Average number of transplants per calendar year performed at UAMS

Transcription

1 Summary clinical service 1. Liver transplant program: The UAMS liver transplant program has been open since May The program performed 180 transplants during its first 7 years and 5 months of existence. The highest number of liver transplants performed in Arkansas was 31 in However, this number decreased to 16 and 19 in 2011 and 2012, respectively. The main objective of my hire in 2012 was to help to develop the liver transplant program under the mentorship of Doctors Frederick Bentley and Gary Barone. From October 1, 2012 to September 22, 2017, our program performed 165 liver transplants. Since I was hired at UAMS, the average number of transplants per calendar year has increased from 24.7 to 33.5 (Figure 1). Average number of transplants per calendar year performed at UAMS October 2012 to July May 2005 to September Figure 1. Average number of liver transplants performed at UAMS per calendar year. * Dr. was hired October 1 st As Figure 2 shows, I have done 152 liver transplants and served as first assistant in 2 additional transplants. Therefore, I have been directly involved in 154 liver transplant operations. In addition, Figure 2 illustrates how the previous record number of transplants per year was matched or surpassed in 2013, 2014, and 2016 (36, 31, and 42, respectively). The 2016 calendar year established a new record for the number of liver transplants performed in Arkansas.

2 Liver transplants performed at UAMS per calendar year (by surgeon) 50 Number of patients * ** Calendar Year Other surgeon Figure 2. Liver transplants performed at UAMS per calendar year (by surgeon). * Dr. was hired October 2012 ** Calendar year 2017 includes January 1 through September 22. In the absence of a liver transplant, patients with End Stage Liver Disease (cirrhosis) have an increased risk of death as compared to the general population. This risk proportionally increases according to their Model for End Stage Liver Disease (MELD) score. Therefore, the MELD score is used as a prognostic indicator that also correlates with the severity of the disease. If no transplant is performed, the expected 3 month mortality rate for cirrhotic patients with a MELD score 31 is at least 53%. [1] The percentage of patients with a MELD score 31 that underwent a liver transplant at UAMS has significantly increased in 2015 and 2016 (Figure 3). Similarly, Figure 4 shows how the UAMS median MELD at the time of transplant shifted from low 20 s to almost 30 during the quinquennium , as well as, how that increase compares regionally and nationally.

3 Percentage of liver transplant recipients at UAMS with a MELD 31 Percentage of patients * Calendar Year Figure 3. Percentage of patients that underwent a liver transplant at UAMS with a MELD score 31. *Dr. was hired October 1 st Figure 4. Median MELD score at the time of transplant. (Source: Scientific Registry of Transplant Recipients) The complexity and acuity of these patients is also demonstrated by the number of patients that have received two or more organs from the same deceased donor. These types of transplants are known as multivisceral transplants. The number of cirrhotic patients that are receiving simultaneous liver kidney (SLK) transplants at our institution is on the rise (Figure 5). Since 2013,

4 I have performed 11 of the 12 UAMS SLK transplants and have been directly involved in the immunosuppression and care of all these individuals. Simultaneous liver-kidney transplants performed in UAMS 2013 to to to Number SLK transplants Figure 5. Number of patients that have undergone a simultaneous liver kidney transplant at UAMS. * Dr. was hired October 1 st In summary, figures 1 through 5 demonstrate how during the 5 years that I have been an Assistant Professor in Transplant Surgery, the number, acuity, and complexity of liver transplants performed at UAMS has steadily and significantly increased. 2. United Network for Organ Sharing (UNOS) and Center for Medicare and Medicaid Services (CMS) evaluation Multiple federal organizations including UNOS and CMS evaluate transplant recipient outcomes on a routine basis. These reviews ensure transplant centers in the US meet current practice standards for patient care. Specifically, UNOS evaluates short and long term outcomes and releases a public report every 6 months. This report is available to patients, CMS, and insurance companies. The last UNOS evaluation was released on July 6, Such document assessed the outcomes of every single liver transplant performed between January 1, 2014 and June 30, Our outcomes met current standards in the U.S. No statistical difference was found between actual patient outcomes and the expected outcomes. As Figure 6A demonstrates, the risk of graft failure 1 year after a liver transplant was no different than the expected risk. Similarly, the

5 number of patients that survived more than 1 year after transplant was within the expected range (Figure 6B). Figure 6. Observed Hazard Ratio (HR) of graft failure 1-year after liver transplant at UAMS (Figure 6A). Observed HR of patient death 1-year after liver transplant at UAMS (Figure 6B). Both HR fell within expected values. The UAMS liver transplant program was recently evaluated by CMS (May 2017). Based on this onsite survey, Medicare determined that your transplant center is in substantial compliance with the conditions of participation This statement was copied verbatim et literatim. The full letter is enclosed as Clinical Appendix 1. In summary, the most important agencies that regulate solid organ transplant in the US proved that the increase in volume seen between 2012 and 2017 met current standards and did not compromise the expected outcomes. Patients undergoing a liver transplant at UAMS do not have a different outcome as compared to the US. 3. Hepato Pancreato Biliary (HPB) Clinic In addition to my Transplant Surgery Division responsibilities, my Department of Surgery appointment gives me the opportunity to have a one day clinic at the Cancer Institute. The objective of this clinic is the evaluation of patients with hepatic, biliary, and pancreatic diseases that might require surgical treatment. The median number of patients seen during the last 14

6 weeks was 9.5 per day. Consequently, my HPB practice is also very busy. I have done 109 pancreatic procedures since October 1, These surgeries include 77 pancreaticoduodenectomies (Whipple procedure), 13 distal pancreatectomies, 5 derivative procedures (Puestow or Frey procedures), 4 subtotal pancreatectomies, and 2 total pancreatectomies among other procedures. Although expertise in surgery is subjective, several manuscripts proved that surgeon volume influences the intra and postoperative outcomes of the patients. [2] In such manuscripts, an experienced pancreas surgeon is defined as a surgeon that has done at least 50 Whipple procedures. As an Assistant Professor at UAMS, I have performed 569 operations. Table 1 summarizes them. Clinical Appendix 2 contains a full description of all the surgeries I have done at UAMS. Table 1 Summary of procedures performed as an Assistant Professor in Transplant and HPB surgery from October 1, 2012 September 22, 2017.ype of surgery Type of Surgery Number Total transplant cases 192 Pancreas resections / procedures 109 Liver resections / cases 79 Biliary cases 65 Other 124 Total 569 In summary, my expertise is not limited to Transplant. While most tertiary centers in the US have different physicians assigned to Transplant and Hepatopancreatobiliary (HPB) surgery, I have been fortunate enough to develop a robust clinical experience in both fields. 4. Relative value unit based productivity (RVU) Figure 7 illustrates the total number of RVUs that I have generated each fiscal year while employed at UAMS. The yellow dotted line is the target that was expected each fiscal year based on my clinical time allocation. I have surpassed the anticipated RVU goal except in 2013, in which I only worked 9 months during the fiscal year.

7 Relative value unit (RVU) production per fiscal year RVU * Year Work RVU Expected according to MGMA Figure 7. Relative value unit (RVU) production per fiscal year at UAMS. * 2013 includes October 1 st 2012 through June 30 th 2013) In summary, I have met the anticipated RVU goal each fiscal year that I have worked for 12 months at UAMS. 5. Peer opinion about my clinical Service Table 2 presents comments made by other physicians attesting to the quality of my clinical care. Table 2. Opinions expressed by other physicians about my clinical care. Author Description Dr. Roxane Townsend Chief Executive Officer UAMS On November, 2015, I presented UAMS transplant outcomes to the Solid Organ Transplant Executive Committee. Dr. Roxane Townsend, chief executive officer of UAMS was very satisfied with our outcomes. (Clinical Appendix 3) Dr. Richard Turnage Executive Associate Dean for Clinical Services COM Dr. Kent Westbrook Distinguished Professor of Surgery Chair in Surgical Oncology Dr. William Fiser ARORA Medical Director written in January 2016 by Dr. Richard Turnage expressing his satisfaction with the liver program numbers in the Calendar year (Clinical Appendix 4) Letter of Recommendation for promotion (Clinical Appendix 5) Letter of Recommendation for promotion (Clinical Appendix 6)

8 6. Patient satisfaction Table 3 summarizes several comments and evaluations that patients have made about my daily clinical work at UAMS. Table 3. Summary of evaluations made by patients about my clinical work Appendix Circle of Excellence Dean s List October December 2013 (Clinical Appendix 7) Description Quarterly honor roll COM faculty physicians who scored at or above the 90 th percentile on patient satisfaction at UAMS Circle of Excellence Dean s List January March 2014 (Clinical Appendix 8) Summary evaluation of patients available UAMS webpage (Clinical Appendix 9) Congratulations UAMS Physician March 2016 (Clinical Appendix 10) Congratulations UAMS Physician July 2016 (Clinical Appendix 11) Congratulations UAMS Physician October 2016 (Clinical Appendix 12) Congratulations UAMS Physicians January 2017 (Clinical Appendix 13) Congratulations UAMS Physicians April 2017 (Clinical Appendix 14) Thank you note Patient 1 (Clinical Appendix 15) Thank you note Patient 2 (Clinical Appendix 16) Quarterly honor roll COM faculty physicians who scored at or above the 90 th percentile on patient satisfaction at UAMS The UAMS webpage has the summary of several patients that have been evaluated by me. My patient ranking is 4.9 out of 5. This is available to referrals and patients. from UAMS Faculty center sent to physicians who have been recognized by our patients for providing excellent care and enhancing their UAMS patient experience. Sent to physicians that achieved a star rating of 4.7 or higher out of 5 stars. from UAMS Faculty center sent to physicians who have been recognized by our patients for providing excellent care and enhancing their UAMS patient experience. Sent to physicians that achieved a star rating of 4.7 or higher out of 5 stars. sent from Dr. Jeannette Shorey to physicians who have been recognized by our patients for providing excellent care and enhancing their UAMS patient experience. Sent to physicians that achieved a star rating of 4.7 or higher out of 5 stars. sent from Dr. Jeannette Shorey to physicians who have been recognized by our patients for providing excellent care and enhancing their UAMS patient experience. Sent to physicians that achieved a star rating of 4.7 or higher out of 5 starts. sent from UAMS Faculty Center to physicians who have recognized by our patients for providing excellent care and enhancing their UAMS patient experience. Sent to physicians that achieved a star rating of 4.7 or higher out of 5 stars. Gratitude expressed by the family of one of my Surgical Oncology patients. This message was sent after her death which was secondary to recurrence of her disease several months after surgery. Gratitude expressed by the relative of a patient that received a successful transplant.

9 Thank you note Patient 3 (Clinical Appendix 17) Thank you note Patient 4 (Clinical Appendix 18) Thank you note Patient 5 (Clinical Appendix 19) Patient evaluation 1 (Clinical Appendix 20) Patient evaluation 2 (Clinical Appendix 21) Patient evaluation 3 (Clinical Appendix 22) Patient evaluation 4 (Clinical Appendix 23) Donation to UAMS by a successful liver transplant recipient. Gratitude card after receiving a successful transplant. sent by relative of a patient that underwent a Whipple procedure. This was sent to Dr. Hutchins and me. Monthly StarCard evaluation May Rated 5 out 5, ranked 1 st out of 218 eligible providers at UAMS. One of the comments states I am receiving excellent care from my physician. He absolutely understands what is going on with my condition and the symptoms. It took a year to find someone that can help me... Monthly StarCard evaluation March Rated 5 out 5, ranked 1 st out of 211 eligible providers at UAMS. Patient comment states I had a liver transplant and Dr. was great. He was so caring, patient and encouraging A fantastic Dr Monthly StarCard evaluation February Rated 5 out 5, ranked 1 out of 225 eligible providers at UAMS. Patient comment Him and the whole staff are very sweet and kind Monthly StarCard evaluation August Rated 4.82 out of 5 stars, ranked 94 th of 211 providers at UAMS. Patient comment states Dr. was the best surgeon when it came to doing my procedure. One amazing man that the cancer institution could have 7. Media coverage of my work My work as a surgeon has been covered several times by media, the two most significant are the coverage of a liver transplant patient in December This was broadcasted by Univision last year (Appendix ). In addition, the living donor kidney transplant performed by Dr. Gerardo Tamayo and I was covered by ABC. This was broadcasted in April 2016 (Appendix 25

10 8. Bibliography [1] R. Wiesner, E. Edwards, R. Freeman, A. Harper, R. Kim, P. Kamath, W. Kremers, J. Lake, T. Howard, R. M. Merion, R. A. Wolfe and R. Krom, "Model for End-Stage Liver Disease (MELD) and Allocation of Donor Livers," Gastroenterology, pp , [2] M. Schmidt, O. Turrini, P. Parikh, M. G. House, N. J. Zyromski, A. Nakeeb, T. J. Howard, H. A. Pitt and K. D. Lillemoe, "Effect of Hospital Volume, Surgeon Experience, and Surgeon Volume on Patients Outcomes After Pancreaticoduodenectomy A Single - Institution Experience," Archives of Surgery, vol. 145, no. 7, pp , 2010.