Brigham and Women's Hospital Department of Surgery Harvard Medical School External Review 2017-2021

PGY 1 2021 Graduates 2021 Graduate Varnel Antoine, MD Alexandra J. Berger, MD David Harris, MD Harvard Medical School Genitourinary and Reconstructive Surgery, Faculty, University of Wisconsin School of University of Colorado Medicine and Public Health Christopher Magnani, MD Stanford University School of Medicine Manuel Ozambela, MD Breast Surgery Fellowship Urologic Oncology Fellowship, MD Anderson Zhiyu (Jason) Qian, MD Cancer Center Program Director: David Geffen School of Medicine at the Tari King, MD University of California Los Angeles Julie Szymaniak, MD Associate Program Director: Urologic Oncology Fellowship, University of Olga Kantor, MD, MS PGY 2 California San Francisco Yefri Baez, MD Current Fellows Ashley Newman, MD Harvard Medical School SUNY Upstate Medical University Acute Care Surgery Fellowship Vincent D’Andrea, MD 2021 Graduates Zucker School of Medicine at Hofstra/ Program Director: Northwell Reza Askari, MD Halley Vora, MD Faculty, Loma Linda University Cancer Center Kendrick Yim, MD Mohammad (Reza) Afrasiabi, MD University of California San Diego School of Acute Care Surgery Fellowship, Brigham and Meghan Garstka, MD Medicine Women’s Hospital Faculty, University of Maryland School of Medicine PGY 3 Brittany Berk, MD 2021 Graduate Cardiothoracic Surgery University of Massachusetts Medical School Fellowship Allison Brown, MD Catherine Gu, MD Faculty, NYU Langone Health Program Director: Perelman School of Medicine at the Michael T. Jaklitsch, MD University of Pennsylvania Adult Cardiac Surgery Fellowship Associate Program Directors: Tsuyoshi Kaneko, MD; Daniel Weiner, Marie Valovska, MD Program Director: MD; and Jon Wee, MD Geisel School of Medicine at Dartmouth Tsuyoshi Kaneko, MD PGY 6 PGY 4 Osama Haddad, MD Cairo University School of Medicine Leonid Belyayev, MD Tracy Han, MD F. Edward Hebert School of Medicine at the Duke University School of Medicine 2021 Graduate Uniformed Services University of the Health Sciences Kevin Melnick, MD Chikashi Nakai, MD Emory University School of Medicine Fellow, Advanced Heart Failure, Medstar, Samuel Freyaldenhoven, MD Washington, DC University of Arkansas College of Medicine Venkat Ramakrishnan, MD University of Louisville School of Medicine Advanced Laparoscopic Borami Shin, MD Fellowship University of California San Diego School of PGY 5 Medicine Program Director: Erica Ditkoff, MD Ali Tavakkoli, MD PGY 7 Columbia University Vagelos College of Associate Program Director: Physicians and Surgeons Eric Sheu, MD, PhD Kryston Boyer, DO Oklahoma State University Center for Health Gricelda Gomez, MD Jillian Angelo, MD Sciences Harvard Medical School Lewis Katz School of Medicine at Temple University Darren Bryan, MD Stephen Reese, MD University of Rochester School of Medicine Boston University School of Medicine and Dentistry Paul Feingold, MD Emory University School of Medicine 23

John Kuckelman, DO BWH/MGH Harvard Combined Sandeep Sachidananda, MD Des Moines University College of Medicine Endocrine Surgery Program St. John’s Medical College, Bangalore, India Michael Lee, MD Program Director: 2021 Graduate University of Pittsburgh School of Medicine Matthew A. Nehs, MD Kostastinos Poulikidis, MD 2021 Graduates Alessandra Moore, MD Attending, Danbury Hospital, CT University of Massachusetts Medical School Marko Boskovski, MD Surgical Critical Care Fellowship Assistant Professor of Cardiac Surgery, 2021 Graduate University of California San Francisco Program Director: Rajshri Gartland, MD Reza Askari, MD Anthony Cipriano, MD Faculty, Endocrine Surgery, Massachusetts Attending Surgeon, Geisinger Health General Hospital Adam Golden, MD Systems, PA Tulane University School of Medicine Endovascular Cardiac Surgery Mia DeBarros, MD Fellowship Crystal Kyaw, MD Attending Surgeon, Thoracic Surgery, Zucker School of Medicine at Hofstra/ Madigan Army Medical Center Program Director: Northwell Tsuyoshi Kaneko, MD Julius Ejiofor, MD Constantine Saclarides, MD Attending Surgeon, Cardiac Surgery, Baylor William Shi, MD University of Miami Miller School of Medicine Scott & White, Dallas, TX University of Melbourne Medical School, Australia Stephanie Yee, MD Desiree Steimer, MD Rowan University School of Osteopathic Associate Surgeon, Division of Thoracic 2021 Graduate Medicine Surgery, Brigham and Women’s Hospital Morgan Harloff, MD 2021 Graduates Cardiothoracic Surgery Thoracic Integrated Residency, Brigham Transplant Fellowship and Women’s Hospital Mohammad “Reza” Afrasiabi, MD Acute Care Surgery Fellowship, Brigham and Program Director: General Thoracic Surgery Women’s Hospital Antonio Coppolino, MD Fellowship Laura Hyde, MD Bassem Ayyash, MD Program Director: Faculty, Lincoln Medical Center, Bronx, NY Lithuanian University of Health Sciences, Michael T. Jaklitsch, MD Lithuania Renaldo Williams, MD Roger Zhu, MD Acute Care Surgery Fellowship, Johns 2021 Graduate SUNY Downstate College of Medicine Hopkins University Hunbo Shim, MD 2021 Graduates Surgical Clinical Nutrition Attending, Ewha Womans University Medical Support Fellowship Center, South Korea Jessica Della Valle, MD Attending, Pardee UNC Health, NC Program Director: Colorectal Surgery Fellowship Malcolm Robinson, MD Melanie Lighter, MD Program Director: Attending, University of Illinois College of Kanwal Bains, MD Nelya Melnitchouk, MD, MSc Medicine at Chicago Dayanand Medical College, India Miquell Miller, MD Minimally Invasive Thoracic Surgical Oncology Fellowship Stanford University of Medicine Surgery Fellowship Program Director: 2021 Graduate Program Director: Mark Fairweather, MD Jon O. Wee, MD Robert Malizia, MD Surgeon, Central Valley Colon and Rectal Daniel Solomon, MD S2u4rgical Associates, Fresno, CA Yale University School of Medicine

PGY 6 Second-Year Fellows Andrew Servais, MD Tufts University School of Medicine Zhi Fong, MD Filipe de Carvalho, MD Sidney Kimmel Medical College at Thomas University of Porto, Rebecca Scully, MD Jefferson University Portugal Geisel School of Medicine at Dartmouth PGY 7 Madhur Nayan, MD 2021 Graduate Faculty of Medicine and Health Sciences at Thinzar Lwin, MD McGill University, Montreal, Canada Andrew Soo Hoo, MD New York Medical College Vascular Surgeon, Dwight D. Eisenhower 2021 Graduates Army Medical Center, Augusta, GA 2021 Graduate Eugene Cone, MD Visiting Professors Winta Mehtsun, MD Urologic Oncologist, Urology of Indiana Attending, University of California San Gerald and Elaine Schuster Distinguished Francisco Alexander Cole, MD Lecturer in Thoracic Surgery Associate Surgeon, Division of Urology, Haiquan Chen, MD Urological Oncology Fellowship Brigham and Women’s Hospital Fudan University Shanghai Cancer Center Program Director: Vascular Surgery Fellowship Hechtman Trauma Lecturer in Surgery Steven L. Chang, MD, MS David A. Spain, MD Program Director: Stanford University School of Medicine First-Year Fellows Matthew Menard, MD Associate Program Director: Lawrence H. Cohn Visiting Professor in Ikena Madueke, MD Marcus Semel, MD Cardiac Surgery University of Illinois College of Medicine at Ralph J. Damiano, Jr., MD Chicago Bryan Dieffenbach, MD Washington University School of Medicine in University of California San Diego School of St. Louis Affan Zafar, MD Medicine Baylor College of Medicine Announcements tract and soft-tissue sarcomas. In (CLEA) in the Department of Surgery. addition to research on treatment The CLEA’s mission is to support the Mark Fairweather, MD, Named outcomes for sarcoma, including department’s commitment to providing Associate Program Director of the retroperitoneal sarcomas and a positive learning environment for Brigham General Surgery Residency gastrointestinal stromal tumors, he all trainees—students, residents Program also serves as an executive officer and fellows. This role is designed to for the Alliance Foundation Trials, serve as a neutral, third party to hear Dr. Fairweather is a graduate of where his work focuses on developing comments and feedback about the Hanover College and received his and validating methods of capturing teaching and learning environments. medical degree from the University high-quality real-world data alongside The CLEA serves as a confidential of Louisville School of Medicine. He ongoing clinical trials. resource for trainees and will be an completed a residency in general impartial, private resource to report surgery at Brigham and Women’s Jamie Robertson, PhD, MPH, Appointed and seek assistance for concerns. The Hospital, followed by a fellowship in Clinical Learning Environment Advocate CLEA will be a resource to educators complex general surgical oncology at (program directors, faculty, residents Massachusetts General Hospital and In addition to her role as director of and others in a teaching role), staff and Brigham and Women’s Hospital. Innovation in Surgical Education, Dr. administration to discuss and resolve Robertson has assumed the role of learning environment concerns. Dr. Fairweather’s clinical interests clinical learning environment advocate include cancers of the gastrointestinal The CLEA will also provide trainees in small programs, such as fellowships, a place to provide feedback and relay information as appropriate to program leadership. 25

Research Brigham and Women’s Hospital 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. 492 445 26 active protocols research funds active clinical trials 58 231 research fellows active grants and contracts $43,231,910 research spending Selected Grants Selected Clinical Trials Alliance: Administrative supplement A15184 irAE biobanking Neoadjuvant combination treatment with pembrolizumab and PI: Monica Bertagnolli, MD defactinib for malignant pleural mesothelioma Sponsor: NIH PI: Raphael Bueno, MD Grant Amount: $2,759,673 Sponsor: Merck & Co. A layered examination of the patient experience to elucidate the A novel approach to lower extremity amputation to augment role of palliative care in surgical care for seriously ill adults volitional motor control and restore proprioception PI: Zara Cooper, MD, MSc PI: Matthew J. Carty, MD Sponsor: NIH Sponsor: Department of Defense (USAMRAA) Grant Amount: $3,256,125 A novel approach to lower extremity residual limb revision to Androgen receptor pathway inhibition through targeting PARP- augment volitional motor control, restore proprioception and 2 in castration-resistant prostate cancer reverse limb atrophy PI: Li Jia, PhD PI: Matthew J. Carty, MD Sponsor: NIH Sponsor: Department of Defense (USAMRAA) Grant Amount: $2,047,315 CTA: Transcatheter replacement of stenotic aortic valve through A microbiome-dependent bile acid metabolite improves type 2 implantation of ACURATE in subjects inDicatEd for TAVR diabetes PI: Tsuyoshi Kaneko, MD PI: Eric Sheu, MD, PhD Sponsor: Boston Scientific Corporation Sponsor: NIH-NIDDK G2r6ant Amount: $3,340,983

Zara Cooper, MD, MSc, Awarded function of FOXA1 is its modulation a $3.3M National Institutes of by poly-(ADP-ribose) polymerase 2 Health Grant (PARP-2), conventionally known as a DNA repair protein. Studies have Over 1 million older adults with demonstrated that PARP-2 is a critical serious illness have major surgery or component in AR signaling through severe trauma each year, and palliative interacting with FOXA1 and facilitating care delivered alongside surgical care AR recruitment to prostate-specific can help relieve patient suffering, enhancers. The overall objective improve postoperative outcomes and of this project is to determine the reduce health care utilization. Although molecular mechanisms by which seriously ill surgical patients benefit selective targeting of PARP-2 inhibits from palliative care, they are less CRPC growth through disruption of likely than other patients to receive FOXA1 function and define PARP-2 as it. The proposed study will provide an an alternative therapeutic target for innovative and layered examination of CRPC. The successful implementation the role of palliative care in surgery in of this project will greatly advance the order to directly inform bedside clinical understanding of multifaceted biology decisions and the implementation of of PARP proteins and their evolving targeted palliative care interventions impact on cancer therapeutics. to improve care for older seriously ill More specifically, the results from surgical patients. the proposed research are expected to provide a strong basis for future Li Jia, PhD, Awarded a $2M development and clinical application of National Institutes of Health selective PARP-2 inhibitors benefiting Grant patients with incurable metastatic castration-resistant prostate cancer. Androgen receptor (AR) is a ligand- activated transcription factor and a Eric Sheu, MD, PhD, Awarded driver of prostate cancer (PCa) growth a $3.3M National Institutes of and progression. Understanding Health Grant the molecular mechanisms of AR- mediated transcription is a key for Dr. Sheu’s group has identified a the development of novel therapeutic bile acid metabolite, CA7S, that is strategies for both castration-sensitive generated by bariatric surgery and prostate cancer (CSPC) and castration- has anti-diabetic properties. This resistant prostate cancer (CRPC). It study’s goals are to evaluate the CA7S is well-known that AR transcriptional metabolite as a novel therapy for type 2 activity is prominently dictated by the diabetes; uncover how CA7S production transcription activator FOXA1, which is regulated by the gut microbiome; acts as a pioneer factor opening the and determine the contribution of condensed chromatin and facilitating CA7S to type 2 diabetes remission, the recruitment of AR. Genome following bariatric surgery. The study sequencing studies have revealed that is funded by the NIH National Institute FOXA1 is one of the most frequently of Diabetes and Digestive and Kidney mutated genes in primary PCa and Diseases (NIDDK), whose mission even more common in metastatic is to conduct and support medical CRPC. Aberrant FOXA1 function is research and research training and to implicated in PCa development and disseminate science-based information progression likely through its impact on diabetes and other endocrine and on AR signaling. Therefore, inhibition metabolic diseases; digestive diseases, of AR through targeting FOXA1 is a nutritional disorders, and obesity; promising therapeutic approach for and kidney, urologic, and hematologic CRPC. However, to date FOXA1 has diseases, to improve people’s health been deemed undruggable. It was and quality of life. recently reported that critical to the 27

The Laboratory for Surgical and Metabolic Research The intersection of science and surgery In the Laboratory for Surgical and Pioneering the field Bent Brigham Hospital. In the newly Metabolic Research at Brigham and of surgical metabolic minted Laboratory for Biochemistry Women’s Hospital, the tradition of research and Metabolism in Surgery, Dr. scientific excellence and commitment Moore pioneered the study of the to finding novel solutions to stubborn The laboratory traces its heritage metabolic impact of surgery and problems in surgery and metabolism to the earliest days of surgical trauma, focusing much of his early dates back decades and continues metabolic research by Francis D. work on understanding the body’s today. Under the leadership of three Moore, MD, third surgeon-in-chief of composition and the metabolic surgeon-scientists with distinct but the Brigham, who in 1948 opened a responses of surgical patients. Dr. overlapping research interests, the research laboratory focused on the Moore, a prolific researcher and author, laboratory carries on its long and biochemical and metabolic impacts wrote his textbook, Metabolic Care of distinguished tradition of pioneering of surgery at what was then the Peter the Surgical Patient, first published treatments and discoveries. in 1959, based on this research. His 28

contributions to the field of surgery improved gut nutrient absorption idea for treating patients with short rewarded him with may honors. and restored muscle mass following bowel syndrome. He appeared on the cover of TIME wasting diseases. His pioneering magazine in 1963, and his textbook work led to multiple patents and FDA By the early 2000s, the intersection remained the standard surgery approval for the use of glutamine in of surgery, nutrition and metabolism text for nearly three decades. More patients with short bowel syndrome. began to shift with the discovery importantly, his pioneering research Under Dr. Wilmore, the laboratory’s that gastric bypass surgeries not transformed the care of surgical name was changed to the Laboratory only reduce weight but also improve patients for generations to come. for Surgical Metabolism and Nutrition diabetes. With Ali Tavakkoli, MD, to better reflect the new focus in the chief of the Division of General and The culture of academic rigor that area of surgical nutrition. He became GI Surgery and co-director of the Dr. Moore established within the the Frank Sawyer Professor of Surgery Center for Weight Management and Department of Surgery helped to at Harvard Medical School in 1989 until Wellness at the Brigham, taking over define modern academic surgery at his retirement in 2003. the leadership of the laboratory in the Brigham and was carried on by 2006, the laboratory’s focus changed many subsequent surgeon-scientists, Following Dr. Wilmore, Danny O. from studying the metabolic impact of who made lasting contributions to the Jacobs, MD, took over directorship of surgery and trauma and approaches advancement of gastrointestinal and the laboratory, focusing his research to optimize post-surgical nutrition, to metabolic surgery (see timeline below). on using nuclear magnetic resonance understanding the anti-diabetic effects Dr. Moore retired from his post at the to assess the effects of malnutrition, of bariatric operations, with the goal of Brigham in 1976 but continued on the starvation, infection and injury on organ developing less-invasive alternatives faculty of Harvard Medical School function and metabolism. Following that replicated the surgical success. as a professor of surgery until 1981 Dr. Jacob’s departure to become the and then as the Moseley Professor chief of surgery at Creighton University In 2015, the lab was reestablished Emeritus, a position he retained until School of Medicine and subsequently under a new name, the Laboratory for his death in 2001. He was elected to chair of the Department of Surgery Surgical and Metabolic Research, to the National Academy of Sciences at Duke University Medical Center, integrate the investigative endeavors in 1981. Stanley W. Ashley, MD, led the group in surgical metabolism with research with a focus on exploring the role of in all other aspects of gastrointestinal In 1979, Douglas W. Wilmore, glucagon-like peptide 2 (GLP-2) in and general surgery, including surgical MD, joined the faculty at Peter Bent augmenting intestinal morphology and immunology and inflammation. Brigham Hospital to continue the work function. His work contributed to the of Dr. Moore in the area of surgical eventual development and marketing Today, the laboratory’s research metabolism. He had been involved in of this peptide as a novel therapy for programs are led by the team of Dr. some of the early work on the use of patients with short bowel syndrome. Tavakkoli; Eric G. Sheu, MD, PhD, parenteral nutrition. Dr. Wilmore and In parallel, Edward E. Whang, MD, co- a minimally invasive and bariatric his team developed modern techniques director of the lab, while contributing surgeon at the Brigham and assistant to measure glutamine and described to the studies on GLP-2, was part of professor of surgery at Harvard the response of this amino acid to a collaborative team that aimed to Medical School; and James Yoo, MD, acute illness. His group was the first to advance the development of a tissue- a colorectal surgeon in the Section demonstrate that glutamine reduced engineered small intestine as a novel of Colon and Rectal Surgery at the infection rates in critically ill patients, Brigham and the Dana-Farber/Brigham and Women’s Cancer Center. Laboratory for Laboratory for Surgical Metabolism and Nutrition Laboratory for Biochemistry and Surgical and Metabolism in Surgery Metabolic Research Laboratory 1948 ― 1979 1979 ― 1997 1997 ― 2006 2006 ― 2015 2015 ― present Groundbreaking Early work on parenteral Intestinal adaptation and Anti-diabetic effects Integrating surgical research on the nutrition newtreatments for short of bariatric surgery metabolism research impact of surgery bowel syndrome and replicating with other aspects on metabolism and Metabolic effects of this effect without of gastrointestinal nutrition malnutrition, stress, infection Role of GLP-2 in augmenting surgery and general surgery, and injury on organ function intestinal adaptation surgical immunology, and metabolism and inflammation Pioneering, collaborative Founded and led by Francis D. Moore, MD workon a tissue-engineered small intestine 29

From surgical 2 diabetes patients had an immediate resolution after gastric bypass surgery metabolic research improvement in their type 2 diabetes in order to do just that. Studies showing to research on after surgery,” Dr. Tavakkoli said. In fact, that gastric bypass surgery eliminates metabolic surgery nearly 40% of patients with diabetes nutrient exposure in the duodenum and who undergo bariatric surgery leave the proximal bowel suggest that these two “The first 50 years of the laboratory’s hospital no longer needing anti-diabetic areas have effects on metabolic and work focused on studying the metabolic medications. He adds that, by now, glucose control. In addition, research impact of surgery and trauma, as well more than 11 randomized trials have on a duodenojejunal endoscopic sleeve as ways to provide and optimize the demonstrated that bariatric surgery to prevent contact between food and nutritional status of malnourished is better at treating diabetes than the the duodenal mucosa has shown that surgery patients and those with short standard-of-care medications and isolation of the proximal bowel from bowel syndrome,” Dr. Tavakkoli said. “By treatment algorithms. nutrient exposure can lead to dramatic the early 2000s, the epidemic of obesity improvements in type 2 diabetes. had led to the establishment of the field The benefits of of bariatric surgery as an important metabolic surgery “We collaborated with Jeff Karp in specialty that not only impacts weight, without surgery the Division of Engineering in Medicine but also overall health,” he added. at the Brigham to find a material “Our goal is to develop less invasive that would coat the proximal bowel The subsequent observation that alternatives that can replicate the to prevent food interaction with the gastric bypass surgery not only reduces metabolic benefits of surgery,” Dr. proximal bowel mucosa,” Dr. Tavakkoli weight, but also improves type 2 Tavakkoli explained. said. “We specifically explored ways diabetes independent of weight loss, to transiently coat the proximal bowel, led to a new era of metabolic surgery, How do you mimic the effects of so when food passes through the with the primary goal of operating on gastric bypass without actually doing intestines, the mucosa doesn’t see the the gastrointestinal tract and correcting the surgery? Dr. Tavakkoli and his team food.” The coating would need to be metabolic derangements. have been investigating the underlying transient, so that people are able to molecular mechanism of diabetes take a multivitamin at a different time to “It was remarkable to see how type avoid developing vitamin deficiency. Their animal studies using modified 30

forms of sucralfate as a barrier in the systemic glucoregulatory effects, while colorectal cancer, such as colitis- small bowel, were published in Nature that the lab is working to develop for associated cancer.” Dr. Yoo’s team is Materials. Sucralfate, a water-insoluble type 2 diabetes, obesity and intestinal trying to determine what changes in the salt, has been used for more than 30 inflammatory disease. colonic environment are putting these years to treat gastric and duodenal patients at higher risk so that they can ulcers. However, it does not adhere In another first, this research team lower their risk. to healthy intestinal mucosa. In their elucidated a microbiome-dependent studies, sucralfate was among the most pathway by which sleeve gastrectomy “We know that the gut microbiome effective barriers to glucose permeation increases CA7S production. They found plays a big role in colon cancer,” Dr. and its barrier effect lasted a few hours. that CA7S is produced in the liver by Yoo said. Specifically, imbalance in the In collaboration with Dr. Karp’s group, a specific sulfotransferase enzyme in gut microbial population is known to the team further engineered sucralfate response to the microbial metabolite, be a major driver of colitis and colitis- to create a novel compound, which lithocholic acid (LCA), transported associated cancer. As noted previously, they named LuCI (Luminal Coating from the gut to the liver by the portal Dr. Sheu’s group has shown that the gut of the Intestine), that binds to healthy vein. By performing a microbiota microbiome is profoundly altered after intestinal mucosa and forms a barrier transplant from sleeve gastrectomy sleeve gastrectomy. “We are merging to nutrient absorption. Their CT imaging mice into germ-free mice, Dr. Sheu the study of inflammation-associated studies showed that LuCI was able to and his team found that the bariatric cancer and sleeve gastrectomy’s form a luminal coating in the proximal surgery microbiome can recreate effects on the microbiome to study bowel and result in a significant this gut-liver pathway, leading to how sleeve gastrectomy affects the lowering of the glucose tolerance curve CA7S synthesis and GLP-1 secretion. development of tumors in colitis- after an oral gavage. This research has Together, these discoveries represent associated cancer,” Dr. Yoo said. now been spun off into the start-up the first molecular pathway that biotech company, AltrixBio. causally connects the microbiome to Using a mouse model of colitis- the improvement of diabetes following associated cancer, the research Exploring how bariatric surgery. team examined sleeve gastrectomy’s bariatric surgery effect on colitis-associated cancer affects the “We are also trying to understand the development and progression via microbiome and beneficial consequences of surgery on alterations in the gut microbiome. immune response the immune system,” Dr. Sheu said. It Using 16S RNA sequencing, they was already known that obesity leads examined stool samples to identify “Our research centers on how to dysregulation of the immune system the normal population of microbes at bariatric operations work to eliminate and chronic inflammation. In a study of baseline and after sleeve gastrectomy type 2 diabetes independent of weight patients undergoing bariatric surgery, or sham surgery to see if there was over loss, as well as the surgery’s impact on Dr. Sheu found dramatic changes in or under expression of certain bacteria the immune system,” Dr. Sheu said. immune cell number, function and species after surgery. The mice that metabolism that occurred early after underwent sleeve gastrectomy had Previous research had identified surgery. Using mouse models of sleeve greater severity of colitis, more tumors increases in glucagon-like peptide 1 gastrectomy, the group has observed and marked increases in microbial (GLP-1), a circulating incretin hormone, that bariatric surgery alters the taxa linked to colitis. Moreover, when and changes in systemic bile acids in frequency and function of specific the sham-treated mice received patients after gastric bypass or sleeve B cells and their antibody products, cecal microbiota transplant from the gastrectomy. Dr. Sheu, in collaboration which they believe play an important sleeve gastrectomy-treated mice, they with Dr. Sloan Devlin’s group at Harvard role not only in glucose metabolism, developed significantly more severe Medical School, were the first to but also the body’s response to colitis and a five-fold increase in identify that the bile acid molecule, infection and vaccines. tumor burden, thereby confirming the CA7S, is increased in the gut after causal role of the microbiota in sleeve sleeve gastrectomy, the most common “Different elements in the GI tract gastrectomy-mediated promotion of bariatric operation performed today, in regulate its function in health and colitis-associated cancer. mice and humans. They have gone on disease,” Dr. Yoo explained. “Our to discover that CA7S regulates glucose research aims to understand how the Training the next metabolism by inducing GLP-1 secretion interaction occurs.” generation of by binding the bile acid receptor, TGR5. surgeon-scientists The team has found that CA7S exerts “Overall, sleeve gastrectomy reduces the risk of developing many cancers Young surgeon-scientists are at the by approximately 30 to 50%,” Dr. heart of the innovative environment that Yoo said. “But patients with chronic inflammatory conditions who undergo sleeve gastrectomy are at greater risk for developing inflammation-associated 31

has flourished in this laboratory. Investigating the Role of Bariatric Surgery in Colitis-Associated Cancer “The number of surgeons doing Active Grants/Awards Recipient Recipient basic science is declining nationally,” Dr. Ashley, Frank Sawyer Professor of Role of Meal Timing in Efficacy of Bariatric Ali Tavakkoli Surgery at Harvard Medical School, Surgery in Obese Individuals Frank Scheer said. “Here, however, we have a solid group of surgeons who have chosen NIH-NHLBI: R01 HL140574 to pursue academic research.” These faculty members have inspired many Shared Decision Making for Bariatric Surgery in Ali Tavakkoli Brigham residents to pursue research Patients with Severe Obesity careers in this field. Executive Stakeholder Advisory Group Member “Surgery residents have been critical to the success of our program,” Research Training in Alimentary Tract Surgery Ali Tavakkoli Dr. Sheu said. “People like David Harris and James Luo have laid the Director of Surgical Technology and Innovation groundwork and driven these important track, Executive Committee projects forward. They bring a unique perspective of clinical knowledge Member of what is important in surgical research models and take projects A Microbiome-Dependent Bile Acid Metabolite Eric Sheu to the next level.” Improves Type 2 Diabetes “The number one thing this lab NIH 1R01DK DK126855-01 (NIDDK) has provided me is mentorship,” Dr. David Harris, who spent two years as American Surgical Association Foundation Eric Sheu a research fellow in the laboratory, Fellowship Award resulting in multiple publications and awards, including the American College Characterization of a novel, gutrestricted of Surgeons’ Research Excellence metabolite that links the microbiome and the Award, said. “There are many people anti-diabetic effects of bariatric surgery in this lab engrossed in research and mentors that understand the value that Pilot Grant, Blavatnik Biomedical Accelerator Eric Sheu different perspectives can bring to the questions we are trying to answer.” Development of synthetic analogs of a sleeve gastrectomy–induced metabolite “This lab has always been a think as a novel therapy for type 2 diabetes tank for high-impact research in and obesity. surgery and investigators who want to think about the complex problems surgeon-scientists on both the national collaboration,” Dr. Yoo said. within the field of surgery,” Dr. Harris and international levels to innovate new “Understanding of the immunologic said. “I’ve been able to explore new approaches to gastrointestinal facets of metabolic research through and metabolic diseases,” Dr. Tavakkoli and cancer effects of bariatric surgery collaborations with scientists at said. “Our faculty have been invited will be critical in terms of knowing Harvard, the Joslin Diabetes Center and internationally to give talks on our when to have surgery and when not to Beth Israel Deaconess Medical Center.” research, and some of our past fellows have surgery,” Dr. Sheu said. are successful academic leaders in the The laboratory also has a strong UK and China.” “As surgeon-scientists, we have international standing, including a a critical role,” Dr. Tavakkoli said. longstanding relationship with the Seeking solutions “We have access to valuable clinical Cambridge surgical training program in through research observations and a laboratory with England, which sponsors a UK trainee collaboration a rich and unique research history to join the lab for two to three years of that inspires you to ask the questions research. Dr. Tavakkoli was himself one “This is an interesting lab, because ‘How?’ and ‘Why?’” of these trainees who joined the lab in we have different scientific interests 1998, under Dr. Ashley and Dr. Whang, within the GI space, but sharing the As the obesity pandemic and parallel after receiving his medical degree from same physical space allows for greater growth in metabolic disorders continue the London Hospital Medical College to expand despite multiple efforts, this in England. laboratory continues its long tradition of pioneering novel solutions to both “We’re training the next generation of persistent and evolving challenges in surgery and metabolism. 32

Center for Surgery and Public Health (CSPH) Making surgery safer, more patient-centered, and more accessible in the U.S. and around the world. One of the founding programs in the delivery of safe, high-quality and and screening delays both on clinical surgical health services research, equitable patient-centered care. outcomes and patient experience. the Center for Surgery and Public They have also made the case for Health (CSPH) is a national leader in Over the past year, CSPH researchers operationalizing equity in health the science of surgical care delivery. have applied their expertise to the system emergency response, using the Exploring surgery through a public COVID-19 pandemic, conducting experiences at Brigham and Women’s health lens, research at CSPH expands research to assess the pandemic’s Hospital to build a case study on how to beyond the operating room, examining wide-ranging impacts on the U.S. explicitly integrate equity into Hospital interactions within the health care surgical system, including changes to Incident Command Systems guidelines. system and the social determinants health care infrastructure, payment and lived experiences of patients. systems, safety standards, clinical With the COVID-19 pandemic Rising to the challenges of the past training and population health. accelerating the transition to digital year, CSPH has continued its work at CSPH researchers have contributed health, CSPH researchers are working the intersection of surgery and public to modeling hospital capacity and with multidisciplinary providers to health, producing research that informs system response to set national and address the equity gap in telemedicine policy and program development for state governmental policies and have for patients with limited English examined the impact of cancer surgery proficiency (LEP). Using findings from publications fellows graduated active fellows 33

the FORTE study, a multi-institutional caregivers is paramount to aligning researchers are looking at how to research collaboration based at CSPH, surgical care with patient goals, better tailor these interactions for other which collects, analyzes and interprets especially for seriously ill and older patient groups, including patients with long-term patient centered outcomes patients. This relationship dynamic has dementia and those who identify as after trauma surgery, our researchers been severely hindered by disruptions sex and gender minorities, to improve designed the Non-English-Speaking in the health care setting during the patient outcomes and experiences. Trauma Survivors (NESTS) Pathway--a COVID-19 pandemic. CSPH researchers Mass General Brigham United Against have examined the experience of Bringing together a diverse team of Racism initiative. Its primary goal is older and seriously ill patients and multidisciplinary experts, CSPH has to increase rates of outpatient mental developed protocols for how to have strived to make surgery safer, more health evaluation for non-English shared decision-making conversations patient-centered, and more accessible speaking survivors of traumatic injury when caregivers and family cannot in the U.S. and around the world, with dealing with symptoms of depression, be present. Following up on previous research that responds to the inequities anxiety or PTSD. studies to identify best practices for of the past, confronts the challenges of using advance care planning (ACP) in today and anticipates the possibilities The shared decision-making process achieving patient care goals, CSPH of tomorrow. among clinicians, patients and their Selected Grants among sexual and gender minority injury using smartphone-based digital (SGM) individuals and their caregivers, phenotyping.” This study will determine Zara Cooper, MD, MSc, was awarded to understand ACP discussion the feasibility of using smartphone- $3.3M from the National Institutes between providers and individuals based digital phenotyping for routine of Health for the study, “A layered who are SGM to help inform patient- collection of post-discharge functional examination of the patient experience centered interventions to facilitate outcomes after traumatic injury. to elucidate the role of palliative care high-quality ACP discussions among in surgical care for seriously ill adults.” this population.” The proposed Regan Bergmark, MD, was awarded The proposed study will provide an research study will inform policy and $34,500 for her study, “Disparities in innovative and layered examination of practice by 1) understanding factors access to experienced surgeons.” CSPH the role of palliative care in surgery in associated with ACP discussions researchers anticipate that entrenched order to directly inform bedside clinical among transgender or gender nonbinary referral patterns are a primary driver decisions and the implementation of Medicare beneficiaries using claims of persistent racial/ethnic segregation targeted palliative care interventions data and 2) understanding the needs, to specific surgeons and hospitals in to improve care for older seriously ill experiences and challenges facing self- America. The goal is to understand surgical patients. identified SGM adults and caregivers these referral patterns by first around ACP. demonstrating differences in the level Zara Cooper, MD, MSc, was awarded of experience of surgeons accessed $435,000 from the Henry M. Jackson Amy Bulger, RN, MPH, and Rachelle by different patient populations with Foundation to extend the “Comparative Bernacki, MD, MS, were awarded quantitative methods, and then using effectiveness and provider-induced $198,228 from the Rita & Alex Hillman qualitative methods to understand demand collaboration (EPIC)” study with Foundation for their study “Serious patient decision-making around choice the Uniform Services University. This illness conversation outreach in the of surgeon and hospital. collaboration has focused on studying time of COVID-19.” The proposed study some of the most pressing health care employs nurse care coordinators in the Robert Riviello, MD, MPH, was awarded challenges faced by military and civilian integrated Care Management Program $6,831 from a Harvard Medical School/ populations, including increasing health (iCMP) at the Brigham to ensure Ariadne Labs Spark Grant for the care costs, comparative effectiveness vulnerable patients have opportunities project, “Protocols for safe postpartum and outcomes, epidemiology, quality to have serious illness conversations care at home for women delivering and practice improvement, health care and share their values and goals. by cesarean section in rural Africa.” disparities. The goal of this project is to develop Juan Herrera-Escobar, MD, MPH, was standardized protocols for postpartum Joel Weissman, PhD, was awarded awarded $28,000 from the Brigham care for women delivering via c-section $99,460 from the National Institutes Internal Stepping Strong Award for his to support safe and affordable home- of Health (NIH) for his supplemental study, “Routine collection of post- based follow-up in rural Africa. study, “Advance care planning (ACP) discharge functional outcomes after 34

Patient-Reported Outcomes, Value & Experience(PROVE) Center 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 Business school (HBS) and the improvement across the U.S., identify International Consortium of Outcomes best practices for implementation of Welcomed new associate director, Research (ICHOM). imPROVE consists such a program and explore whether Maria Edelen, PhD, who is a of a patient-facing web application and PROs can reliably identify quality psychometrician and health policy clinician- and administrative-facing improvement opportunities. researcher with a specific focus on portals, developed through iterative patient-reported outcomes. cycles of feedback from patients and Understanding health-related quality key stakeholders. As of June 2021, of life and psychological well-being Expanded center support to include imPROVE was implemented within during the COVID-19 pandemic. The five Brigham surgery faculty members, the breast oncology and plastic COVID-19 pandemic has resulted in one research faculty, a postdoctoral surgery services across four sites unprecedented, sudden interruptions or research fellow, two research (Dana-Farber Cancer Institute Main alterations to the general population’s assistants, a program manager and an Campus, Dana-Farber Cancer Institute lifestyle, fundamentally altering informatician. Chestnut Hill, Brigham and Women’s how Americans live their lives. Hospital Main Campus, Brigham and These sudden changes may impose Supported 14 research fellows and Women’s Faulkner Hospital) and 22 significant consequences on ones’ residents, 9 research trainees and care team members (surgeons, nurse overall health-related quality of life 8 visiting scholars from the United practitioners and physician assistants). (HRQOL) and psychological well- Kingdom, Germany and the Netherlands To date, over 900 patients have been being. This study aims to understand over the course of three years. enrolled. the impact of Covid on self-reported HRQOL and psychological well- Published 70 papers in peer-reviewed Scaling and spreading electronic being (depression and anxiety) and journals that are related to patient- capture of patient-reported outcomes to identify factors associated with reported outcome measures (PROMs) using a national surgical quality the experiences of stigma. HRQOL development and implementation and improvement program (NSQIP). and psychological well-being were comparative effectiveness studies that Incorporating the patient’s perspective assessed using the PROMIS 10 Global use PROMs to evaluate outcomes. to evaluate surgical quality has yet to Health Questionnaire, the Patient be achieved in the U.S. and represents Health Questionnaire 9 item (PHQ-9) Implemented imPROVE, an innovative a tremendous unrealized opportunity and the Generalized Anxiety Disorder electronic patient-reported data (PRD) for continuous quality improvement. 7-item (GAD-7). In May 2020, the team collection platform developed by the This is a $1.5M AHRQ R18 grant for distributed the baseline survey through PROVE team, within the breast oncology which Andrea Pusic, MD, will serve as an online crowdsourcing platform and service at Dana-Farber Cancer Institute co-PI, along with Clifford Y. Ko, MD collected data from over 2,000 U.S. (DFCI) and the plastic surgery service at (American College of Surgeons), and residents. The baseline survey results Brigham and Women’s Hospital. Larissa Temple, MD (University of are currently under consideration Rochester Medical Center). The study for publication at a peer-reviewed Key Research Initiatives aims to scale and spread the routine journal and the follow-up data is health IT-enabled collection of PROs being analyzed. imPROVE is a new electronic platform from ambulatory surgical patients that was developed in collaboration using a well-established national Development and implementation with breast cancer care providers, surgical quality improvement registry of a patient-reported outcome mea- patients and patient advocates at program. To date, over 2,400 patients sure for gender-affirming treatments Brigham and Women’s Hospital and in nine centers have contributed data. (GENDER-Q). Hormone treatment and Dana-Farber Cancer Institute (DFCI), Results of this research will accelerate gender-affirming surgery provided to as well as members of the Harvard the uptake of using PROs for quality transgender and gender diverse people 35

can dramatically change how the face, reported outcome measure (PROM) Institute (NCI) National Clinical Trials body and genitals look and function. to understand the effectiveness of Network, and nine studies, many However, a critical barrier to measuring headache treatment and its impact with international scope, that are outcomes for such gender-affirming on quality of life. To date, in-depth sponsored by the Alliance Foundation health care is the lack of a patient-re- qualitative data from 18 patients has in collaboration with non-NCI partners. ported outcome measures (PROs). To been conducted. Qualitative interviews address this unmet need, the Canadian will continue until saturation of Alliance researchers across the Institute of Health Research (CIHR) has concepts is achieved. U.S. demonstrated exceptional provided Anne Klassen, MD, the PROVE resourcefulness and commitment to Center collaborator at McMaster Uni- Development of a condition-specific maintaining access to clinical trials versity, with grant funding ($2,080,000 patient-reported outcome measure during the COVID-19 pandemic. Using CDN) to perform an international multi- for patients undergoing vascularized telehealth visits, including virtual phase program of research to develop composite tissue allotransplantation consenting processes, and a variety and implement a patient-reported of the face. Facial transplant surgery of strategies to support at-home care outcome measure for gender-affirming seeks to restore function, as well as delivery, the overall accrual to Alliance treatments (GENDER-Q). This award will improve psychological health and trials was maintained at pre-pandemic be used to cover the development of a social participation for patients who levels for the time from January 2020 to PROM for gender-affirming treatment have experienced catastrophic injuries. October 2021. (GENDER-Q) and its implementation Despite high clinician-reported success into clinical practice. The GENDER-Q rates, the lack of validated PROMs The Alliance Foundation enters its will provide a comprehensive set of that capture important concepts for third year of funding member research independently functioning scales that these patients makes it impossible in response to the group’s strategic cover concepts such as appearance, to accurately measure the extent to priorities. Proposals are funded up to body image, physical, sexual and psy- which these operations improve quality $250,000 per proposal over two years, chosocial function. To date, in-depth of life from the patient perspective. and four proposals per year are planned qualitative data from 84 patients from The objective of this project is to for funding in 2021. The Alliance various countries (United States, Cana- develop and validate a patient- strategic priorities currently include: da, Denmark and the Netherlands) has reported outcome measure specific been used to create preliminary scales for face vascularized composite tissue Addressing health disparities by for feminizing and masculinizing gen- candidates and recipients. To date, increasing accrual of minority and der-affirming procedures. The center the team has conducted a systematic vulnerable population members to is currently seeking feedback from a literature review to identify PROMs that Alliance research protocols, and by global team of experts and patients to are currently being used to measure assessing the impact of the Social establish content validity (i.e., compre- outcomes in this patient population Determinants of Health (including hensiveness, comprehensibility and develop a preliminary conceptual financial toxicity) on outcomes in and relevance) of the GENDER-Q scales, framework (manuscript in press). Alliance trials. followed by the launch of the GENDER-Q They have also performed in-depth field test at multiple sites across the qualitative and cognitive interviews with Expanding Alliance portfolio in globe in late fall 2021. The PROVE four postoperative patients. Qualitative implementation science (including Center is a full partner in this program interviews were conducted using a de-implementation). of research. semi-structured interview guide and cognitive interviews involved the review Developing methods to enhance Development of a condition-specific of existing scales from the FACE-Q awareness of and effective utilization patient-reported outcome measure Head and Neck Cancer and Craniofacial of Alliance data and banked for patients with chronic headaches. Modules teams, using the think-aloud biospecimens. Headaches impose a tremendous approach. Qualitative and cognitive burden on ones’ quality of life, including interviews will continue with pre- and Expanding Alliance capability to support physical and cognitive function. postoperative patients until saturation molecular, biomarker driven studies, Traditionally, treatment for headaches of concepts is achieved. including imaging as a biomarker. has involved preventative and abortive medications, opioids, injectables and Alliance for Clinical Developing and implementing a medical devices. More recently, surgical Trials in Oncology strategy to engage and support early techniques have evolved to decompress career investigators from all relevant the peripheral sensory nerves around Alliance continues to expand its disciplines, with particular emphasis the skull to improve the frequency, research portfolio, currently serving on researchers from underrepresented severity and duration of headaches. as the lead organization for 47 clinical minority groups. The team is developing a new patient- trials funded by the National Cancer 36

News Faculty News & Notes Paul Davidson, PhD, was elected the & Notes secretary of the American Society for Geoffrey Anderson, MD, MPH, was Metabolic and Bariatric Surgery (ASMBS) New Endowed Chairs elected to the editorial board of the Integrated Health Section. Journal of Surgical Research; was named Zara Cooper, MD, MSc co-lead for the Non-English-Speaking Christopher Ducko, MD, was elected Michele and Howard J. Kessler Trauma Survivors (NESTS) Pathway to the Medical Executive Committee at Distinguished Chair in Surgery and as part of the Mass General Brigham South Shore Hospital. Public Health United Against Racism initiative; and was recommissioned as a major in the U.S. Mark Fairweather, MD, was appointed Ali Salim, MD Air Force Reserves on a critical care air Student Advanced Elective director in the BWH Distinguished Chair in Surgery transport team. Brigham Department of Surgery. Stefan G. Tullius, MD, PhD Stanley Ashley, MD, was named a Joaquim Havens, MD, was a nominee Joseph E. Murray Distinguished Chair in dedicatee of the American College for the Excellence in Mentoring Award Transplant Surgery of Surgeons Owen H. Wangensteen from Harvard Medical School; and was Scientific Forum; and was appointed to an instructor at the Stratus Center for Faculty Promotions the American College of Surgeons Board Medical Simulation Update in Primary of Governors Diversity Pillar. Care Mass Casualty Simulation in Professor Tampa, FL. Steven Piantadosi, MD, PhD Thanh Barbie, MD, received an R01 grant from the National Institutes of Health Kamal Itani, MD, was awarded an Associate Professor for her work on optimizing therapeutic honorary fellowship from the Surgical Joaquim M. Havens, MD STING agonism in triple-negative breast Infection Society (SIS) and the SIS M. Blair Marshall, MD cancer; and received a Susan F. Smith Presidential Citation. James Yoo, MD Center for Women’s Cancers Innovation Grant for improving antigenicity in triple- Molly Jarman, PhD, MPH, was named Assistant Professor negative breast cancer. statistical editor of the Journal of Shailesh Agarwal, MD Surgical Research. Justin Broyles, MD Raphael Bueno, MD, became a member Carleton E. Corrales, MD of the Cancer Biomarkers Study Section Tsuyoshi Kaneko, MD, was appointed Tanujit Dey, PhD of the National Institutes of Health. associate chair of the Society of Ann Marie Egloff, PhD, MPH Thoracic Surgeons (STS) Workforce on Molly Jarman, PhD, MPH Nancy Cho, MD, was elected to the New Technology. Abraham Lebenthal, MD Association for Academic Surgery (AAS) Alice Maxfield, MD Program Committee; was elected to Olga Kantor, MD, MS, was appointed vice Christina Minami, MD, MFA, MS the American Association of Endocrine chair of the Society of Surgical Oncology George Molina, MD, MPH Surgeons (AAES) Education Committee; (SSO) Fellows & Young Attendings Stephanie Nitzschke, MD, MS and was elected to the Society of Asian Subcommittee. Namrata Patil, MD, MPH, MBBS Academic Surgeons (SAAS) Program Kavitha Ranganathan, MD Committee. Tari A. King, MD, was named a fellow Rosh Sethi, MD, MPH of the American Society of Clinical Thomas C. Tsai, MD, MPH Thomas E. Clancy, MD, was named Oncology (ASCO). Ashley Vernon, MD the inaugural Distinguished Scholar in Surgical Oncology at the Brigham. Sayeed K. Malek, MD, was appointed to serve on the Clinical Advisory Board of Zara Cooper, MD, MSc, was named the the New England Donor Services (NEDS); inaugural Michele and Howard J. Kessler and was named director of the Brigham Distinguished Chair in Surgery and Public transplant service line. Health at the Brigham; and received the Brigham Department of Surgery Richard Alice Z. Maxfield, MD, was appointed E. Wilson Teaching Award. associate program director of the Harvard Medical School/Mass Eye Antonio Coppolino, MD, was awarded and Ear/Mass General Brigham the Division of Thoracic and Cardiac Otolaryngology–Head & Neck Surgery Surgery 2021 F. Griffith Pearson Award Residency Program. for Excellence in Teaching. 37

Christina Minami, MD, MFA, MS, was infertility in female surgeons: Impact Scott Swanson, MD, was named co- awarded a Grant for Early Medical/ on surgeon burnout and attrition;” was editor of Sabiston & Spencer Surgery of Surgical Specialists’ Transition to the keynote speaker at the University of the Chest, 10th edition; was appointed Aging Research (GEMSSTAR) award Pittsburgh Physician Thrive Program editor of the Guest Edition of Current from the National Institute on Aging, Parenting and a Career in Medicine Challenges in Thoracic Surgery; and was “Locoregional treatment decision- Symposium; and was lead author of named co-chair of the AATS Thoracic making in older adults with early- the study, “Incidence of infertility and Clinical Practice Standards Committee. stage hormone receptor-positive pregnancy complications in U.S. female breast cancer.” surgeons,” which was published in Stefan G. Tullius, MD, PhD, was named JAMA Surgery. the Joseph E. Murray Distinguished Chair Elizabeth Mittendorf, MD, PhD, in Transplant Surgery at the Brigham; completed a Master in Healthcare Chandrajit P. Raut, MD, MSc, was the was appointed to the Medical Board Management at the Harvard T.H. Chan Kathy Maxwell Visiting Professor at Ohio of the National Kidney Registry; was School of Public Health; was named State University; and was elected to the appointed co-chair of the International treasurer elect for the American Society American Surgical Association (ASA). Society of Vascularized Composite of Clinical Oncology (ASCO); and was Allotransplantation (ISVCA) and awarded a grant from the Massachusetts Nakul Raykar, MD, MPH, was appointed the International Society of Uterus Life Sciences Center to support the fellowship director of the Harvard Transplantation (ISUTx) Congress, establishment of a digital pathology Medical School Program in Global 2023; was co-organizer of the 2021 effort within the Breast Oncology Surgery and Social Change; and International Society of Uterus Program at the Dana-Farber/Brigham was named interim vice chair for the Transplantation Congress; and was and Women’s Cancer Center. Advocacy Committee and institutional named chair of the 2021 International representative for the Association of Transplantation Congress Science George Molina, MD, MPH, received the Academic Global Surgery (AAGS). Committee. Minority Faculty Career Development Award from the Brigham and Women’s Robert Riviello, MD, MPH, was appointed Jiping Wang, MD, PhD, was awarded the Hospital Center for Diversity and professor of surgery and the inaugural Brigham Department of Surgery Donald Inclusion; and was awarded the KL2/ chair of the Department of Surgery at D. Matson Award. Catalyst Medical Research Investigator the University of Global Health Equity in Training (CMeRIT) award. Rwanda; was appointed deputy director Anna Weiss, MD, was appointed director of the Harvard Medical School Program of Breast Surgery at Dana-Farber/ Faina Nakhlis, MD, was awarded a Dana- in Global Surgery and Social Change; Brigham and Women’s Cancer Center Farber Cancer Institute Friend’s Grant and was awarded the American College in affiliation with South Shore Hospital; for her work on refining local-regional of Surgeons International Surgical was awarded a Dana-Farber Cancer therapy for inflammatory breast cancer. Volunteerism Award. Institute Friend’s Grant and a Susan F. Smith Center for Women’s Cancers Stephanie Nitzschke, MD, MS, was Ali Salim, MD, was named the inaugural Innovation Grant. appointed a member of the American BWH Distinguished Chair in Surgery; was Board of Surgery Entrustable appointed associate editor of the Journal Abby White, DO, was the course director Professional Activities (EPA) Revision of Trauma and Acute Care Surgery; for the Fredric G. Levin Lung Cancer Work Group. was named a member of the American Symposium. Association for the Surgery of Trauma Dennis P. Orgill, MD, PhD, was awarded Program Committee; and was appointed Resident/Fellow News & Notes the Research Achievement Award by to the American Surgical Association the American Association of Plastic Advisory Membership Committee. Sourav Bose, MD, MBA, MSc, PGY-3, Surgeons (AAPS). was the recipient of the Esther Tsai Doug Smink, MD, MPH, was appointed Sugg Award from the Society of Asian C. Keith Ozaki, MD, was appointed to associate medical director for surgery by Academic Surgeons (SAAS) for the the Society for Vascular Surgery (SVS) CRICO. highest scoring resident abstract, Strategic Board of Directors. “Fetal base editing ameliorates Desiree Steimer, MD, was a Thoracic cardiac pathology in a mouse model of Erika Rangel, MD, MS, was awarded Surgical Robotics Fellowship recipient mucopolysaccharidosis type I,” at the the Brigham and Women’s Hospital from the American Association for annual Academic Surgical Congress; Department of Surgery Robert T. Osteen Thoracic Surgery (AATS) Foundation. and was the recipient of the Joe Leigh Junior Fellowship award for the project Simpson Award for the Best Early Career titled, “Pregnancy complications and Investigator at the annual International 38

Conference on Prenatal Diagnosis and study, “Defining the natural history from the University of Michigan Therapy for his oral presentation “In and drivers of surgical referral of Undergraduate Research Opportunity utero genome editing restores cardiac pediatric umbilical hernias to reduce Program (UROP). function and improves survival in unnecessary surgery.” mucopolysaccharidosis type I.” Rowza Rumma, MD, PGY-5, was Frances Hu, MD, MSc, PGY-3, was the awarded the Johnson & Johnson James Etheridge, MD, PGY-2, was the recipient of an American College of Innovation Grant from Johnson & recipient of an American College of Surgeons Scientific Forum Excellence Johnson and Harvard Catalyst for her Surgeons Scientific Forum Excellence in in Research Award for her abstract, project, “Clinical predictive modeling Research Award. “Surgeon-reported barriers and of anastomotic leaks using hyper facilitators to Adoption of standards for spectral imaging.” Sameer Hirji, MD, PGY-3, received the goal-concordant care in patients with Harvard Affiliated Emergency Medicine advanced cancer.” Bixiao Zhao, MD, PhD, PGY-3, was Residency (HAEMR) 2021 General awarded the Best Basic Science Paper Surgery Consult Resident of the Year Thinzar Helmi Lwin, MD, MS, PGY-7, award at the American Association Award; was awarded the Department was awarded the Society of Surgical of Endocrine Surgeons (AAES) of Surgery Class of 1963 Scholar Oncology (SSO) Resident/Fellow Essay 2021 Annual Meeting for his work Award; and was awarded the American Contest Best Basic Science Research entitled, “Glycolytic inhibition with College of Cardiology Massachusetts Paper Award for the study, “Rapid tumor 3-bromopyruvate suppresses tumor Chapter Research Award for his work on, labeling kinetics with a site-specific near- growth and improves survival in a “Outcomes of surgical explantation of infrared anti-CEA nanobody in a patient- murine model of anaplastic thyroid TAVR – A population-based, nationally- derived mouse model of colon cancer.” cancer;” and received the Podium representative analysis.” Prize at the New England Surgical Pooja Neiman, MD, MPA, PGY-3, Society (NESS) 2021 Annual Meeting Katherine He, MD, MS, PGY-3, was won a 2020 American Association for the for his presentation, “Inhibition of the recipient of a National Institutes of Surgery of Trauma (AAST) Resident lactate export suppresses growth Health (NIH) National Research Service Research Scholarship; and received the and metabolism of anaplastic Award (NRSA) F32 fellowship for the 2020-2021 Outstanding Mentor Award thyroid cancer.” Top Doctors Boston Magazine’s 2021 “Top Doctors” issue recognizes 41 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 Gerard Doherty, MD Steven Mentzer, MD The following board- Atul Gawande, MD, MPH Scott Swanson, MD certified Brigham Oral Ronald Bleday, MD Pardon Kenney, MD, MMSc Jon Wee, MD Medicine specialists were Joel Goldberg, MD, MPH Tari King, MD Daniel Wiener, MD included in Boston Sayeed Malek, MD Magazine’s “Top Dentists Otolaryngology Faina Nakhlis, MD Urology 2021” list: Chandrajit Raut, MD, MSc Herve Y. Sroussi, DMD, PhD Donald Annino, MD, DMD Esther Rhei, MD Steven Chang, MD, MS Nathaniel S. Treister, DMD, DMSc Scott Shikora, MD Adam Kibel, MD Sook-Bin Woo, DMD, MMSc Plastic Surgery Douglas Smink, MD, MPH Michael Malone, MD Ali Tavakkoli, MD Michael O’Leary, MD, MPH 39 Matthew Carty, MD Ashley Vernon, MD Graeme Steele, MD Yoon Chun, MD Dennis Orgill, MD, PhD Thoracic and Cardiac Vascular Surgery Andrea Pusic, MD Surgery Christian Sampson, MD Michael Belkin, MD Simon Talbot, MD Raphael Bueno, MD Edwin Gravereaux, MD Christopher Ducko, MD Matthew Menard, MD Surgery M. Blair Marshall, MD Charles Ozaki, MD Hari Mallidi, MD Stanley Ashley, MD Monica Bertagnolli, MD Thomas Clancy, MD

Development With our donor’s support, the Brigham Department of Surgery is able to deliver the highest quality patient care, pursue the most innovative and promising medical research and train the brightest medical minds to become the next generation of health care leaders. Cogan and Cornille give in Cogan and Cornille received pledged $450,000 to continue their memory of friendship and love excellent medical care from their support of the Pamela and Nick doctors at the Brigham for many Gelsomini Breast Surgical Oncology With a connection spanning seven years. And for Cornille, the Brigham Fellowship. Directed by Tari King, MD, decades, the late John “Jack” Cogan holds special meaning. Toward the the fellowship has supported several and the late John Mannick, MD, proved end of Cogan’s life, the therapeutic trainees since 2018, two of whom some friendships are timeless. They approaches of the Osher Center for finished and stayed on as full-time met as young men at Harvard in 1945, Integrative Medicine helped improve faculty in the Dana-Farber/Brigham after Cogan served in World War II, his mobility, which was vital to him as and Women’s Cancer Center. and formed a bond that would outlast an avid runner. To honor her husband’s long-distance moves, raising families memory and recognize those benefits, Gelsomini looks forward to and building successful careers. Cornille contributed $125,000 to the seeing more fellows rise through the Cogan became an esteemed lawyer center to support patients’ well-being program and bring their expertise to and leader in the financial services and advance therapies emphasizing communities in need, especially rural industry. Dr. Mannick became a the mind-body connection. or remote areas where specialty care pioneering vascular surgeon and may be scarce. She also marvels at surgeon-in-chief at the Brigham. “Every day he could, Jack would the highly targeted, minimally invasive run along the Charles River,” Cornille treatments being honed and perfected “Jack and John were powerhouses said. “In the end, he couldn’t run like today by Brigham surgeons. in their lives,” Mary Cornille, Cogan’s he did before, but learning Tai Chi and wife, said. “Jack had a remarkable receiving manipulative therapy at the “I’ve been inspired watching the career and was involved in many civic Osher Center noticeably improved his fellows come into their own and and charitable organizations. And John movement and provided relief.” flourish as surgeons and scientists,” was a wonderful doctor, leader in his Gelsomini said. “It’s so promising to field, and dear friend. They inspired Cornille hopes her gift will enable the know what care teams can do now each other throughout their lives.” center to increase medical education and to envision where the next five and awareness of integrative medicine. years will bring us. All of the steps When Dr. Mannick died in late 2019, “If this means more people could be being taken and all of the people who Cogan was facing his own serious helped the way Jack was, that would will survive because of their work—it’s health challenges. Nonetheless, be truly wonderful,” she said. wonderful to witness change.” he was determined to endow a professorship to preserve his friend’s Gelsominis renew commitment Caneparis provide critical legacy. Though Cogan didn’t see to breast cancer fellowship resources for lung patients it come to fruition, he ensured his wishes would be fulfilled through a $4 For the past 10 years, as long This past year, David and Diane million bequest from his estate, which as she has been a breast cancer Canepari continued their philanthropy established the John Anthony Mannick survivor, Pamela Gelsomini has been to the Brigham’s Lung Center through a Professorship of Surgery at Harvard proud to be part of the Brigham’s commitment of more than $800,000 to Medical School. The incumbent will efforts to transform cancer care. An support new technologies that directly be a professor or associate professor entrepreneur and avid cook and food enhance patient care. focused on vascular or immunology- blogger, she credits the Brigham for related surgery at the Brigham. restoring her health and generously supports the hospital to help other patients facing a breast cancer diagnosis. Gelsomini stays connected with her care providers and actively participates on the hospital’s Cancer Research and Care Advisory Board, which keeps her informed of the latest science and treatment advances. She and her husband, Nick, recently 40

“We’re excited this technology is opening up new possibilities and know Dr. Bueno and his team will continue innovating and improving care.” The Caneparis’ support has helped Goldman-Blotner family fuels he and his wife, Nancy Adams, did not the Brigham acquire a specialized mesothelioma cancer research hesitate to seek medical help. After portable chest CT scanner, which Schoen was rushed to the Brigham by enables critical imaging in the Following Mark Blotner’s diagnosis ambulance, they learned he needed operating room or at the bedside of of mesothelioma, a rare lung cancer emergency surgery to mend his aorta, acutely ill patients. In addition, a new often caused by asbestos exposure, he the main artery that pumps blood from state-of-the art robotic device will and his wife, Cindy, have been inspired the heart to the rest of the body. aid bronchoscopies to identify and by his surgeon Raphael Bueno, MD, eliminate small peripheral nodules in chief of the Division of Thoracic and “We look at May 19, 2020, as my new the lungs. Cardiac Surgery at the Brigham. first birthday,” Schoen, who recovered with excellent results after a seven- “David and Diane are making an Over the last several years, the hour procedure, said. “Surviving the incredible impact on the care we can Goldman-Blotner family and their surgery, and in such good health, is deliver to lung patients,” Raphael friends have raised more than a miracle to me,” he added, noting Bueno, MD, chief of the Division $500,000 to bolster Dr. Bueno’s the high mortality rate for an aortic of Thoracic and Cardiac Surgery, investigations, including his work dissection if not tended to quickly. co-director of the Lung Center and to test drugs in clinical trials and to “Without a doubt, Nancy and I wanted David’s physician, said. “The mobile CT explore harnessing the immune system to make a meaningful gift to the scanner will be a game-changer, since to fight mesothelioma. In particular, hospital as a way to say thank you.” it allows us to capture images in the Cindy’s father, Allan Goldman, has operating room and for immobilized continued his generosity with multiple The couple committed $1 million to patients, while the robotic device substantial gifts. the Brigham for research to improve enhances and refines bronchoscopies. the understanding of vascular and We’re so grateful for David and Diane’s “My family and I are committed cardiovascular disease. Half their gift generosity.” to supporting Dr. Bueno’s research fuels a vascular disease biobank and and are very encouraged by the biospecimen collection, under the The Caneparis’ giving builds on revolutionary advances he and his direction of Gerard Doherty, MD, chair their recent contributions to the team are making,” Goldman said. of the Department of Surgery, and hospital’s COVID-19 response— which half supports women’s cardiovascular allowed the Brigham to secure ECMO Lifesaving experience spurs disease initiatives under the leadership machines that provide lifesaving Schoen and Adams to give of Hadine Joffe, MD, MSc, executive breathing support to patients in $1 million director of the Connors Center for critical care. Diane and David, an Women’s Health and Gender Biology. active and committed member of In May 2020, 62-year-old Scott the hospital’s Lung Center Advisory Schoen was exercising at home when “We’re grateful for Scott and Nancy’s Board, have a history of supporting he started experiencing chest pain and generosity and flexibility to support the center, including gifts for research, dizziness. Though Massachusetts had areas we think will be most effective in a comprehensive lung screening a surge in COVID-19 cases at that time, developing new knowledge of disease,” program and the thoracic surgery Dr. Doherty said. fellowship program. “With Scott as a member of the “I’m grateful that I’ve received Mass General Brigham Board of excellent care from Dr. Bueno and want to continue supporting his work in helping other patients with lung conditions, especially those facing COVID-19,” David said. 41

Trustees and Nancy as a member of treatment. technologies and retain talented the Women’s Health Advisory Board at The gift is also fueling surgeons. This funding enables more the Brigham, they are both tuned into surgeons to become certified in the needs for research to help im- cardiovascular research focused advanced robotic surgery systems, prove diagnosis and treatment,” on atherosclerosis and other while also paving the way for more Dr. Joffe added. arterial diseases and supporting residents to continue their careers at the Brigham’s plans to renovate the hospital. The Crowleys” gift also For Schoen, the ability to return the Emergency Department. With allows surgeons at all levels to pursue to full activity one month after these enhancements, the hospital research and develop programs that surgery, including golfing, with no will increase its capacity to offer make surgery safer, more patient- complications or lingering pain, is the more specialized, streamlined and centered and accessible. best outcome he could have imagined. comfortable emergency care for patients who turn to the Brigham. Dr. Doherty says these are just a “It’s a new lease on life. We feel few ways the Crowleys’ giving helps to blessed to give back to the talented Crowley family empowers stellar improve surgical care for patients at vascular experts at the Brigham,” surgical leadership the Brigham and beyond. he said. When Andy and Janice Crowley “I am honored to hold the Crowley Gift benefits cancer research established the Crowley Family Family Distinguished Chair,” Dr. and Emergency Department Distinguished Chair in the Department Doherty said. “The Crowleys’ continued expansion of Surgery in 2013, they sought to generosity has been invaluable, honor the excellent care their family especially through the heightened To keep moving medicine toward received at the Brigham. challenges of the COVID-19 pandemic. individualized approaches, it takes Their support has helped us plan for investment in bold research and The chair has empowered Gerard the long-term and launch countless innovative health care delivery ideas. Doherty, MD, surgeon-in-chief, to careers. That should give us all hope strengthen the hospital’s world-class for the future of medicine.” Recognizing these needs, two surgical leadership and support his longtime supporters of the Brigham team of experts at every stage of Bulens family invests in cardiac anonymously contributed $150,000 to their careers. The Crowleys recently surgery fellows research for breast cancer and heart deepened their commitment to the disease, as well as the expansion chair with a $300,000 gift, which will Hoda Javadikasgari, MD, the newest and improvement of emergency further Dr. Doherty’s efforts to shape Bulens Family Fellow in Cardiac department facilities. the future of surgical care. Surgery, is passionate about using computer science to develop new This generous gift builds on “Our family has leaned on the cardiac surgical techniques and the supporters’ history of aiding Brigham for our care and the hospital enhance patients’ health. investigators in the Division of Breast has always been there for us,” Andy Surgery, who are developing more said. “We’re proud to support the chair Through this advanced fellowship, personalized approaches for breast so the Brigham maintains its surgical she has an opportunity to conduct cancer screening, prevention and excellence.” research that improves conventional cardiac surgery techniques and The chair provides resources that develops new, minimally invasive are especially critical as Dr. Doherty approaches to heart valve repair works to expand training in new and replacement. 42

Lynne and Donald Bulens, whose him a star to countless patients and in theSupport the Work giving launched the fellowship in 2017, families. His exceptional caregiving of the Department recently made a generous new gift to made a strong impression on members of Surgery sustain the program. of the MacDonald family, who recently gave $250,000 to the Brigham Each year, thousands of people “We’re tremendously thankful for through the Frank R. and Elizabeth entrust the Department of Surgery the support of the Bulens family,” Simoni Foundation, a philanthropic at Brigham and Women’s Hospital Tsuyoshi Kaneko, MD, who is over- organization that supports education, to provide them with excellent seeing Dr. Javadikasgari’s work, health care and other needs in the medical care. Many people turn to said. “Because of their commitment, Greater Boston community. us because of our long history of the next generation of talented medical firsts and reputation for researchers is pursuing pioneering With this gift, the Simoni Foundation attracting the finest surgical trainees work in cardiovascular surgery.” seeks to honor Dr. Clancy by and surgeons in the country. One of establishing a fund to strengthen the reasons we have been able to Dr. Javadikasgari envisions outcomes research for pancreatic, build such a strong program—and to improved surgery and outcomes biliary and liver cancers—one of Dr. establish new standards of surgical for patients with severe mitral Clancy’s greatest priorities. This type care—is because of philanthropic valve disease who cannot undergo of research examines patients’ results contributions from people like you. conventional surgery. Doctors after surgeries or other interventions can conduct a minimally invasive to determine which approaches work Gifts from our alumni, patients and procedure called MitraClip to implant best and which can be improved. friends help us to train our staff in the a device and help the mitral valve latest surgical techniques, to make close more completely, but it requires “We admire Dr. Clancy’s passion for advances in surgery through research careful planning to ensure correct improving treatment and quality of life and to achieve the best possible placement. Through the fellowship, Dr. for patients,” Matthew MacDonald, outcomes for patients. When you Javadikasgari plans to develop a new president of the Simoni Foundation, make a gift to the Department of mathematical model to predict optimal said. “We are pleased to provide Surgery, you enable our medical MitraClip placement in patients. flexible resources for him to lead and team to provide the most advanced pursue research that can change the care and make a difference for every Raphael Bueno, MD, chief of the course of these cancers.” patient and family member we see. Division of Thoracic and Cardiac Surgery, sees the Bulens’ philanthropy Dr. Clancy is thankful to the family For more information if you are as crucial in fulfilling the division’s for helping his team uncover insights interested in making a gift to the goals for training and future care. about these diseases and to ultimately Department of Surgery at Brigham steer the field toward more targeted, and Women’s Hospital, or to a “Our fellows are tackling some of successful treatments. “The Simoni specific physician or scientist within the field’s most vexing challenges,” Foundation’s generous support is the department, please contact he said. “They are paving the way for critical to accelerating promising Susan Andrews, assistant vice new surgical approaches that will help investigations. This work will inform president of the Development Office, patients in Boston and beyond.” and guide care for patients today and at 617.424.4349 or [email protected] Frank R. and Elizabeth Simoni Foundation advances cancer care Thomas Clancy, MD, is one of the top surgical oncologists specializing in pancreatic, biliary and liver cancers. As a researcher and educator, Dr. Clancy is at the forefront of progress for treating these serious and often life-threatening cancers, which can develop undetected to advanced stages when treatment becomes less successful. Also known for his compassion and attentiveness as a surgeon, Dr. Clancy possesses qualities that have made 43

Leadership Sarah Broughton Herd Director, Surgery Education Office Gerard M. Doherty, MD Moseley Professor of Surgery, Harvard Medical School Matthew S. Sandler, MBA Surgeon-in-Chief, Brigham and Women’s Hospital & Senior Director of Finance Dana-Farber Cancer Institute Crowley Family Distinguished Chair, Department of Surgery, David A. Steger, MS Brigham and Women’s Hospital Director of Communications C. Keith Ozaki, MD Victoria (Tori) Wilmarth, MBA Executive Vice Chair, Department of Surgery, Brigham and Director of Network Strategy Women’s Hospital John A. Mannick Professor of Surgery, Brigham and Women’s Division Administrators Hospital Professor of Surgery, Harvard Medical School Paul Buckley Breast Surgery Douglas S. Smink, MD, MPH Chief of Surgery, Brigham and Women’s Faulkner Hospital Jennifer Fanning Vice Chair for Education General and Gastrointestinal Surgery Ronald Bleday, MD Nathan J. Burke, MBA Vice Chair for Quality and Patient Safety Oral Medicine Tari A. King, MD Michelle Swoboda, MHA Vice Chair for Multidisciplinary Oncology Otolaryngology—Head and Neck Surgery Elizabeth Mittendorf, MD, PhD Shannon Weiss, RN, MBA Vice Chair for Research Plastic and Reconstructive Surgery Louis L. Nguyen, MD, MPH, MBA Jenna Khalili, MBA Vice Chair for Digital Health Systems Surgical Oncology Malcolm K. Robinson, MD Philip Girard, MS Vice Chair for Clinical Operations Thoracic and Cardiac Surgery Ali Salim, MD Keila Jackson, MHA Vice Chair for Surgical Critical Care Transplant Surgery Jennifer Shin, MD, SM Susannah Rudel, MPH, MBA Vice Chair for Faculty Development Trauma, Burn and Surgical Critical Care Philip D. Roberts, MBA Sandra Doolan, MBA Executive Administrator Urology Suzanna Clark, MHA Lorraine T. Levitsky Senior Director of Operations Vascular and Endovascular Surgery Gina Tonogbanua Custer, MA, CRA Administrative Director of Research Department of Surgery • 75 Francis Street • Tower 1 – Room 110 • Boston, MA 02115 Contact Us • [email protected] • 617.732.8181 Follow Us • twitter.com/brighamsurgery Brigham Surgery Alumni Stay in Touch! The Brigham Surgery Alumni Group consists of graduates of Brigham and Women’s Hospital surgery residency and fellowship programs and former Department of Surgery faculty members. If you would like to join the Brigham Surgery Alumni Group and receive news and updates from the Department of Surgery, please visit: brighamsurgerynews.com/alumni/ or email us at: [email protected]

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