy, started anesthesiologists, and so it was the “line team”—a team of surgeons determined that their skills could Initially, concern about residents on call to do the labor-intensive task be best used in caring directly for themselves getting COVID infection, of placing arterial and central lines COVID patients,” Dr. Doherty said. led to the addition of redundancy into to free up ICU staff for other duties. the residency program by down- Surgeons and advanced practitioners volunteered for home hospital duty, BWH DOS 19

where they took off-hours calls from come together in such a unified we did not use extra PPE when it was COVID patients recovering at home. way to support our patients and not needed. We also tried to have Still others, focused on teaching our staff.” fewer staff going into COVID rooms and assisting COVID ICU staff in order to spare PPE.” with proper donning and doffing “We ended up preparing for of personal protection equipment an even greater wave of COVID Halting Scheduled (PPE)—a task very familiar to patients than we experienced,” Surgeries surgeons but much less familiar to Dr. Ozaki said. “But having clinicians in the ICU and emergency that structure in place was On March 15, 2020, the governor department. reassuring and, if volume had of Massachusetts took the approached overwhelming, we extraordinary step of directing It was not only the medical staff had the structure in place to hospitals to postpone elective who stepped up to help. “Over 50 handle that.” surgeries in order to free up space for Department of Surgery staff were COVID-19 patients. redeployed during the surge,” Keeping Staff Safe Kevin T. Hart, MBA, senior director “It was a phased scaling down of Operations, said. “We had staff Keeping teams safe while process,” Malcolm Robinson, that went from working in an caring for COVID patients was MD, associate chair of Clinical outpatient clinic, serving as an “my biggest personal worry,” Operations, explained. “We started administrative assistant, researcher Dr. Doherty said. “Early in by asking people to voluntarily cut or a project manager, to providing the pandemic, we heard of caregivers becoming seriously Everyone ill or dying of COVID infection apparently contracted while stepped caring for patients. We had limited supplies of PPE, and up and we did not have protocols for protecting ourselves played an during medically necessary exposures in the emergency important room, during codes, in the ICU or in the operating room. role... We were all trying to interpret the information from other integral support to our COVID institutions and from our own response, whether it was observing experts, in real time, and trying the donning and doffing of PPE to to provide care to the greatest ensure proper handling; handing out number of patients while protecting masks; monitoring social distancing; ourselves. This was complicated and providing COVID testing; or passing very stressful for all involved, but out donated meals to staff. Everyone I am happy to say that it has been stepped up and played an important largely successful in preventing the role in our successful institutional rampant caregiver infections and response to this pandemic. We also potential for severe harm that we had surgeons, physician assistants all feared.” and nurses, who don’t typically work in the ICUs or on inpatient floors, “The Incident Command team working on the COVID hotline had a pretty solid understanding or handing out supplies. It was of the limitations of our current extraordinary to watch everyone supply and had anticipated this and put in orders and gotten people fit tested,” Dr. Nitzschke, who served as operational liaison to the Brigham Incident Command, said. “We never felt that we didn’t have what we needed. We tested patients so that 20 BWH DOS

back on non-essential cases. Over because of COVID. based on parameters such as the next few weeks, we put tighter When it came time to scale up available beds, available resources and tighter parameters on. First and available staff. eliminating nonurgent cases, then surgeries again, Dr. Robinson cases that could wait four to six and his team developed a priority “We had to coordinate reopening weeks, then those that could wait for schema for how to address the the ORs with repatriation of OR only two weeks.” backlog of about 4,500 deferred staff back to the department,” Dr. surgery patients. They assigned Robinson explained. “That includes The hospital ramped down from priority scores 1 through 4 by each surgeons, nurses, anesthesiologists, the usual 43 to 44 operating rooms to surgical service. For example, very radiologists, nurse anesthetists and about 10% capacity, with the largest few plastic surgery cases were the central processing staff who were volume decreases in orthopedic considered priority 1 or 2, whereas engaged in N95 mask reprocessing surgery, plastic surgery and weight many oncologic surgery and efforts.” It started with a handful of loss surgery. Everyone, patients neurosurgery cases were priority. ORs and eventually worked back up included, was aware of the pandemic The Mass General Brigham eCare to the full 44 operating rooms. “We and the governor’s declaration team added priority fields to the worked with Incident Command to about stopping elective surgeries. Epic system for the restarting of gauge the number of COVID patients So, most patients were anticipating procedures and new functionality in the hospital and, as that number postponements, and many were so that cases could be reviewed, came down, we could repatriate staff afraid to have surgery in the hospital assigned priority and scheduled to surgery.” BWH DOS 21

Digital Health and the video platforms, hardware and Nguyen said (see inset). “Typically, software integration, documentation we would see all patients in the Practice of the Future and scheduling of virtual visits, was clinic prior to scheduling a potential among the more than 250 COVID- surgery. The COVID-19 experience In January 2019, Louis Nguyen, related changes made to the Epic has taught us that we can evolve to MD, MBA, MPH, associate chair EMR by eCare. digital health and it works.” of Digital Health Systems in the Department of Surgery, was the “The Virtual Care team was COVID-related Changes clinical lead for Surgery for all overwhelmed by the initial increase of Mass General Brigham, when in volume,” Dr. Nguyen said. that are Here to Stay Dr. Doherty tapped him to bring “They had to switch to a new video his digital health expertise to the platform, build new processes and In addition to making greater use Department of Surgery. When increase capacity within a very short of virtual care, COVID has changed COVID-19 hit a year later and made period.” They also had to teach users the way surgery staff protects virtual visits a necessity, this turned how to schedule and manage virtual themselves and their workforce. out to be a prescient and fortuitous visits while working remotely, where That includes additional PPE for decision. they did not have all the technology surgeries, as well as working offsite available at the office. and seeing more patients at satellite The department quickly adapted centers when it is not necessary to be to digital health and used virtual To accommodate physicians and physically present in the hospital. visits to keep seeing patients safely administrative and support staff from their homes. Virtual visits working from home, the department “We’re thinking this will not be using video platforms aren’t new set up systems for remote Epic access, the end of pandemics,” Dr. Ozaki and had already been used in some file server access, phone triage, said. “We need to be prepared for practices to complement in-person virtual meetings and scheduling, future infectious pathogens. We need care, particularly for patients as well as providing cameras and to ensure the safety of our patients who live far away. With COVID microphones. and reassure them of our infection restrictions, virtual visits grew by prevention practices.” over 3,000%. This magnitude of “Virtual care has emerged as virtual care expansion, including one major area of reimagination for “We’ve gone to a lot of remote our practices moving forward,” Dr. learning,” Dr. Scully added. “With The feedback from patients and providers has been very positive. Most plan to continue to use virtual visits after the pandemic. LOUIS NGUYEN, MD, MBA, MPH 22 BWH DOS

residents staffing four hospitals and perspectives of these patients, who Expanded all on different schedules, remote were often seriously ill and perhaps Use of Virtual learning makes it easier to make it to near the end of life, was critical,” Visits Is Here teaching sessions. Similarly, doing Dr. Ozaki said. to Stay some M&M sessions via Zoom allows for more people working offsite and Prepared for Although they faculty who otherwise would not be won’t completely able to participate.” the Next Crisis replace in-person visits, virtual visits “We also saw firsthand the If they need to do it all again, offer another importance of having a diverse the Department of Surgery is now option for seeing workforce,” Dr. Ozaki said. “At accustomed to taking care of COVID patients. Virtual times, many of the patients in patients and has established a visits eliminate the COVID ICUs were non-native standard of care for managing these travel time, and English speakers. Being able to patients. This was achieved through patients can communicate with them and regular lessons-learned meetings resume work/ understand how they perceive things throughout the crisis—talking personal activities is very important. In normal times, through and documenting what soon after the visit. family members would assist in worked and what didn’t and creating communicating with these patients living guidelines in real time that PERIOPERATIVE VISITS and consoling them.” But the highly were refined as more was learned Initial virtual visit to meet patient contagious nature of COVID-19 about this insidious disease. and coordinate testing or imaging meant that they could not be ordered locally; second visit in present to support their loved ones. “We now know so much person focuses on interaction and Much like the medical workforce, about preventing the spread of examination the translator workforce was also a respiratory borne infection,” stretched thin. “Having providers Dr. Doherty said. “And we will PRE-PROCEDURE EVALUATION who were able to communicate and incorporate these changes into our VISITS understand the cultural and social practices going forward, much like Transitioned from about 50% we did for blood-borne infections in phone/video evaluations to 100% the wake of the HIV crisis.” POSTOPERATIVE VISITS “In the beginning, there were Effective whenever there are no many unknowns. How sick will the sutures patients be? How many will there be?” Dr. Salim said. “Now we know MONITORING VISITS what to do and how to prepare Virtual visits with imaging ourselves.” obtained at the patients’ convenience “It’s certainly not desirable to have a pandemic and be forced to make these decisions and changes,” Dr. Robinson said. “One silver lining, though, is the teamwork…working together in different ways than we had before. Having such an acute and difficult problem forced us to work outside the box and forge new relationships, both horizontal and vertical, that will be beneficial going forward.” “We’ve built the systems and put the processes in place and are ready to do it again,” Dr. Nitzschke said. “The sense of community and shared mission is still there. It should be easier the second time around.” 

COVID Research REGAN BERGMARK, MD, were pleasantly surprised care unit: A multi-site, PTSD, higher than numbers participated as site PI on with the role virtual care mixed-methods study.” prior to the COVID-19 a study led by Dr. Rachel played in their practices. The purpose of the study pandemic; and better Kelz from the University Risk of infection and illness was to understand the communication and decision- of Pennsylvania, which were major stressors, and psychological impact(s) making will be associated focused on the U.S. surgical in some cases increased of physical isolation on with lower psychological workforce during the time at home was greatly family members of patients symptoms, providing specific COVID-19 pandemic. The appreciated. Also involved admitted to the COVID-19 process measures that could multicenter, longitudinal with the study was Zara ICU. The study evaluated be used to develop future interview and survey study Cooper, MD, MSc. the prevalence of symptoms interventions. This research centered on residents and of PTSD in family members will help develop better ways attending surgeons from five RAPHAEL BUENO, MD, using the Impact of Events to support family members large academic departments served as the site PI with Scale-Revised (IES-r) at 90 who cannot be in the ICU of surgery, including UPenn, groups at the Broad Institute to 120 days after patients physically and advance the University of Michigan, of MIT and Harvard and were admitted to the ICU. improvements in delivery of UC San Francisco, Cornell Boston Children’s Hospital Depression and anxiety care in the ICU, preparedness University and the Center for to collect airway specimens were also evaluated using and response for future Surgery and Public Health to determine the ACE2 the Hospital Anxiety and outbreaks. Also involved (CSPH) at the Brigham. receptor levels based on Depression Scale (HADS), with the study were Rachelle The study investigated changing ages/sex/meds. as well as family member Bernacki, MD; Masami Kelly; the impact of COVID-19 In addition, he invented a satisfaction with decision- Christina Sheu; and Emma on surgical volume, home new filter to protect staff making and communication Kerr. support, stress levels and patients from potential and the correlation of during and after the surge, viral infection emanating various factors such as CHRISTINA MINAMI, academic productivity, from chest tube drainage preexisting psychiatric MD, MS, collaborated on and the challenges and systems. This filter has been diagnosis that could impact a study titled, “Association opportunities for surgeons developed from inexpensive the development of stress- between time to surgery during the pandemic. medical grade supplies related disorders. The and pathological stage in The study is ongoing and and can be easily placed study was conducted in 12 ductal carcinoma in situ multiple publications are in in the line. The clinical trial academic and community and early-stage, hormone- submission and preparation, is currently in process and medical centers across receptor-positive breast but the first round of licensing is being explored. the country, including the cancer.” The study was a interviews, which consisted This new technology might Brigham, Johns Hopkins retrospective analysis of the of 300 surgeons, showed that revolutionize how we treat all Hospital and Columbia National Cancer Database there were high peak stress chest tube drainage systems University. Mixed-methods between 2010 and 2016, with levels, reduced operative at Mass General Brigham and of chart review, survey the objective to understand case volumes and loss of universally. interviews and semi- the possible ramifications of home support during the structured interviews (not the surgical delays in women pandemic’s first surge. There ZARA COOPER, MD, MSC, conducted at the Brigham) with ductal carcinoma in were also differences in peak focused on the families were used to collect data. situ (DCIS) and early-stage, stress levels for different of COVID-19 patients in The study is ongoing, but hormone-receptor-positive genders. Preliminary the study, “Stress-related the team has deduced some breast cancer by examining findings suggest there were disorders in family members hypotheses: Over 40% of the association among time immense challenges delaying of COVID-19 patients family members will develop to surgery, pathological surgical care, and surgeons admitted to the intensive significant symptoms of staging and overall survival. 24 BWH DOS

The findings suggest that are often based on overall mortality, which colleagues at the Harvard increased time to surgery expert opinion. The study suggests an indirect effect Global Health Institute, he was associated with a small evaluated prolonged time to of COVID-19-related delays was influential in developing increase in pathological treatment initiation (TTI), the on mortality. Colon and lung state and national testing upstaging in DCIS but did period between cancer patients benefitted targets, which were widely not impact overall survival. diagnosis and the start of the most from timely covered by major media Increased time to surgery definitive treatment, and treatment, as well as low outlets during the pandemic. was not associated with its effect on mortality as stage breast cancer patients. Dr. Tsai also collaborated increased pathological a function of cancer type In contrast to current with a TTSI (test, trace, upstaging or change in and stage for the four most pandemic-related guidelines, supported isolation) overall survival in early-stage, prevalent cancers in the the study supported more collaborative to develop a hormone-receptor-positive U.S.—nonmetastatic breast, timely definitive treatment consensus framework to breast cancer patients on prostate, non-small cell lung for intermediate and high- guide a national response neoadjuvant endocrine (NSCLC) and colon cancer. risk prostate cancer patients. for COVID-19. On the therapy. The findings also Using the National Cancer Also involved with the study research side, he is actively support the suggested delay Database from 2004 to 2015, were Christina Minami, MD, using aggregated mobility recommendations that were over 2.2 million patients MS; George Molina, MD, data to understand the followed during the height of were included in the study. MPH; and Eugene Cone, MD. effectiveness of social the COVID-19 pandemic. The Findings concluded that a distancing orders on true outcomes of the surgical general increase in the 5- THOMAS TSAI, MD, transmission of COVID-19, delays that were necessary and 10-year predicted overall focused on understanding as well as collaborating with during the pandemic will be mortality was found across the effect of the COVID-19 a consortium of hospitals to seen in the coming years, all cancers. Median TTI by pandemic on access to care evaluate the spillover effects but the data suggests that cancer was as follows: 32 in the U.S. and generating of the COVID-19 pandemic patients may not suffer days for breast, 79 days for actionable evidence to guide on emergent and elective worse outcomes due to their prostate, 41 days for NSCLC policy making. Alongside medical and surgical care.  surgical delays. Also involved and 26 days for colon. It with the study were Olga was evident that for all the Kantor, MD, MS; Tari King, studied cancers shorter TTI MD; Elizabeth Mittendorf, was associated with lower MD, PhD; Anna Weiss, MD; and Faina Nakhlis, MD. QUOC-DIEN TRINH, MD, worked on a study tiled, “A critical question for the COVID-19 pandemic era: Do delays in cancer treatment change survival outcomes?” Optimal time to treatment is underexplored, and recommendations for which cancer treatments can be deferred during crises such as the COVID-19 pandemic BWH DOS 25

PHYSICIAN ASSISTANT SPOTLIGHT The Department of Surgery Continues to Grow and Strengthen its PA Model The Department of Surgery (DoS) flow with Admitting and works Surgery, who has been with the at Brigham and Women’s Hospital on changing workflows around Brigham for 22 years, said. has over 100 full-time physician our extended recovery room and assistants (PAs) working in 11 of inpatient floor discharges as a The PA role has evolved very its 12 divisions. The role of the PA member of the surgical operations quickly. In just the past 15 months, has grown and evolved rapidly team, led by Malcolm Robinson, PA numbers in the DoS have grown in the last few years—from the MD, associate chair of Clinical by about 28%. “I think the growth integration of the PA model into Operations in the DoS. of the PA group over the past five to the DoS, to the creation of new seven years speaks to the competent, leadership roles like that of Jennifer “Jen brings a much-needed consistent and valuable care that Beatty, PA-C, who has been serving perspective of the department’s they provide to patients in all areas as director of Clinical Operations 110 physician assistants and has of care,” Beatty said. Now there are and Surgical Physician Assistants been invaluable in coordinating PA more visible roles for PAs, and not since March of last year. Beatty’s efforts,” Dr. Robinson said. just PA-related positions but also unique and first-of-its-kind role at hospital-wide leadership roles. the Brigham entails operations, PA According to Beatty, this new leadership, and quality and safety centralized leadership over the PAs “The role of the PA over the past responsibilities. has had many benefits. Her role several years has become a diverse has opened better communication and well understood profession, As director of the surgical PAs between the PAs and leadership and which expands into every area of in the department, Beatty oversees allowed the PAs to strengthen their medicine and surgery, with more seven chief PAs in the divisions of voice in the department. Genina and more jobs trending toward Breast Surgery; Cardiac Surgery; Salvio, PA-C, chief PA for Cardiac specialization,” Salvio said. She General and Gastrointestinal Surgery, who has been with the recalls other changes she has Surgery; Plastic and Reconstructive Brigham since 1989, has also seen a experienced as a PA in the past 31 Surgery; Trauma, Burn and Surgical positive change with the centralized years of her career, “When I first Critical Care; Thoracic Surgery; PA leadership. started working at the Brigham, PAs and Vascular and Endovascular didn’t have prescription writing Surgery. Additionally, she serves “Any concerns are dealt with privileges, we couldn’t bill for as chief PA for those divisions that in real time and that gives us the visits or procedures and we were do not have one. On the operations support and reassurance we are a not required to go through the side, Beatty reports to the hospital’s respected group of PAs,” Salvio said. credentialing process.” daily safety huddles, which are led With the centralized leadership, PAs by Charles A. Morris, MD, MPH, now have a place to elevate issues The DoS is also trying to offer the associate chief medical officer at or concerns and receive support more opportunities for PAs with the Brigham, where hospital leaders from various resources, both within the creation of three committees, and stakeholders meet to report and outside the department. Beatty which are co-chaired by chief and barriers to patient care, patient considers herself an advocate for the senior PAs, that focus on education, census information and anticipated PA group, and her having an active skills building and onboarding. discharges. and participatory role at leadership The committees are working on meetings and committees has been building strong training programs “She’s an ever-present face at the integral in supporting the PAs and to prepare new PAs and develop Daily Safety Huddle, where she’s showcasing their work. new skills for more experienced PAs. helped bring terrific departmental Recently, quarterly grand rounds visibility to an interdepartmental “Having a voice at the table allows were made available specifically for group helping to advance high- for Jen to offer a PA perspective the surgical PAs, but Beatty says this quality, safe care,” Dr. Morris said. and discuss ways in which PAs can is just the beginning of what she be utilized to improve patient care hopes will become ongoing learning Beatty also helps manage bed throughout the department,” Evan opportunities for the group.  Hall, PA-C, chief PA for Thoracic 26 BWH DOS

PAs Respond to the COVID-19 Crisis Like many other health care facilities COVID patients increased during the with COVID patients, they were and hospitals, the Brigham faced surge. Seven PAs were deployed to redeployed to other services in the many challenges brought on by the the ICU to work for the three teams hospital or working remotely with COVID-19 pandemic. The PA group staffed by surgery/anesthesia and the newly implemented virtual also had their challenges. Most of continued to work there until the rounds. the difficulties arose from limited teams were deactivated. With the resources and having to develop transition from in-person visits to “During the pandemic, our service new workflows to cover was moved three different times COVID requirements. PAs had to adapt to new almost all virtual visits, PAs had to to make room for the COVID-19 scheduling and logistical change their workflows and train ICUs, and we all worked in very needs, while working in on the virtual platform, while also unfamiliar areas of the hospital. multiple environments assisting patients. The group came The PAs were instrumental in under the stress of together to help with the inpatient staffing the COVID-19 medical potentially becoming visits that were still taking place. teams and ICUs and other services infected with the virus. In total, 33 PAs were redeployed throughout the hospital due to our to several areas treating COVID diverse education, versatility and “The willingness of patients. experience,” Salvio said. team members to learn new skills and provide “Having a PA leadership position As many other health care workers much needed relief to in the DoS allowed us to quickly experienced similar challenges, stressed systems was evaluate our PA workforce and the PAs endured constant schedule an invaluable resource determine what PAs were able to be changes due to colleagues being ill, for the hospital. Jen and redeployed,” Beatty said. “I worked arduous work structures working her co-leaders exceeded with the chief PAs and division seven 12-hour days in a row and all expectations and administrators to determine which then seven days off during six-week ensured that there was PAs were available and where they periods, as well as overwhelming complete coverage in all would be most successful to be worry for their colleagues and the areas,” Hall said. With redeployed.” possibility of exposing their families cooperation and ongoing to the virus. close communication, PAs were Many of the PAs who were seamlessly integrated into multiple redeployed volunteered to do so. “It was truly a team effort,” Beatty services, including staffing COVID If they weren’t directly working said.  ICU units. According to Beatty, the surgical PAs were the first group redeployed to assist the inpatient medicine PA teams caring for COVID patients. Most went through a rapid onboarding process and some were able to move into a medicine team without official training and even covered the regular medicine service patients. “There was nothing but positive feedback about the surgery PAs, as they filled roles on the inpatient medicine teams and one also joined the virtual rounding team,” Beatty said. The COVID ICUs also faced staffing issues as the number of BWH DOS 27

At the Forefront of Breast Surgical Oncology 28 BWH DOS

Brigham and Women’s Hospital productive group of more junior her risk of breast cancer,” Dr. is leading the way in expanding faculty members in research, teaching King said. “The B-PREP program the boundaries of breast cancer and clinical care.” is unique because it resides in an knowledge and developing more ambulatory breast center at a general precise treatments. Tari A. King, All three women came to the hospital, so we are able to identify MD, Elizabeth Mittendorf, MD, Brigham after 10 to 15 years at other a broader population of women at PhD, and Andrea Pusic, MD, have pre-eminent cancer centers—Dr. risk—specifically those who are not established a breast cancer surgery, King and Dr. Pusic from Memorial already seeking services from the reconstruction and research program Sloan Kettering Cancer Center and cancer center.” that spans the entire continuum Dr. Mittendorf from the University of of the disease, with world-class Texas MD Anderson Cancer Center. “Patients come to the expertise in surgical oncology, plastic Comprehensive Breast Health Center and reconstructive surgery, cancer “The fact that these international with a range of breast complaints, pathology and diagnostic imaging— leaders in their fields are all women, including breast lumps, pain, all in collaboration with their medical and all professors of surgery at infections, imaging abnormalities, and radiation oncology colleagues at Harvard Medical School, and that nipple discharge or high-risk breast Dana-Farber Cancer Institute (DFCI) each has been honored with an lesions, such as lobular carcinoma in and researchers at Harvard Medical endowed chair, is important,” Dr. situ,” Dr. King explained. The typical School (HMS). Doherty explained. “Over half of our high-risk clinic model that focuses general surgery trainees are women, on patients with known breast cancer The Leadership Team as are many of our junior faculty risk factors misses opportunities to members. I hope that it is inspiring intervene with preventive strategies “Building great programs often and enabling for them to see women for many additional women at requires recruiting visionary leaders who have succeeded, and been increased risk for breast cancer. who can assemble a critical mass of recognized as succeeding, along paths talented people,” Gerard M. Doherty, that they might choose to follow.” B-PREP offers a customized MD, chair of the Department of risk assessment program that Surgery, said. “Dr. Tari King joined Personalized Breast includes traditional breast cancer the Department of Surgery in 2015, risk factors, such as family history and it has been her determination and Cancer Care and prior high-risk lesions, as well enthusiasm to recruit critical partners as emerging risk factors, such as with complimentary skill sets that Dr. King, a nationally recognized lifestyle and personal behaviors. have made this the best breast surgery expert in lobular carcinoma in situ, B-PREP highlights modifiable risk program in the country.” serves as chief of the Division of factors and opportunities for focused Breast Surgery at the Brigham and behavioral changes in this broader “In 2018, we were able to recruit chief of Breast Surgery at Dana- population of women at increased Dr. Elizabeth Mittendorf to lead the Farber/Brigham and Women's Cancer risk. Through B-PREP, women receive research efforts of the Division of Center. tailored screening recommendations, Breast Surgery and the broader Breast expedited referrals for genetic Oncology Program and Dr. Andrea Dr. King developed and leads testing, interventions geared toward Pusic to lead the Division of Plastic the Breast Cancer Personalized risk reduction (e.g., exercise, weight and Reconstructive Surgery, because Risk Assessment, Education and management, dietary suggestions), Tari made the opportunity to do Prevention (B-PREP) Program, housed education about risk reducing something special very clear,” Dr. in the Brigham Comprehensive Breast medications and opportunities to Doherty added. “Together, these three Health Center—an outpatient clinic participate in novel clinical trials. have nurtured an extraordinarily that cares for nearly 4,000 women and men every year with various breast- B-PREP’s experienced and related concerns. compassionate clinical care team also “Every woman should understand ...these international leaders in their fields are all women... GERARD DOHERTY, MD BWH DOS 29

includes medical oncologists, nurse research priorities and then bringing on four key priorities: Prevention practitioners, physician assistants those research findings back into the and early disease, patient-centered and a social worker to help women clinic to inform patient care.” outcomes, tailored local-regional understand their breast cancer therapeutic strategies and tumor risk and support them along their As a national leader in the immunology,” Dr. Mittendorf journey. development of immunotherapy said. The robust platform includes for breast cancer, Dr. Mittendorf laboratory studies, correlative Robust Research has been the principal investigator studies, clinical trials, patient- Platform on numerous trials investigating reported outcome studies and cancer vaccines, including the phase artificial intelligence predictive “We aim to perform high quality III PRESENT trial study of a HER2- modeling. research that asks the right questions targeted vaccine, a study evaluating and moves the field forward,” Dr. vaccination in combination with “In the Clinical Oncology Quality Mittendorf, director of the Breast trastuzumab; and most recently, Database (COQD), we capture data Immuno-Oncology Program and co- the phase III IMpassion031 trial on the diagnosis, treatment and long- director of the Breast Cancer Clinical that showed a benefit of adding term outcomes of all patients that we Research Program at Dana-Farber/ immune checkpoint blockade to operate on as Brigham surgeons,” chemotherapy in the presurgical Dr. Mittendorf said. Established in Brigham and Women's Cancer setting. January 2016, the COQD currently Center, said. “We believe in using includes data for nearly 8,000 patients clinical observations to drive our “Our research program is aimed at and is a tremendous resource for driving clinical innovation focused 30 BWH DOS

Patient-Centered Focus Putting the focus of surgical care on the patientʼs goals for treatment and Dr. Pusic, chief of Plastic and the patient’s experience after surgery Reconstructive Surgery, is an has long been at the core of Dr. Pusic’s internationally renowned innovator practice. A leader in the area of PROs and and leader in patient-reported outcomes surgical experience, Dr. Pusic launched (PROs) and patient satisfaction in surgery. the Patient-Reported Outcomes, Value With dual training in outcomes research & Experience (PROVE) Center at the and surgery, she leads a team of experts Brigham in 2018. She is also principal in psychometrics, quality of life and social investigator of a study funded by the science methods to develop, validate and Patient-Centered Outcomes Research use new quantitative measures to assess Institute (PCORI) that examines how patient outcomes. electronic patient reporting of symptoms may improve surgical care. “Patient-reported outcomes are those outcomes that only patients can know The patient-reported outcomes measure and tell us about,” Dr. Pusic said. “They (PROM) that Dr. Pusic developed for include things like quality of life, breast surgery, the BREAST-Q, has been body image, physical function and the widely adopted for research and clinical experience of care. These are things that care, translated into 40 languages and matter a great deal to our patients.” used as the basis for development of other Breast Surgery Research Program Collaborative investigation across the continuum of care to set new standards for evaluation and treatment of benign and malignant breast disease answering research questions. Prevention Patient- Tailored Tumor “Perhaps most importantly, it and Early Centered Local-Regional Immunology allows us to review our clinical Disease Outcomes experience in order to inform Therapeutic treatment recommendations, as Strategies well as identify areas for research that will positively impact our QUALITY & VALUE | TRAINING & EDUCATION | BIOSPECIMEN COLLECTION breast cancer patients,” Dr. Mittendorf explained. Robust Research Platform The research program LABORATORY STUDIES also maintains an extensive biospecimen collection effort that Tumor biology and immunologic response mechanisms is essential for performing cutting edge research that requires fresh CORRELATIVE STUDIES tumor tissue. All patients operated on at Brigham Heath are asked to Linking tumor types to clinical outcomes consent to specimen collection that allows their breast tissue/tumors CLINICAL TRIALS to be banked and used for research purposes. Assessing existing and emerging therapies PATIENT-REPORTED OUTCOMES STUDIES Validating new clinical care models and documenting survivorship issues ARTIFICIAL INTELLIGENCE PREDICTIVE MODELING Improving risk assessment and treatment guidelines BWH DOS 31

outcome measures in surgery. Next surgery and radiation oncology,” Dr. junior colleagues. We all came here up— the imPROVE Breast Cancer Pusic explained. “The coordination Care app for patients to record and among all these elements of care here after developing our early careers follow quality-of-life measures in real is phenomenal.” elsewhere, where we learned a time on a smartphone. tremendous amount about how to Shaping the Future develop an academic career,” Dr. “Patient-reported outcomes data of Breast Surgical Mittendorf said. “Working together are essential whenever the goal of a Oncology mentoring junior faculty is one health care intervention is to make important part of our synergy. Our a patient feel or function better,” Dr. The Breast Surgical Oncology shared interests and goals allow us to Pusic explained. “By understanding Fellowship Program at the Brigham co-mentor and develop these young these outcomes, we can better tailor is among the most competitive and clinician-researchers in our vision care to individual patients and better sought-after programs of its kind for the future of cancer care and address their needs.” in the country, receiving nearly 100 research.” applications for just two positions “Our patient-centered focus gives each year. “Working with some of the best us the opportunity to integrate and brightest young breast surgical PROMs into every step of the breast “We enjoy creating a supportive oncologists and expanding the cancer journey,” Dr. Pusic said. environment to mentor these patient-centeredness of breast This patient-centered care model trainees,” Dr. King said. “I enjoy surgery care is exciting,” Dr. Pusic is made possible with the support working with fellows to address said. “We are three female leaders of physician assistants, nurses clinically relevant research questions shaping a breast cancer care program and nurse practitioners, patient that can be asked and answered around the values of compassion, navigators, social workers, and within their one-year fellowship. collaboration, nurturing and exercise and nutrition specialists. It is particularly rewarding for our mentoring.” “You can’t get big transformative fellows to have success presenting changes off the ground if you don’t their research at national meetings.” “We believe that we should learn have a great team,” Dr. Pusic said. “We also enjoy mentoring our something from every patient that we care for,” Dr. King said. “We are “On their breast cancer journey, always looking to move the field patients want great oncology care, as forward to give back to the next well as great care in surgery, plastic generation of patients.”  32 BWH DOS

BREAST SURGERY AND BREAST PLASTIC AND RECONSTRUCTIVE SURGERY by the numbers CLINICAL OPER ATIONS BREAST SURGERY 13 2 8 5 3 BREAST PLASTIC breast nurse nurses AND RECONSTRUCTIVE surgeons breast surgical physician practitioners SURGERY oncology fellows assistants 1 9 9 nurse practitioners breast plastic physician surgeons assistants RESEARCH PERSONNEL BREAST SURGERY 6 9 BREAST PLASTIC 5 3 AND RECONSTRUCTIVE clinical research SURGERY clinical research research staff laboratory staff research staff laboratory staff RESEARCH PORTFOLIO $4,15M Federal, foundation, nonprofit and industry including awards from: total costs in current funding •National Cancer Institute (NCI) •Susan G. Komen •American Society of Clinical Oncology (ASCO) •American College of Surgeons (ACS) •Stand Up To Cancer •Agency for Healthcare Research and Quality (AHRQ) •Patient-Centered Outcomes Research Institute (PCORI) P U B L I C AT I O N S 101original research articles published January to December 2019

Education CURRENT RESIDENTS Darshan Vora, MD George Washington University School The Department of Surgery General Surgery of Medicine combines top-notch clinical care with world-class research Program Director: PGY 2 and cutting-edge education to Stephanie Nitzschke, MD provide comprehensive surgical Associate Program Directors: Alexis Antunez, MD training programs. Teaching Jennifer Irani, MD; Matthew Nehs, University of Michigan Medical School tomorrow’s leaders today… MD, PhD; Naomi Shimizu, MD James Fitzgibbon, MD 152 PGY 1 Lewis Katz School of Medicine at Temple interns and residents University CATEGORICAL 37 Kerri McKie, MD fellows Isaac Alty, MD University of Massachusetts Medical School Harvard Medical School 5 Brittany Powell, MD Jake Awtry, MD Stanford Medical School ACGME-accredited Johns Hopkins University School of Medicine surgical residency programs Cullen Roberts, MD Ilaria Caturegli, MD Warren Alpert Medical School of Brown 5 University of Maryland School of Medicine University ACGME-accredited Eliza Hersh, MD Max Riley, MD surgical fellowships Icahn School of Medicine at Mount Sinai Washington University School of Medicine 12 Annabelle Jones, MD Sarabeth Spitzer, MD Renaissance School of Medicine at Stony Stanford Medical School non-ACGME-accredited Brook University surgical fellowships Megan Sulciner, MD Yun Jee Kang, MD University of Minnesota Medical School 34 BWH DOS Harvard Medical School Biqi Zhang, MD Sangki Oak, MD Harvard Medical School University of Pittsburgh School of Medicine PGY 3 Alexander Ordoobadi, MD Harvard Medical School Karan Chhabra, MD University of Michigan Medical School Soelling, Stefanie, MD Emory University School of Medicine Jessica Feliz, MD University of Virginia School of Medicine PRELIMINARY Adam Fields, MD Christian Cerecedo Lopez, MD Icahn School of Medicine at Mount Sinai Universidad Anáhuac Facultad de Ciencias de la Salud, Mexico Katherine He, MD University of Michigan Medical School Chin Fung [Kelvin] Kan, MD University of Queensland Faculty Patrick Heindel, MD of Medicine, Australia Keck School of Medicine of USC Martin Kauke-Navarro, MD Sameer Hirji, MD Universität zu Köln Medizinische Fakultät, Johns Hopkins University School of Medicine Germany Eva Rouanet, MD Joseph Phalen, MD University of Massachusetts Medical School Boston University School of Medicine Matthew Vivero, MD Ishan Sinha, MD Columbia University Vagelos College Warren Alpert Medical School of Brown of Physicians and Surgeons University Christine Wu, MD Sameer Singhal, MD University of Michigan Medical School George Washington University School of Medicine

PGY 4 James Etheridge, MD Elizabeth Lilley, MD Eastern Virginia Medical School Palliative Care Fellowship, Massachusetts Jamie Knell, MD General Hospital UC San Diego School of Medicine Frances Hu, MD Emory University School of Medicine Rebecca Scully, MD Pamela Lu, MD Vascular Surgery Fellowship, Brigham and University of Massachusetts Medical School Lenka Ilcisin, MD Women’s Hospital Harvard Medical School Arin Madenci, MD James Senturk, MD, PhD University of Michigan Medical School Joshua Jolissaint, MD Minimally Invasive Surgery Fellowship, University of Virginia School of Medicine Mount Sinai Hospital David Mahvi, MD University of Wisconsin School of Medicine Abby Larson, MD Kristin Sonderman, MD, MPH and Public Health Johns Hopkins University School of Medicine Surgical Critical Care Fellowship, R Adams Cowley Shock Trauma Center/University of Danny Mou, MD James Luo, MD Maryland Medical Center Emory University School of Medicine University of Chicago Pritzker School of Medicine Russell Witt, MD William Phillips, MD Hepatobiliary Surgery Fellowship, MD Rush University Medical College Pooja Neiman, MD Anderson Cancer Center David Geffen School of Medicine at UCLA Rowza Rumma, MD Cardiothoracic Surgery Stanford Medical School Paige Newell, MD Integrated (I-6) Program Lewis Katz School of Medicine at Temple Paul Salem, MD University Program Director: Mayo Clinic Alix School of Medicine Michael T. Jaklitsch, MD Laura Piechura, MD PGY 5 Stanford Medical School PGY 1 Bryan Dieffenbach, MD Jason Pradarelli, MD Thais Faggion Vinholo, MD UC San Diego School of Medicine University of Michigan Medical School Yale School of Medicine Anthony Haddad, MD Mehida Rojas-Alexandre, MD John Finnigan, Jr., MD American University of Beirut Faculty Yale School of Medicine Icahn School of Medicine at Mount Sinai of Medicine Lily Saadat, MD PGY 2 Jonathan Hills-Dunlap, MD Northwestern University Feinberg School Stanford Medical School of Medicine Patrick Gedeon, MD Duke University School of Medicine George Li, MD Vanessa Welten, MD Duke University School of Medicine Northwestern University Feinberg School Andreas Habertheuer, MD of Medicine Medical University of Vienna, Austria Heather Lyu, MD Johns Hopkins University School of Medicine Elizabeth Yates, MD PGY 3 University of Michigan Medical School Alessandra Moore, MD Sue Wang, MD University of Massachusetts Medical School Bixiao Zhao, MD UCSF School of Medicine Yale School of Medicine Linda Pak, MD Hoda Javadikasgari, MD University of Michigan Medical School 2020 GRADUATES Tehran University of Medical Sciences, Iran Nidhi Udyavar, MD Alexandra Columbus, MD PGY 4 George Washington University School Minimally Invasive Surgery Fellowship, Lahey of Medicine and Health Sciences Hospital & Medical Center Farhang Yazdchi, MD Shahid Beheshti University of Medical RESEARCH Gillian Fell, MD Sciences, Iran Pediatric Surgery Fellowship, Children’s Rachel Atkinson, MD Hospital LA Yifan Zheng, MD Geisel School of Medicine at Dartmouth Boston University School of Medicine David Harris, MD Sourav Bose, MD Minimally Invasive Surgery Fellowship, Perelman School of Medicine at the Brigham and Women’s Hospital University of Pennsylvania Samuel Enumah, MD Johns Hopkins University School of Medicine BWH DOS 35

RESEARCH PGY 3 2020 GRADUATES Ariana Jones, MD Ciersten Burks, MD Alessandra Colaianni, MD UCSF School of Medicine Indiana University School of Medicine Head and Neck Oncologic and Reconstructive Surgery Fellowship, Vanderbilt Morgan Harloff, MD Lauren Miller, MD University Kaohsiung Medical University, Taiwan Perelman School of Medicine at the University of Pennsylvania Allen Feng, MD Kathleen Weiss, MD Head & Neck Oncologic Surgery and University of Miami Miller School of Medicine Tara Mokhtari, MD Microvascular Reconstruction Fellowship, Stanford Medical School University of Michigan Otolaryngology Alan Workman, MD Natalie Justicz, MD Program Director, Perelman School of Medicine at the Facial Plastic and Reconstructive Surgery Harvard Otolaryngology Residency University of Pennsylvania Fellowship, University of Michigan Program: Stacey T. Gray, MD Assistant Program Director: Vinay Rathi, MD Anuraag Parikh, MD Kevin S. Emerick, MD Yale School of Medicine Head and Neck Microvascular Fellowship, Brigham Site Director: Ohio State University Alice Z. Maxfield, MD PGY 4 PGY 1 Alisa Yamasaki, MD Eric Barbarite, MD General Otolaryngology Private Practice, Riu Han Liu, MD University of Miami Miller School of Medicine Somerset, NJ Johns Hopkins University School of Medicine Adeeb Derakhshan, MD Oral Medicine Margaret Mitchell, MD Cleveland Clinic Lerner College of Medicine Vanderbilt University School of Medicine of Case Western Reserve University Program Director, Oral Medicine Residency Program: Nathaniel Danielle Reny, MD Suresh Mohan, MD Treister, DMD, DDMSc Perelman School of Medicine at the Warren Alpert Medical School of Brown University of Pennsylvania University PGY 1 Isaac Wasserman, MD Krupa Patel, MD Brittany Klein, DDS Icahn School of Medicine at Mount Sinai Weill Cornell Graduate School of Medical University of North Carolina Adams School Sciences of Dentistry Lucy Xu, MD University of Chicago Pritzker School Tiffany Wang, MD PGY 2 of Medicine Keck School of Medicine of USC Prazwala Chirravur, BDS PGY 2 PGY 5 India (certificate program) Ryan Bartholomew, MD Nicholas Abt, MD Malak Al-Hadlaq, BDS Harvard Medical School Johns Hopkins University School of Medicine Saudi Arabia (certificate and DMSc program) Elliana DeVore (Kirsh), MD Jenny Chen, MD PGY 3 Harvard Medical School Harvard Medical School Amal Bajonaid, BDS Krish Suresh, MD Shekhar Gadkaree, MD Saudi Arabia (certificate and MMSc Northwestern University Feinberg School Johns Hopkins University School of Medicine program) of Medicine Vivek Kanumuri, MD Yuanming Xu, DDS Michael Wu, MD Rutgers Robert Wood Johnson Medical China (certificate and MMSc program) Harvard Medical School School Rossella Intini, DDS Roy Xiao, MD Ashley Miller, MD Italy (certificate program) Case Western Reserve University School University of Michigan Medical School of Medicine Shaiba Sandhu, DDS RESEARCH UCSF School of Dentistry (certificate program) Christopher McHugh, MD, PhD Wayne State University School of Medicine Phoebe Kuo Yu, MD Yale School of Medicine 36 BWH DOS

2020 GRADUATE Frankie Wong, MD Ashleigh Francis, MD David Geffen School of Medicine at UCLA Microsurgery Fellowship, MD Anderson Nancy Wilson, DMD Cancer Center Faculty, James B. Edwards College of Dental PGY 5 Medicine at the Medical University of South Mark Greyson, MD Carolina Timothy Irwin, MD Hand Fellowship, UCLA Pennsylvania State University College of Medicine David Mattos, MD Private Practice, Long Island Plastic Surgical Plastic Surgery Dylan Perry, MD Group University of Massachusetts Medical School Program Director, Harvard Plastic Erin Taylor, MD Surgery Residency Program: Arman Serebrakian, MD, MS Microsurgery Fellowship, Memorial Sloan Kyle Eberlin, MD Lewis Katz School of Medicine at Temple Kettering Cancer Center Associate Program Director: University Lydia Helliwell, MD Urology CHIEF RESIDENTS INTEGRATED PROGRAM Program Director: Lisa Gfrerer, MD, PhD George Haleblian, MD PGY 1 Medical University of Vienna, Austria PGY 1 Charles Hwang, MD Brent Pickrell, MD University of Michigan Medical School Baylor College of Medicine Yefri Baez, MD Harvard Medical School Ian McCulloch, MD Jacob Rinkinen, MD West Virginia University School of Medicine University of Michigan Medical School Vincent D’Andrea, MD Zucker School of Medicine at Ricardo Ortiz, MD INDEPENDENT PROGRAM Hofstra/Northwell Harvard Medical School JUNIOR RESIDENTS Kendrick Yim, MD PGY 2 UC San Diego School of Medicine Ashley Ehret, MD Brittany Caruso, MD Rutgers Robert Wood Johnson Medical PGY 2 Lewis Katz School of Medicine at Temple School University Brittany Berk, MD Vishwanath Chegireddy, MD University of Massachusetts Medical School Seth Fruge, MD Morehouse School of Medicine Louisiana State University School of Medicine Catherine Gu, MD SENIOR RESIDENTS Perelman School of Medicine at University Kimberly Khouri, MD of Pennsylvania New York University Grossman School Jason Gardenier, MD, PGY 6 of Medicine University of Virginia School of Medicine Marie Valovska, MD Geisel School of Medicine at Dartmouth PGY 3 Silviu Diaconu, MD, PGY 6 Northwestern University Feinberg School PGY 3 Olivia Abbate, MD of Medicine Georgetown University School of Medicine Tracy Han, MD CHIEF RESIDENTS Duke University School of Medicine Sarah Karinja, MD Columbia University Vagelos College Mario Aycart, MD, PGY 7 Kevin Melnick, MD of Physicians and Surgeons Tufts University School of Medicine Emory University School of Medicine Eric Wenzinger, MD Ravi Sood, MD, PGY 7 Venkat Ramakrishnan, MD Medical University of South Carolina University of Chicago Pritzker School University of Louisville School of Medicine of Medicine PGY 4 PGY 4 2020 GRADUATES Jason Clain, MD Erica Ditkoff, MD Tufts University School of Medicine KC Collins, MD Columbia University Vagelos College Academic Practice, Baystate Medical Center of Physicians and Surgeons Brittany Vieira, MD Northwestern University Feinberg School Joani Christensen, MD of Medicine Microsurgery Fellowship, MD Anderson Cancer Center BWH DOS 37

Gricelda Gomez, MD Adult Cardiac Cardiothoracic Harvard Medical School Surgery Fellowship Surgery Fellowship Stephen Reese, MD Program Director: Program Director: Boston University School of Medicine Tsuyoshi Kaneko, MD Michael T. Jaklitsch, MD PGY 5 Chikashi Nakai, MD PGY 6 Wakayama Medical University, Japan Alexandra J Berger, MD Kryston Boyer, DO Warren Alpert Medical School of Brown 2020 GRADUATE Oklahoma State University Center for Health University Sciences Yuji Kawano, MD Manuel Ozambela, MD Robotics Fellowship, Emory University Darren Bryan, MD Harvard Medical School University of Rochester School of Medicine Advanced Laparoscopic and Dentistry Julie Szymaniak, MD Fellowship Rutgers Robert Wood Johnson Medical Paul Feingold, MD School Program Director: Emory University School of Medicine Ali Tavakkoli, MD 2020 GRADUATES John Kuckelman, DO David Harris, MD Des Moines University College of Medicine Hyo Sang Chiang, MD University of Virginia School of Medicine Urologist, Kaiser Permanente, Colorado Michael Lee, MD 2020 GRADUATE University of Pittsburgh School of Medicine Alexander Cole, MD Urologic Oncology Fellowship, Brigham Colston Edgerton, MD PGY 7 and Women’s Hospital & University College Faculty, Medical University of South Carolina London University Medical Center Marko Boskovski, MD Yale School of Medicine Jeffrey Howard, MD Breast Surgery Fellowship Urologic Oncology Fellowship, UT Anthony Cipriano, MD Southwestern Medical Center Program Director: Lewis Katz School of Medicine at Temple Tari King, MD University Valary Raup, MD Andrology & Prosthetic Urology Fellowship, Halley Vora, MD Mia DeBarros, MD Columbia University Lewis Katz School of Medicine at Temple Boston University School of Medicine University CURRENT FELLOWS Julius Ejiofor, MD Meghan Garstkam, MD UT Southwestern Medical Center Acute Care Tulane University School of Medicine Surgery Fellowship Desiree Steimer, MD 2020 GRADUATES University of Kentucky College of Medicine Program Director: Reza Askari, MD Olga Kantor, MD, MS 2020 GRADUATES Faculty, Brigham and Women’s Hospital Allison Brown, MD Kareem Bedeir, MD University of Wisconsin School of Medicine Alison Laws, MD Cardiac Surgeon, Cardio-Thoracic & and Public Health Faculty, Brigham and Women’s Hospital Vascular Surgical Associates, Mobile, AL 2020 GRADUATE Hassan Khalil, MD Faculty, Brigham and Women’s Hospital Mehreen Kisat, MD Faculty, University of Wisconsin Hospital and Andrew Papoy, MD Clinics Cardiac Surgeon, University of Alabama at Birmingham Sunu Philip, MD Thoracic Surgeon, Pierce Street Surgery Center, Sioux City, IA 38 BWH DOS

Cardiothoracic 2020 GRADUATE Oral Oncology and Oral Surgery Transplant Medicine Fellowship Fellowship Humbo Shim, MD Cardiothoracic Surgery Transplant Program Director: Program Director: Fellowship, Brigham and Women’s Hospital Piamkamon Vacharotayangul, DDS, PhD Antonio Coppolino, MD 2020 GRADUATE Hunbo Shim, MD General Thoracic Hanyang University College of Medicine, Surgery Fellowship Moaiad Salous, DMD Korea OMFS Intern, Lincoln Center, New York, NY Program Director: 2020 GRADUATE Michael T. Jaklitsch, MD Surgical Critical Care Fellowship Mohamed Keshk, MD Jessica Della Valle, MD Staff Surgeon, Brigham and Women’s University of Florida College of Medicine Program Director: Hospital Reza Askari, MD Colorectal Surgery Melanie Lighter, MD Mohammad “Reza” Afrasiabi, MD Fellowship St. George’s University School of Medicine Creighton University School of Medicine Program Director: Jorge Castro, MD Laura Hyde, MD Nelya Melnitchouk, MD, MSc University of Cartagena School of Medicine UCSF School of Medicine Robert Malizia, MD 2020 GRADUATES Renaldo Williams, MD University of Buffalo Jacobs School of University of Mississippi School of Medicine Medicine and Biomedical Sciences Mayrim Rios Perez, MD 2020 GRADUATES 2020 GRADUATE Matthew Pommerening, MD Faculty, Brigham and Women’s Hospital Allison Brown, MD Peter Najjar, MD Acute Care Surgery Fellowship, Brigham Assistant Professor of Surgery, Johns Hopkins Jillian Sinopoli, MD and Women’s Hospital University Thoracic Attending, Case Western Reserve University School of Medicine Choyin “Yvonne” Chung, MD Vascular Surgery Fellowship, Saint Louis Endocrine Surgery Minimally Invasive Thoracic University Fellowship Surgery Fellowship Alfredo Cordova, MD Program Director: Program Director: Assistant Professor of Surgery, Ohio State Matthew A. Nehs, MD Jon O. Wee, MD University Rajshri Gartland, MD Negar Ahmadi, MD Laura Hansen, MD Vanderbilt University School of Medicine University of Toronto Faculty of Medicine Minimally Invasive Surgery Fellowship, Hofstra/Northwell 2020 GRADUATE Kostastinos Poulikidis, MD New York Medical College Sean Wrenn, MD Assistant Professor of Surgery, Rush Medical Center 2020 GRADUATES Endovascular Cardiac John S. Young, MD Surgery Fellowship Faculty, Brigham and Women’s Hospital Program Director: Ealaf Shemmeri, MD Thoracic Surgery Residency, University Tsuyoshi Kaneko, MD of Buffalo Morgan Harloff, MD Kaohsiung Medical University, Taiwan BWH DOS 39

Surgical Oncology Fellowship Urological Oncology Vascular Surgery Fellowship Fellowship Program Director: Program Director: Chandrajit P. Raut, MD, MSc Program Director: Matthew Menard, MD Steven L. Chang, MD, MS Thinzar Lwin, MD Andrew Servais, MD New York Medical College Eugene Cone, MD Tufts University School of Medicine Warren Alpert Medical School of Brown Winta Mehtsun, MD University Rebecca Scully, MD University of Virginia School of Medicine Geisel School of Medicine at Dartmouth Alexander Cole, MD 2020 GRADUATE Johns Hopkins University School of Medicine Andrew Soo Hoo, MD Wayne State University School of Medicine George Molina, MD 2020 GRADUATES Faculty, Brigham and Women’s Hospital 2020 GRADUATES Melissa Huynh, MD Attending Physician, Schulich School of Gaurav Sharma, MD Medicine & Dentistry at Western University, Attending Surgeon, Kaiser Permanente, Ontario California Alice Yu, MD Jillian Walsh, MD Attending Physician, Moffitt Cancer Center Attending Surgeon, Capital Health, New Jersey Visiting Professors Stephanie Nitzschke, MD, Named Program Director of the Brigham David J. Sugarbaker General Surgery Residency Program Lectureship in Thoracic Surgery Dr. Nitzschke is an acute care surgeon, Gail Darling, MD, FRCSC, FACS trauma surgeon and surgical intensivist University of Toronto at Brigham and Women’s Hospital and an instructor in surgery at Harvard Medical Joseph E. Murray Visiting School. She is a graduate of Loyola University Professor in Transplant Stritch School of Medicine and completed Surgery a general surgery residency at INOVA Donna L. Farber, PhD Fairfax Hospital. She also completed a burn Columbia University Medical Center surgery fellowship at the U.S. Army Institute of Surgical Research and a trauma and Lawrence and Judith Schlager critical care fellowship at the University of Family Lecturer in Surgical Pennsylvania. She joined the trauma and Oncology critical faculty in 2014 and has been the Jennifer Tseng, MD, MPH medical director of the Brigham Burn Center Boston Medical Center since 2017. Nina S. Braunwald Visiting Dr. Nitzschke is an active participant in Lecturer in Surgery resident and medical student education. Her Jennifer Romano, MD research interests include clinical outcomes University of Michigan Medical for burn and trauma patients. She has School authored over 20 peer-reviewed manuscripts and chapters and presented 20 surgical 40 BWH DOS care abstracts and lectures regionally and nationally. 

Research Brigham Health is an international powerhouse in biomedical research dedicated to pioneering discoveries that will translate into new prediction methods, treatments, and cures for the world’s most devastating and complex diseases. 454 188 389 research funds active grants & contracts active protocols 63 56 research fellows active clinical trials $40,501,132 research spending SELECTED GRANTS Adaptive immune regulation of traumatic injury PI • James Lederer, PhD Defining mechanisms of immunotherapy resistance in Sponsor • National Institutes of Health (NIH) head and neck squamous cell carcinomas Grant Amount • $ 2,073,180 PI • Ravindra Uppaluri, MD, PhD Sponsor • National Institutes of Health (NIH) SELECTED CLINICAL TRIALS Grant Amount • $ 4,259,203 CTA • Genetic testing for all breast cancer patients (GET Understanding and improving surgical decision-making FACTS) for persons living with dementia, their family caregivers PI • Anna Weiss, MD and their providers: A mixed methods study Sponsor • Myriad Genetics, Inc. PI • Joel Weissman, PhD Sponsor • National Institute on Aging (NIH-NIA) MDIC Work Order • AltaValve early feasibility study Grant Amount • $ 4,172,072 protocol PI • Tsuyoshi Kaneko, MD Senescent cells drive mt-DNA accumulation and Sponsor • 4C Medical Technologies, Inc. inflamm-aging PI • Stefan G. Tullius, MD, PhD CTA • Post-market retrospective study of the Renú soft Sponsor • National Institute on Aging (NIH-NIA) tissue (volumizing) implant (Renú Voice) in the treatment Grant Amount • $ 2,554,955 of vocal fold medialization and vocal fold insufficiency PI • Thomas Carroll, MD Prevalence effects in visual research: Theoretical and Sponsor • Cytophil, Inc. practical implications PI • Jeremy M. Wolfe, PhD BWH DOS 41 Sponsor • National Eye Institute (NIH-NEI) Grant Amount • $ 1,790,000

Stefan G. Tullius, MD, PhD Awarded $2.5M National Institutes of Health Grant Dr. Tullius was awarded a National immunogenicity. With aging, senescent cells accumulate, producing Institutes of Health (NIH) grant increasing amounts of inflammatory products. for his study, “Senescent cells drive mt-DNA accumulation and This grant will delineate specific immune responses when inflamm-aging.” transplanting older organs. Dr. Tullius and his group will test if the depletion of senescent cells through senolytics will improve The sharp discrepancy transplant outcomes and modify immune responses. The between demand and supply proposal will also test if senescent cells will be transferred in organ of organs causes high mortality transplants and if those senescent cells will impact aging. As donor and morbidity rates in waitlisted and recipient ages may vary substantially, it is also possible that patients. Organ transplantation aging processes in transplant recipients may be either accelerated is hampered by a limited supply or that the transplantation of a younger organ will slow aging. The of organs, with many patients supported research may help to increase the availability of organs waiting for numerous years for transplants, delineate organ-age specific immune responses and numerous patients dying before getting a transplant. The and determine the fate of senescent cells transferred with organ aging population is also on the rise, and although organs from transplantation. Optimizing the utilization and outcomes of older older donors are available, they are frequently not considered or transplanted organs is also expected to reduce mortality and discarded with concerns of compromised function and augmented morbidity rates of waitlisted patients with end-stage organ failure.  Joel S. Weissman, PhD Awarded $4.4M National Institutes of Health Grant Dr. Weissman was awarded a persons living with dementia, challenges of surgical decision- understand the landscape National Institutes of Health their family caregivers and making in clinical settings. of surgical decision-making (NIH) grant for his study, their providers: A mixed The study focuses on surgery among PLWD and providers “Understanding and improving methods study.” because it is common among prior to assessing surgical surgical decision-making for elderly PLWD, represents outcomes among these Surgical decision-making is a critical inflection point in patients. Results will provide challenging for persons living quality of life and therefore, critical data to inform training with dementia (PLWD) due to is a fraught process for all on how best to care for PLWD limited longitudinal data on involved. facing surgery and support outcomes, a patientʼs limited policy decisions designed to ability to fully participate in Results of this study will improve patient-centered care. the discussion and an absence support key advancements in Surgeons and other providers, of evidence-based guidelines. Alzheimerʼs Disease Related along with patients and their The aim of this study is to Dementias (ADRD) research caregivers, will be able to use understand the epidemiology by focusing on under-studied these data to improve surgical of surgery for PLWD, as areas of surgical decision- decision-making to align care well as patient, caregiver, making by key stakeholders. with patient values.  and provider practices and Currently, there is a need to 42 BWH DOS

Jeremy Wolfe, PhD Awarded $1.8M National Institutes of Health Grant Dr. Wolfe was awarded a grant have undesirable effects. Most “Dual-Threshold” model that internal, mental representation from the National Institutes of notably, miss (false negative) better captures the important of the search target (or targets). Health (NIH) and the National errors are markedly elevated at aspects of the prevalence Project 2 is concerned with the Eye Institute (NEI) for the study, low prevalence. This is a clear effect data by proposing two impact of prevalence on these “Prevalence effects in visual problem if the purpose of the effects of low prevalence: (1) “target templates.” Advances research: Theoretical and search is to detect something the conservative shift in the in artificial intelligence (notably practical implications.” rare but important like cancer criterion for deciding if an deep learning) are producing or a terrorist threat. Previous attended item is a target and tools to assist expert searchers. Low prevalence searches work has documented this (2) a lowering of the “quitting However, once deployed, these form an important and pattern of increased miss threshold.” The quitting AI tools have been less effective problematic class of visual errors in several expert threshold determines when than theory predicts. Project 3 search tasks. These are tasks domains, including cytology observers end a search. tests the hypothesis that part where the search target is rare. (cervical cancer screening), Quitting too soon also of the problem is another side Many socially important tasks airport baggage screening increases the chance that the effect of low prevalence, and like airport security or cancer and breast cancer screening. observer will miss a target. the project tests a potential screening are low prevalence False alarm (false positive) intervention. Finally, clinicians tasks. Previous work, much error rates typically decline Prevalence effects have searching for one type of target of it from Dr. Wolfeʼs lab, has at low prevalence, moving in been studied in experimental (e.g., pneumonia) are supposed shown that low prevalence can the opposite direction from isolation from other aspects to report signs of other miss errors. This indicates a of search. However, in tasks possible problems (e.g., lung shift in the observer’s decision like breast cancer screening, cancer). Project 4 probes the criterion. At low prevalence, other factors interact with role of prevalence in the failure observers become more prevalence. The four projects to report such “incidental reluctant to call something a in the present proposal findings.” Again, several target. Several studies have each investigate one of interventions are tested. shown that this “conservative” these interactions. Project 1 This is “use-inspired, basic criterion shift is not adequate examines the relationship of research” whose results will to explain the entire prevalence prevalence to the “vigilance provide guidance for experts effect. Dr. Wolfe and Dr. decrements” that are seen as performing socially important VanWert (2010) developed a time elapses in a task. In search, low prevalence tasks.  observers must maintain an Ravindra Uppaluri, MD, PhD Awarded $4.3M Cancer Moonshot Grant Dr. Uppaluri, chief of the to accelerate cancer research and aims to make more therapies Division of Otolaryngology- available to more patients, while also improving our ability to Head and Neck Surgery in the prevent cancer and detect it at an early stage. Department of Surgery and chief of Head and Neck Surgical Dr. Uppaluri will serve as principal investigator on this project Oncology at Dana-Farber and alongside David Barbie, MD, and Robert Haddad, MD, both from Brigham and Women’s Cancer Dana-Farber Cancer Institute. Co-Investigators include James Center, received a U01 Cancer Lederer, PhD, and Ann Marie Egloff, PhD, MPH, both from the Moonshot grant from the Brigham Department of Surgery; and Robert Manguso, PhD, National Cancer Institute (NCI) from the Broad Institute. The team seeks to understand why and the National Institute of many patients with head and neck cancers display resistance Dental and Craniofacial Research to immunotherapy drugs, with the goal of improving treatment (NIDCR) for his project, “Defining mechanisms of immunotherapy response rates for this patient population. resistance in head and neck squamous cell carcinomas.” An initiative of the NCI, the Cancer Moonshot program seeks The NCI is the federal government’s principal agency for cancer research and training. The mission of the NIDCR is to improve dental, oral and craniofacial health.  BWH DOS 43

CENTER FOR SURGERY AND PUBLIC HEALTH (CSPH) Making surgery safer, more patient-centered, and more accessible in the U.S. and around the world. cancer military and comparative outcomes research effectiveness program on CSPH Research ATIVE METHODS •• patient- Cores FOCUS ON oriented policy global •••••••• • • • • • • • • •••• ••QUALIT & practice surgery (ppopp) • • • QUANTIT PATIENT-CENTERED surgical culture HEALTH CARE THAT IS SAFE, EFFECTIVE, AND EQUITABLE ATIVE METHODS ••••• trauma, surgical health emergency scientists aligning general surgery, & long-term research with outcomes patient priorities (SHARPP) Founded in 2005 as a joint initiative surgical safety checklists, created more accessible in the U.S. and of Brigham and Women’s Hospital, a national agenda for surgical around the world. Harvard Medical School and disparities research and launched the Harvard T.H. Chan School the pioneering work of rising stars In the past months, the COVID-19 of Public Health, the Center for in surgical health services research. pandemic and the health systemʼs Surgery and Public Health (CSPH) They are advancing the science of response has led to new challenges has been at the forefront of public surgical care delivery by studying and exposed old problems within health research of surgical care effectiveness, quality, equity and the U.S. health system. The CSPH delivery within and without value at the population level and has responded with a surgical our nation’s health care system. training the most gifted of a new health services research agenda Utilizing innovative research generation of physician-scientists. for the COVID-19 pandemic, and methodologies grounded in clinical Their efforts are making surgery the centerʼs director, Zara Cooper, reality, the center has developed safer, more patient-centered and MD, MSc, recently joined Annals of Surgery as an associate editor, 44 BWH DOS

NEW FUNDING HIGHLIGHTS Zara Cooper, MD, MSc, Thomas C. Tsai, MD, National Collaborative The overarching goal was awarded $156,000 MPH, was awarded on Gun Violence of the proposal is from the National $337,219 from the Research: The study, to identify ways to Palliative Care Research Massachusetts “Evaluating and improve hospital billing Center (NPCRC) for her Consortium on Pathogen improving the accuracy data efficiently and study, “The trauma dyad: Readiness (MassCPR) of ICD-coded hospital substantially such that Tended to caregivers and the Massachusetts data systems in they can be used for of injured frail elders,” Life Sciences Center estimating the incidence surveillance of nonfatal which involved recruiting (MLSC) for his study, of nonfatal firearm firearm injuries by informal caregivers “Update to the HGHI injuries by intent type,” a intent. Matthew Miller, of older adults who COVID-19 U.S. hospital collaboration of Brigham MD, ScD, MPH, co- have gone through a capacity model: ICU and Womenʼs CSPH director of the Harvard traumatic injury. surge, post-acute care and the Department of Injury Control Research beds and survey of Emergency Medicine; Center, is overall PI and Joel Weissman, mechanical ventilator Northeastern University; Eric Goralnick, MD, MS, PhD, was awarded a supply.” the Harvard Injury is site PI. $4.4 million National Control Research Institutes of Health Molly Jarman, PhD, Program at the Harvard (NIH) R01 grant for the MPH, was awarded T.H. Chan School of study, “Understanding a $606,250 National Public Health; and the and improving surgical Institute on Aging (NIA) Medical Text Extraction, decision-making for K01 Mentored Research Reasoning, and Mapping persons living with Scientist Development System (MTERMS) lab, dementia, their family Award for the project, led by Li Zhou, MD, PhD, caregivers and their “Health impacts of was awarded a two-year providers: A mixed prehospital pain grant by the National methods study.” management for injured Collaborative on Gun older adults.” Violence Research. 6 207 13 publications published active fellows fellows graduated leading a focus on the promotion of accessible and more affordable Military Health System to provide equity and social justice in surgical health systems for all patients. the best, most effective care for care and workforce. The CSPH continues to focus on military service members and their research that matters—from the families, while also providing The CSPH is continuing to expand role health care practitioners can significant insight into how to create its role as an intellectual home for play in preventing and mitigating an equitable health system. The surgical health services research firearm injury, to untangling how CSPH is helping develop consensus at Brigham and Women’s Hospital. dementia impacts a patient’s ability on what “serious illness” looks The center’s growing cohort of up- to communicate palliative and like in the preoperative context, by and-coming researchers includes surgical care goals. The center’s examining access to surgical care in surgeons and PhD researchers, continuing partnership with the Chiapas, Mexico, and what “quality” who are looking to challenge our Uniformed Services University of and “access” mean in pursuit of assumptions in the pursuit of the Health Sciences is assisting the eliminating disparities.  creating safer, more effective, more BWH DOS 45

To leverage leading-edge techniques to transform the collection, analysis and feedback of patient-reported outcomes and experiences at Mass General Brigham and around the world. YEAR AT A GLANCE through iterative cycles of feedback from and challenge to patients, health care patients and key stakeholders. Over the professionals and health care systems alike. EXPANDED their support to eight past 18 months, the team has worked Wound impact on patients varies greatly members of Brigham Surgery faculty: closely with their IT vendor (ADK Group) and in terms of recovery and return to usual Two research faculty, six residents, a key stakeholders to refine the content and activities and health-related quality of life postdoctoral research fellow, seven build the platform. They have held seven (HRQOL). The WOUND-Q is a new patient- students and nine visiting scholars. multidisciplinary stakeholder meetings reported outcome measure developed with 24 experts in the field of breast by the Breast Surgery team to assess PUBLISHED 53 papers in journals, cancer care (three patient advocates, six wound characteristics, health-related including Annals of Surgery, The Lancet breast and plastic surgeons, four medical quality of life, and experience of care and Oncology, Plastic and Reconstructive Surgery oncologists, three radiation oncologists, treatment in patients with all types of and Quality of Life Research. one anesthesiologist, two nurses and chronic wounds in any anatomic location. five resident researchers); three Harvard Scale content was developed and refined LAUNCHED the imPROVE Breast Cancer Business School affiliates, with expertise in through 60 qualitative and 20 cognitive Care app, developed in collaboration with value-based health care; and four product interviews with patients and feedback the Division of Breast Surgery, Dana-Farber developers/designers. Individual patient from 21 experts. Field-test data provided Oncology and patient advocates. interviews with 24 patients and two focus by over 1,000 participants from four groups with 12 members of the DFCI Patient countries (the U.S., Canada, Denmark and COMPLETED the development and Family Advisory Council (PFAC) have also the Netherlands) was used to finalize the international validation of two new patient- been completed. Findings from these WOUND-Q. Data was analyzed using the reported outcome measures (PROMs): The meetings, interviews and focus groups were Rasch measurement theory (RMT) analysis WOUND-Q for chronic wounds and the used to generate design ideas, including to identify the best subset of items to retain LYMPH-Q for lymphedema patients. the features, functionalities and content in each scale based on a standardized set for the platform. Feedback was obtained of psychometric criteria. The WOUND-Q KEY INITIATIVES in an iterative manner and brought back has since been finalized and will now to the IT developers for refinement of the be made available for distribution. The imPROVE Breast Cancer Care platform. Starting September 2020, they manuscript describing the development of Andrea Pusic, MD, Tari King, MD, and began user testing and implementation of the WOUND-Q is currently in preparation. teams are leading an initiative to develop the patient-facing web application within The team plans to publish additional clinical and implement a new electronic platform the breast surgery service at DFCI. They will papers from this dataset. The WOUND-Q called imPROVE Breast Cancer Care. The also continue to build and implement the will be an important tool to improve clinical imPROVE project is being conducted in clinician- and administrative-facing portals care and evaluate new treatments for collaboration with breast cancer care over the coming year. patients with chronic wounds. providers, patients and patient advocates at Brigham and Women’s Hospital and Measuring Outcomes and Experiences Development of a condition-specific Dana-Farber Cancer Institute (DFCI), as well of Chronic Wound Patients: The patient-reported outcome measure as members of Harvard Business School WOUND-Q for patients with upper extremity (HBS) and the International Consortium Each year, millions of individuals require lymphedema: The LYMPH-Q Upper for Health Outcomes Measurement treatment for chronic wounds. Wounds Extremity Module (ICHOM). imPROVE consists of a patient- represent an important health problem Breast cancer treatment is the most facing web application and clinician- and administrative-facing portals developed 46 BWH DOS

common cause of upper extremity from around the world who are aged 18 and specific codes related to eating from lymphedema in Western countries. Risk years or older. Over 2,000 participants the original set of 63 patient interview factors for developing arm lymphedema provided data and analysis. Manuscript transcripts. Scale refinement included include axillary lymph node dissection preparation is currently underway. The cognitive interviews with 17 patients and (ALND), sentinel lymph node biopsy team will also continue to prospectively feedback from 19 experts. To finalize and radiation therapy of the axilla or a survey this patient population over time. the scales, an international field test was combination of these treatments. Arm conducted with patients from Canada, lymphedema is a debilitating diagnosis Measuring Patient-Reported Outcomes Denmark, the Netherlands and the U.S. that may significantly diminish a in Bariatric Surgery: The BODY-Q Data was also obtained through Prolific. patient’s HRQOL due to symptoms (e.g., In collaboration with the Brigham Over 4,000 (2,057 Prolific and 1,947 clinical) swelling, pain, infection) and reduced Health Center for Weight Management participants were enrolled in the field-test arm function. To better understand and Metabolic Surgery, Dr. Pusic, Ali study and the Rasch measurement theory and measure outcomes that matter to Tavakkoli, MD, and team have established (RMT) analysis was used to refine and patients with arm lymphedema, a valid an international collaboration with the finalize the scales. Multiple papers have and reliable patient-reported outcome Netherlands and Denmark to develop been published and are being prepared measure (PROM) was needed. The team and validate new scales that form the from this data. conducted in-depth and semi-structured BODY-Q Eating Module. The BODY-Q is qualitative interviews with women with a patient-reported outcome measure Development and validation of new arm lymphedema following breast cancer published in 2009 that was developed scales to measure outcomes related to treatment to develop items that will form to measure outcomes of bariatric and breast cancer and its treatment the lymphedema scales. Scales were body contouring surgery. The BODY-Q The BREAST-Q is a patient-reported later refined through cognitive interviews Eating Module fills an important gap in the outcome measure (PROM) for breast with patients and clinical experts. existing BODY-Q scales, measuring the surgery patients developed by the Finally, a field test was performed on an following constructs: Expectations from Breast Surgery team that is widely used international sample of 3,222 women in weight loss, eating behavior, eating-related nationally and internationally. Recently, the U.S. (through the Love Research Army) distress, work life and eating-related the BREAST-Q was qualified by the FDA for and Denmark. The Rasch measurement symptoms. Content for these scales was use in regulatory decisions. This year, they theory (RMT) analysis was used to developed from reexamining the general developed additional BREAST-Q scales examine reliability and validity. Manuscript preparation for the study is currently underway for submission to a peer- reviewed journal. Understanding health-related quality of life (HRQOL) and psychological well- being during the COVID-19 pandemic The COVID-19 pandemic has resulted in unprecedented, sudden interruptions or alterations to the general population’s lifestyle, fundamentally altering how Americans live their lives. These sudden changes may impose significant consequences on a person’s overall health-related quality of life (HRQOL) and psychological well-being. This study aims to understand the impact of COVID-19 on self-reported HRQOL and psychological well-being (depression and anxiety) and to identify factors associated with the experiences of stigma. HRQOL and psychological well-being were assessed using the PROMIS Global Health 10 Survey, the Patient Health Questionnaire-9 (PHQ- 9) and the Generalized Anxiety Disorder 7-item (GAD-7) scale. In May 2020, the baseline survey was distributed through Prolific, an online community of members BWH DOS 47

to further expand its use and support success rates, the lack of a validated Alliance U.S. member innovation in reconstructive surgery. patient-reported outcome measure (PROM) sites include 46 Academic that captures important concepts for these Medical Centers and 1.BREAST-Q Sensation Module patients makes it impossible to accurately 72 Community Health In recent years, surgical innovation measure the extent to which these Systems. and the availability of cadaveric nerve operations improve patient quality of life. grafts have offered potential return The objective of this project is to develop Alliance Foundation Trials of breast sensation. To support and validate a PROM specific for face are also underway in seven outcomes research in this area, the team vascularized composite tissue candidates other countries: Australia, developed new scales that form the and recipients. To date, the team has Austria, Canada, France, BREAST-Q Sensation Module. Content conducted a systematic literature review Germany, Italy and Spain. was developed and refined from 36 to identify PROMs that are currently being qualitative and seven cognitive interviews used to measure outcomes in this patient A total of 52 Alliance-led with patients and feedback from 18 population and develop a preliminary therapeutic clinical trials are experts. In collaboration with the Love conceptual framework (manuscript in currently enrolling patients Research Army (formally known as the preparation). They have also performed in- with a range of cancers: GI Army of Women), a field-test study was depth qualitative and cognitive interviews tract, breast, lung, GU tract, performed, and 1,204 members provided with three postoperative patients. brain, leukemia, lymphoma, data to finalize the scales. The new Qualitative interviews were conducted myeloma, endocrine and skin. scales measure breast sensation, quality using a semi-structured interview guide of life impact and breast symptoms. and cognitive interviews involved the Alliance research Development of the BREAST-Q Sensation review of existing scales from the FACE-Q operations team spearheaded Module was funded by The Plastic Head and Neck Cancer and Craniofacial the activation of the Surgery Foundation (The PSF). Modules teams using the think-aloud “Evaluation of SARS-CoV-2 approach. Qualitative and cognitive antibody-containing plasma 2.BREAST-Q Animation Deformity interviews will continue with pre and thErapy” (ESCAPE) trial: “A Scale postoperative patients until saturation of prospective, randomized, Implants have traditionally been concepts is achieved. double-masked, placebo- placed underneath the pectoralis controlled trial of high-titer muscle (subpectoral). This approach Scaling and spreading electronic COVID-19 convalescent to implant placement results in capture of patient-reported outcomes plasma (HT-CCP) for the animation deformity, where the shape using a National Surgical Quality treatment of hospitalized of the reconstructed breast changes Improvement Program (NSQIP) patients with COVID-19 of or distorts when the pectoralis muscle Incorporating the patient’s perspective moderate severity.” contracts and the implant moves. to evaluate surgical quality has yet to be Treatment options to mitigate animation achieved in the U.S. and represents a Alliance research also deformity have advanced to include tremendous unrealized opportunity for continues to be active in areas prepectoral implant placement. To better continuous quality improvement. This is a of biomarker development, understand the impact of animation $1.5M AHRQ R18 grant for which Dr. Pusic cancer prevention, cancer deformity and its treatments, the team will serve as co-PI with Clifford Y. Ko, MD, care delivery research, recently finalized the development of from the American College of Surgeons outcomes research, health the animation deformity scale for the (ACS) and Larissa Temple, MD, from the disparities and symptom BREAST-Q Reconstruction Module. Field- University of Rochester Medical Center. intervention. test data from 651 members of the Love The study aims to scale and spread the Research Army were used to finalize routine, health IT-enabled collection of New Alliance initiatives the scale. patient-reported outcomes (PROs) from in the past year include a ambulatory surgical patients using a working group focusing on Development of a condition-specific well-established national surgical quality rural sites and a Value of patient-reported outcome measure improvement registry program. To date, Cancer Care Working Group. for patients undergoing vascularized over 2,400 patients in nine centers have composite tissue allotransplantation contributed data. Results of this research In 2020 Alliance launched the of the face will accelerate the uptake of using PROs ICAREdata initiative, a project Facial transplant surgery seeks to restore for quality improvement across the U.S., to facilitate clinical research function, as well as improve psychological identify best practices for implementation using the electronic health health and social participation for patients of such a program and explore whether record. who have experienced catastrophic PROs can reliably identify quality injuries. Despite high clinician-reported improvement opportunities.  48 BWH DOS

top docs Boston Magazine’s 2020 “Top Doctors” issue recognized 44 Department of Surgery faculty members this year. Congratulations to the following providers for being recognized as the best in their respective fields: Colon and Rectal Surgery Katherina Calvillo, MD Steven Mentzer, MD Ronald Bleday, MD Thomas Clancy, MD Scott Swanson, MD Christian Corwin, MD Gerard Doherty, MD Jon Wee, MD Joel Goldberg, MD, MPH Margaret Duggan, MD Daniel Wiener, MD Atul Gawande, MD, MPH Otolaryngology Pardon Kenney, MD, MMSc Urology Donald Annino, MD, DMD Tari King, MD Steven Chang, MD, MS Sayeed Malek, MD Adam Kibel, MD Plastic Surgery Faina Nakhlis, MD Michael Malone, MD Matthew Carty, MD Chandrajit Raut, MD, MSc Michael O’Leary, MD, MPH Yoon Chun, MD Esther Rhei, MD Graeme Steele, MD Dennis Orgill, MD, PhD Scott Shikora, MD Bohdan Pomahac, MD Douglas Smink, MD, MPH Vascular Surgery Andrea Pusic, MD Ali Tavakkoli, MD Michael Belkin, MD Christian Sampson, MD Ashley Vernon, MD Edwin Gravereaux, MD Simon Talbot, MD Matthew Menard, MD Thoracic and Cardiac Surgery Charles Ozaki, MD Surgery Raphael Bueno, MD Stanley Ashley, MD Christopher Ducko, MD Monica Bertagnolli, MD Hari Mallidi, MD The following board-certified Brigham Oral Medicine specialists were included in Boston Magazine’s “Top Dentists 2020” list: Nathaniel Treister, DMD, DMSc • Sook-Bin Woo, DMD, MMSc BWH DOS 49

News Donald Annino, MD, was selected for President’s Task Force on Race; and & Notes the William W. Montgomery Award for was named associate editor of Annals Excellence in Teaching by the graduating of Surgery. New Endowed Chairs chief residents from the Harvard M. Blair Marshall, MD Medical School (HMS) Otolaryngology— Laura Dominici, MD, was appointed Michael A. Bell Family Head & Neck Surgery Residency chair of the Dana-Farber/Brigham Distinguished Chair in Program. and Women’s Cancer Center Cancer Healthcare Innovation Committee of the American College of Chandrajit P. Raut, MD, MSc Stanley Ashley, MD, was appointed Surgeons (ACS) Commission on BWH Distinguished Chair in to the American College of Surgeons Cancer (CoC). Surgical Oncology (ACS) Board of Governors; the ACS Robert Riviello, MD, MPH Massachusetts District #2 Committee Atul Gawande, MD, MPH, was Steven C. and Carmella on Applicants; the Massachusetts appointed chairman of the board of R. Kletjian Foundation Physician Health Services (PHS) Clinical Haven, the health care venture founded Distinguished Chair in Global Advisory Committee; and was selected by Amazon, Berkshire Hathaway and Surgery as a member of the ACS Academy of JPMorgan Chase, after two years as Master Surgical Educators. founding CEO. Faculty Promotions Reza Askari, MD, was selected as a Joaquim Havens, MD, was awarded Professor member of the Brigham Quality & Risk the Brigham Murray Simonian Mentor Tari A. King, MD Management (QA/RM) Committee; Award. Associate Professor and received the Outstanding Faculty Robert Riviello, MD, MPH Mentor Award from Harvard Medical Lydia Helliwell, MD, was appointed Assistant Professor School (HMS). associate program director for the Thanh Barbie, MD Harvard Plastic Surgery Combined Jessica Erdmann-Sager, MD Regan Bergmark, MD, was awarded Residency Program. Martin Kathrins, MD the 2020 Brigham and Women’s Suniti Nimbkar, MD Hospital Faculty Career Development Kamal MF Itani, MD, was awarded Hisashi Tsukada, MD, PhD Award. the 2019 Association of VA Surgeons Daniel Wiener, MD Distinguished Service Award. Monica Bertagnolli, MD, was elected 50 BWH DOS to the American Cancer Society Board Molly Jarman, PhD, MPH, was of Directors. selected for participation in the National Institute on Aging Butler-Williams Christopher Burns, MD, was named Scholars Program; was awarded the assistant trauma medical director at James G. Zimmer New Investigator South Shore Hospital; was selected Research Award from the American as a member of the Minimally Invasive Public Health Association (APHA) Aging Surgery and Emerging Technologies and Public Health Section; and was Ad Hoc Task Force of the Eastern awarded the Loan Repayment Program Association for the Surgery of Trauma for Health Disparities Research Award (EAST); was a recipient of the Brigham from the National Institute on Minority 2020 Donald D. Matson Teaching Health and Health Disparities (NIMHD). Award; and was selected as a member of the Military Health System Strategic Tsuyoshi Kaneko, MD, was selected as Partnership American College of a member of the American Association Surgeons (MHSSPACS). for Thoracic Surgery (AATS) Foundation JATS Fellowship Committee; and was Nancy Cho, MD, was nominated chair selected as a member of the American of the Communications Committee for College of Cardiology (ACC) Cardiac the Society of Asian Academic Surgeons Surgery Team Member Section and (SA A S). Leadership Council. Thomas Clancy, MD, was awarded Pardon Kenney, MD, was honored the Nobility in Science Award from the for his 30 years of service as chief National Pancreas Foundation (NPF). of Surgery at Brigham and Women’s Faulkner Hospital with the naming of the Zara Cooper, MD, MSc, was elected surgical service as the “Kenney Service”; chair of the Brigham Equity Advisory and was a visiting professor at Mount Council; was selected as a member of Auburn Hospital. the American College of Surgeons (ACS)