Annual Report 2010-2011

DEPARTMENT OF GENERAL SURGERY

CLINICAL:  For fiscal year 2011, the Department of General Surgery had 7,086 cases, a 4% increase from FY10.  The number of visits increased 4.4% at 28,690, with work RVUs at 233,006, a 2.4% increase from FY10. The General Surgery Multispecialty (GSM) and the Surgical Oncology Clinics both converted to provider based clinic business practices.  Additionally, the Surgery Outpatient Department (OPD) staff and the GSM Clinic staff were merged into one team to support both functions.  Clinic site leadership teams received weekly Press Ganey survey comments and participated in monthly patient satisfaction team meetings.  Resources from the Press Ganey product were shared with the teams, staff and faculty, and each clinic adopted daily huddles to address team needs and issues identified by the survey product. 

Wake Forest Baptist Health (WFBH) Brenner Children’s Hospital (BCH) was accredited as a Level 1 Pediatric Trauma Center by the American College of Surgeons (ACS) this year.   This confirmation recognizes that acutely injured children should be treated by a multidisciplinary trauma team, which is accessible at all times and is overseen by a surgeon with expertise and commitment in both the care of children and the trauma disease process.  There are approximately 30 verified Level 1 Pediatric Trauma Centers in the nation and the BCH designation is the only Level 1 Pediatric Trauma Center in the state of North Carolina.  Pediatric Surgeon John K. Petty, MD is the Medical Director for Pediatric Trauma at WFBH and BCH.  Although not directly involved in providing patient care, the Childress Institute for Pediatric Trauma (CIPT)   provided support and direction to the effort to gain Level 1 status as a pediatric trauma center as one of CIPT’s first commitments made upon formation in 2008.

The Bariatric Services program, lead by Dr. Fernandez prepared a white paper for a Weight Loss Center to provide a programmatic platform for collaborative growth and national recognition through a continuum of services and research to be offered by WFBH/WFU.  The Wake Wellness and Weight Center (WWWC) evolved from the white paper as a business plan and was approved for implementation in July 2012.   The Wake Wellness and Weight Center (WWWC) will improve the patient experience and clinical outcomes by expanding the continuum of care provided and consolidating services in one location. Additionally, this initiative will advance the practice of weight management through surgical and nonsurgical clinical care, patient education and research.

Dr. Alan Farney in the Abdominal Transplant Program spent time working with a Wake Forest Institute for Regenerative Medicine (WFIRM) team to facilitate an Islet Cell Transplantation service proposal for implementation in FY 2012.  With a new ultrasound in the Surgical Oncology Clinic, sonography was consistently offered as a tool for diagnosis and surgical treatment of the thyroid surgical patient population referred to Dr. Jennifer Cannon’s Endocrine Surgery practice. Dr. John Stewart established and implemented a Melanoma Clinic under the Surgical Oncology multidisciplinary model.  Dr. Gregory Waters is offering TEM’s surgery as part of his colorectal surgical practice. 

The clinical mission of the Surgery-Hypertension faculty is to translate new treatments and technologies to the clinical setting.  The yhave developed and applied non-invasive procedures for hemodynamic and vascular assessments, including new billable diagnostic tests for autonomic dysfunction, and continue to assist in Phase I/II clinical trials for novel cancer therapies.   Drs. Brosnihan, Chappell, Gallagher, Tallant and Varagic all received Research Excellence Awards. Dr. Chappell co-authored, along with several Wake Forest PIs (see awards), the Paper of the Year, “Major role for ACE-independent intrarenal ANGII formation in type II diabetes”, and L Harrison-Bernard senior authored; American Physiological Society - Renal Section.

ACADEMIC:  For fiscal year 2012, The Department of General Surgery has 34 residents and 5 fellows. The Resident Review Committee (RRC) for Surgery accredited the Critical Care Fellowship Program for 5 years beginning October 28, 2010.  We began work on an application to the AAST for accreditation of the Acute Care Surgery Fellowship Program.  The ASTS approved the Abdominal Transplant Fellowship Program for a second fellow position beginning July of 2012.   The Hypertension Program had 18 trainees participated in research (17% under-represented, 33% foreign - Egypt, India, Spain, Jordan), receiving numerous travel and other awards, and hosted a US Brazil Exchange Program with 5 undergraduate and 3 postdoctoral students.

Dr. Meredith was awarded funding for a 3 year project titled Emergency Medical Services for Children–Targeted Issues Grant with funding of $811,000 direct costs.  Dr. John Petty in the Pediatric Surgery Program has developed a promising new surgical procedure to address gastric reflux in an animal model applicable to pediatric surgery.  The Hypertension Program under Dr. Diz’s leadership continued its commitment to excellence in research and training in cardiovascular sciences with emphasis on collaborative clinical and translational activities.  The Surgery-Hypertension faculty continued service for professional societies and NIH and hold leadership roles intramurally and within professional societies,  We received extramural funding of roughly $3.5 million direct costs, published 1 book chapter, approximately 30 full journal articles, and 48 abstracts. 

Examples of clinical research topics in General Surgery-Hypertension include: 

• Human urine proximal tubule cells used for expression of components of the renin-angiotensin system and racial differences in adolescents born prematurely (Pediatrics, Perinatal, Nephrology)
• Non-invasive autonomic or vascular dysfunction assessment for dietary nitrite intervention, characterization of children with chronic nausea, as objective measures of behavioral interventions and coupled with magnetic resonance spectroscopy for brain transmitters (Pediatrics, Complementary and Integrative Medicine, Reynolda faculty, Neurology, Anesthesiology, Pepper Center, CBI, Maya Angelou Center)
• Cancer treatment Phase I/II trials (Pediatrics, Cancer Center)
• Sex differences in sub-clinical vascular disease in patients at risk for stroke (Neurology). 

Translational collaborations  focus on non-invasive blood pressure and vascular measures to complement neurohumoral profiles in Vervet monkeys (Primate Center), angiogenesis and cell growth (Cancer Center), gender differences and salt sensitivity related to aging, heart function and renal injury in rats, pre-eclampsia in humans and rats, and fetal programming in humans and sheep (Anesthesiology, Perinatal, Pediatrics, Nephrology).