CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE...

transcript

CT SURGERY

IN THE USA

Society of Thoracic Surgeons

in the21st Century

Keith S. Naunheim, M.D.

President, Society of Thoracic Surgeons

CT SURGERY

IN THE USA

STS IN THE21st CENTURYFinancial Disclosure

I only wish

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSurgeon Demographics

Ikonomides JS

Ann Thorac Surg 2016; 102:2118

4343 active STS members

29% response rate

Median age 54 yrs

Academic 37%

Hospital employed 40%

Private practice 18%

Govt employed 2%

Other 3%Over 7300 members

in 95 countries

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Mission

Enhance the ability of

cardiothoracic surgeons to

provide the highest quality

patient care through education,

research, and advocacy

How the hell do we do that?

CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Fiscal year 2017-18, the TSF

Raised $1.5 million dollars for charitable use

Gave almost $900,000 in awards to surgeons

Since 1998 as the TSFRE

$16 million for CT surgery research/education

200 research and fellowship grants awarded

Basic, applied & health policy research

Residents, early & mid career attendings

Funding Research

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Databases

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Congenital

Cardiac

117 sites

95% of cases

475,000

Cardiac

1080 sites

95% of cases

6.5 million51 papers 31 papers 19 papers

CT SURGERY

IN THE USA

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Cardiac

1080 sites

95% of cases

6.5 million

Intermacs

163 sites

99% of cases

>19,000

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCardiac Surgery Trends

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CT SURGERY

IN THE USA

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

US population All + 7.7%

> 65 + 24%

CT SURGERY

IN THE USA

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CABG Off Pump 12%

IMA 99%, BIMA 5%, Radial 5%

CT SURGERY

IN THE USA

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

MVR Repair/Replace 60/40

CABG Off Pump 12%

CT SURGERY

IN THE USA

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

AVR Declining volumes

MVR Repair/Replace 60/40

CABG Off Pump 12%

CT SURGERY

IN THE USA

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Cardiac

1080 sites

95% of cases

6.5 million

Intermacs

163 sites

99% of cases

>190,000

CT SURGERY

IN THE USA

SAVR vs TAVR

29829 3026528493

18384 1809017507

1591017544

2014 2015 2016 2017

AVR & CABG

STS/ACC TVT Registry March 2018

65,757 89,269

Low risk

High risk

Intermediate

SAPIEN 3

PARTNER 2SURTAVI

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMoral of the Story

TAVR is absolutely here to stay

TMVR is probably here to stay

If you a. Are under the age of 55

b. Want to implant valves

It’s time to get some wire skills

CT SURGERY

IN THE USA

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Cardiac

1080 sites

95% of cases

6.5 million

Intermacs

163 sites

99% of cases

>19,000

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Intermacs Database

LVAD Intermacs

Over 160 programs

Over 19000 patients

Continued growth

CT SURGERY

IN THE USA

STS IN THE21st CENTURYLVAD Trends

AxialCentrifugal

Intermacs Annual Report 2017MOMENTUM 3

HeartMate II vs III

Centrifugal flow in III

Fewer strokes

Fewer reoperations

NEJM 2018; 378:1386

CT SURGERY

IN THE USA

STS IN THE21st CENTURYECMO Trends

McCarthy et al Sem Thorac Cardiovasc Surg 2015; 27:81

2015: 61: 31-6

CT SURGERY

IN THE USA

STS IN THE21st CENTURYEvolving Your Practice

CT SURGERY

IN THE USA

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Cardiac

1080 sites

95% of cases

6.5 million

Intermacs

163 sites

99% of cases

>190,000

CT SURGERY

IN THE USA

STS IN THE21st CENTURYThoracic Surgery Trends

National Lung Screening trial NEJM 2011

Cohort Person Lung ca Mortality Mortality

Years Deaths per 10,000 Reduction

LDCT 144,103 356 247

CXR 143,368 443 309

20%p = 0.004

“Screening with low dose chest CT

conclusively reduces mortality from lung

cancer in high risk patients.”

Medicare & USPSTF cover for screening

CT SURGERY

IN THE USA

Screening will lead to smaller, early stage lesions

Suppositions

Americans want less invasive treatment methods

Increased usage of minimally invasive surgery

Increased usage of sub lobar resections

Increased usage of non surgical therapy (SBRT)

CT SURGERY

IN THE USA

Limited to the STS General Thoracic Database

CT SURGERY

IN THE USA

VATS and Robotic Surgery

Robotic

Unpublished quarterly analysis of the Premier Database

2009 2012 2014 20162010

CT SURGERY

IN THE USA

SEER Data

2000-2010

Stage I

Resections

Kapadia et al Ann Thorac Surg 2017; 104:1881

Pneumo

83 80%

Sublobar

13 18%

CT SURGERY

IN THE USA

National Cancer Database (70% of all cancer pts)

2008 to 2013 107,233 pts stage IA NSCLC

Demographics, comorbidity, treatment type & year

Trends in SBRT

JNCI Ca Spect 2017; 1:1-6

CT SURGERY

IN THE USA

Surgery

12% relative decline

Trends in SBRTHolmes et al JNCI Ca Spect 2017; 1:1-6

49.5%43.7%

Lobe/Pneum

16.3% SBRT

240% relative rise

Are patients getting

adequate treatment?

No RCT proves

SBRT is equivalent

No RCT proves

SBRT isn’t

CT SURGERY

IN THE USA

Highest quality clinical care

Research

Education

Advocacy

Mission

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMeetings

CT SURGERY

IN THE USA

May 18-19, 2018 ● Chicago, IL

sts.org/roboticthoracic

New in 2018!

Thoracic Meetings

CT SURGERY

IN THE USA

ASTRO ASCO STS

CT SURGERY

IN THE USA

Shanghai Medical

Association

September 8-9,

Shanghai, China

Thoracic Meetings

CT SURGERY

IN THE USA

CT SURGERY

IN THE USACardiothoracic Meetings

CT SURGERY

IN THE USA

November 8-9,

Shenyang, China

Chinese Society of Thoracic and Cardiovascular Surgery

Cardiothoracic Meetings

CT SURGERY

IN THE USACardiac Meetings

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Annual Meeting

Didactic

Sessions

University

CT SURGERY

IN THE USA

CT SURGERY

IN THE USA

STS IN THE21st CENTURYVideos Webinars Podcasts

CT SURGERY

IN THE USA

STS IN THE21st CENTURYAnnals of Thoracic Surgery

Monthly CME Articles in

General Thoracic Surgery

annalsthoracicsurgery.org

CT SURGERY

IN THE USA

Highest quality clinical care

Research

Education

Advocacy

Mission

CT SURGERY

IN THE USA

CT SURGERY

IN THE USA

STS IN THE21st CENTURYPatient Safety & Education

CT SURGERY

IN THE USA

STS IN THE21st CENTURYctsurgerypatients.org

The Patient Guide to Heart, Lung, and Esophageal SurgeryA Website Presented by Cardiothoracic Surgeons Committed to Improving Patient Care

Available in English and Spanish

CT SURGERY

IN THE USA

STS IN THE21st CENTURYPatient Handouts

CT SURGERY

IN THE USA

STS IN THE21st CENTURYFuture Trends

Workforce

Technology

Transparency

CT SURGERY

IN THE USA

CT Surgery Applications

The Age of Darkness

1993 1994 1995 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Total Number of Applicants

Active Positions Available

U.S. Medical School Graduate Applicants

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCT Surgery Resurgence

Six YearIntegratedPositions

Two/ThreeYear Standard

Positions

Six Year

Integrated

Applicants

Two/Three

Year Standard

Applicants

CT SURGERY

IN THE USA

STS IN THE21st CENTURYActive Physicians

AAMC Data www.aamc.org/data/workforce/reports/458712/1-3chart.html

All specialties 34%

CT SURGERY

IN THE USA

STS IN THE21st CENTURYDemographics

CT SURGERY

IN THE USA

STS IN THE21st CENTURYActive Trainees

AAMC Data www.aamc.org/data/workforce/reports/458712/1-3chart.html

All specialties 46%

CT SURGERY

IN THE USA

STS IN THE21st CENTURYFemale Participation

New Female Diplomates

Total Women Certified

CT SURGERY

IN THE USA

STS IN THE21st CENTURYFemale Surgeons

U Michigan St Louis U

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Women Surgeons

CT SURGERY

IN THE USA

STS IN THE21st CENTURYTechnology Trends

CT SURGERY

IN THE USA

Virtual Reality Preop planning

Education

Augmented Reality Preop planning

Intraop decisions

Artificial Intelligence All of the above PLUS

NLP EMR

Computer vision Imaging analysis

Neural networks Computer “judgment”

Machine learning Scary SkyNet Stuff

More Computer Stuff

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Mechanical Assist

VAD ECMO TAH

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Perc Valves

TMVRTAVR

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Robotic Surgery

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Robots

Transenterix

HapticFeedback

Eye sensingCamera control

ReusableInstrumentation

CT SURGERY

IN THE USA

ControlConsole

UniportalInstrumentation

RoboticArm

CT SURGERY

IN THE USA

MedRobotics Flex

Robotic Trends

CT SURGERY

IN THE USA

MedRobotics Flex

CT SURGERY

IN THE USA

STS IN THE21st CENTURYRobotic Evolution

Master - Slave

Robocop ED-209

Semiautonomous

Independent

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Transparency

CT SURGERY

IN THE USA

STS IN THE21st CENTURYPublic Reporting

CT SURGERY

IN THE USA

STS IN THE21st CENTURYQuality Improvement

Public reporting is the right thing to do and the Society

regards this as a professional responsibility

Adult Cardiac

AVR + CABG

MVR + CABG

Congenital Cardiac

VSD Glenn/HF

TOF Fontan

CAVC Truncus

AS Norwood

AS/VSD Coarct

General Thoracic

Lobectomy

Esophagectomy

CT SURGERY

IN THE USA

Quality reporting currently at program level

Individual procedures

Composite score

Next step - reporting at individual surgeon level

Individual procedures (summing the O/Es)

New composite score for five procedures

Confidential reporting to surgeons - or is it?

Surgeon Level Composite

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Pressure Than Ever

More difficult patients

More needless paperwork

More ongoing scrutiny

Regulatory agencies

Third Party payers

Media (social & others)

STS involvement maximizes your

opportunity for self determination

CT SURGERY

IN THE USA

STS IN THE21st CENTURYThe Surgeon’s Century

CT SURGERY

IN THE USA

Thank You

Questions?

CT SURGERY

IN THE USA

STS IN THE21st CENTURYTransplantation Trends

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CT SURGERY

IN THE USA

STS IN THE21st CENTURYAugmented Reality

CT SURGERY

IN THE USA

STS IN THE21st CENTURYAugmented Reality

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMan vs Robot

CT SURGERY

IN THE USA

STS IN THE21st CENTURYThree Laws of Robotics

1. A robot may not injure a human being, or, through

inaction, allow a human being to come to harm

2. A robot must obey the orders given it by human

beings except where such orders would conflict with

the First Law

3. A robot must protect its own existence as long as

such protection does not conflict with the First or

Second Laws

CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE...

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