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| The Monthly Pulse |
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| Society of Thoracic Surgeons launches new risk calculators for SAVR after TAVR, other key heart surgeries
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| The Story |
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| The Society of Thoracic Surgeons (STS) recently announced a new risk calculator to help providers make informed decisions when evaluating patients for surgical aortic valve replacement (SAVR) following a prior transcatheter aortic valve replacement (TAVR), multi-valve surgery, or tricuspid valve surgery. The STS President notes that the new calculator incorporates complex procedures which were not included in previous risk models. Information from the STS Adult Cardiac Surgery database was used to create the new calculator. |
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| What You Should Know |
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| STS risk calculators are often considered the gold standard for cardiothoracic surgeons when making treatment decisions. They can also be helpful when care teams collaborate with patients to review treatment options. The new calculators drew on data from tens of thousands of patients to analyze risks of mortality, and will offer value for providers seeking to make informed decisions for a broader patient population.
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| Enhanced recovery after surgery program focusing on chest tube management improves surgical recovery after video-assisted thoracoscopic surgery
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| The Story |
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| A study of 120 patients was recently performed to evaluate the effects of an enhanced recovery after surgery (ERAS) program focused on chest tube management following thoracoscopic surgery for lung cancer. Results showed that the patients in the ERAS group had a shorter hospital stay, fewer postoperative complications, and a remarkably shorter duration of chest tube placement. A VATS-specific ERAS program was developed with a focus on chest tube management and involved interdisciplinary collaboration among thoracic surgeons, anesthesiologists, and nutritionists.
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| What You Should Know |
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| Chest tube placement can have a significant impact on the postoperative management and recovery of lung cancer patients. While this study was small, the 60 patients in the ERAS group experienced significantly better outcomes than those in the control group, including 12.9 hours for first food intake versus 18.4 hours, 68.6 hours of chest tube placement versus 92.8 hours, and significant differences in VAS scores on the second postoperative day. While further studies are needed, this evidence suggests a dedicated ERAS program for chest tube management could benefit lung cancer patients in numerous ways.
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| Mind the gap! Interdisciplinary approach to anterior chest wall reconstruction after total sternectomy |
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| The Story |
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| Recently, researchers performed a combined rigid and aesthetic soft tissue reconstruction of the anterior chest wall following complete sternectomy in four patients. These complex cases of sternum reconstruction were performed via an interdisciplinary surgical approach involving STRATOS® titanium bars and myocutaneous vastus lateralis muscle free flaps. Following the procedure, all patients reported stability of the chest wall and good quality of life. |
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| What You Should Know |
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| There are several ways to perform chest wall reconstruction following a total sternectomy. Yet, the number of patients requiring the procedure is scarce, thereby limiting repeatability. Researchers sought to develop a standardized, interdisciplinary approach for thoracic and plastic surgeons. While this study sample is small, the outcomes are strong and suggest that the proposed method may be worth further consideration.
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| Leadership Reflections |
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Crucial Conversations
I recently read the book Crucial Conversations by Joseph Grenny, Kerry Patterson, Ron McMillan, Al Switzler, and Emily Gregory. This book covers numerous tools and communication strategies — skills which I believe can benefit just about anyone at any stage in their career. It’s rich with valuable takeaways, but I’ll cover a few in particular that stood out to me.
Acronyms that include 3-5 key takeaways represent an effective method of remembering a set of concepts. In the book, the acronym STATE is introduced as a way to structure your conversation. This framework allows you to address a conversation that may include high emotion, high stakes, and/or differences of opinion around core facts in a non-threatening way. Here is a brief overview of the five concepts.
Share your facts - This step provides an opportunity for the initiator to list key facts and circumstances as objectively as possible. The focus is on facts over feelings or interpretations. This is about what happened based on personal experience and observations. Any areas of uncertainty are best left out of this portion of the conversation, or, if introduced, should be noted as uncertainties.
Tell your story - In this portion, the focus shifts from the facts to how the initiator is experiencing the outcomes from those facts. This is the place to explore how the key facts and circumstances were interpreted or felt by the initiator.
Ask for the other’s path -
Now the conversation opens up to the other party. This is an invitation by the initiator for a response. Were there any facts that deserve clarification? Are there aspects of the story that need further exploration? What story is developing from the respondent's perspective?
Talk tentatively -
Particularly in circumstances where the stakes are high, it may be natural to speak assertively. However, this can lead to the conversation shutting down. By speaking tentatively, we leave space to explore differences in perception.
Encourage testing -
Allow space for both parties to discover a shared interpretation of facts and circumstances. This is a collaborative process where both participants feel heard and understood.
I encourage you to read this excellent book. Personally, my initial reaction in difficult situations is to practice avoidance, which is never a good strategy. The tools provided in the book have been instrumental in helping me prepare for difficult conversations and circumvent the tendency to avoid them. My final takeaway is that these techniques require practice to master. Each time I utilize the model and engage in the resulting conversation, I get just a bit better.
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| STS Coronary Conference |
| Fri., Jun. 7 - Sat., Jun. 8 |
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Carolina Perfusion Symposium |
| Fri., Jul 19 - Sun., Jul. 21 |
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| 2024 STS Boot Camp |
| Thurs., Aug. 22 - Sun., Aug. 25 |
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| 2024 AANP Fall Conference |
| Thurs., Sept. 19 - Sun., Sept. 22 |
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| American College of Surgeons Clinical Congress 2024 |
| Sat., Oct. 19 - Tues., Oct. 22 |
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