General Surgery

CHICAGO – Patients who underwent modified laparoscopic Sugarbaker parastomal hernia repair were a third less likely to experience recurrence as those repaired with other surgical techniques in a multicenter, retrospective study in 62 patients.

The recurrence rate was 16.6% for the modified Sugarbaker technique, compared with 61% for keyhole repair, 69.2% for ostomy relocation, and 33.3% for open repair (P value < .001). Median follow-up was 16.6 months, 19.6 months, 16.4 months, and 27.2 months (P = .748).

In an adjusted Cox proportional hazards regression model, the Sugarbaker technique (hazard ratio, 0.28; P = .021) and body mass index (HR, 1.09; P = .013) were the only significant predictors of time to hernia recurrence.

Using the Kaplan-Meier method, 80% of Sugarbaker patients would be recurrence free at 2 years vs. about 60% of those in the other groups (log-rank P = .021), Mr. Francis DeAsis, a research assistant from NorthShore University Health in Evanston, Ill., reported at the annual meeting of the Central Surgical Association.

The findings are in keeping with prior Sugarbaker studies involving 177 repairs between 2005 and 2013, reporting recurrence rates between 4% and 20% and morbidity of 12%-43%, he said.

Morbidity was 40% among the 25 Sugarbaker repairs in the current analysis, significantly lower than that in the Keyhole, relocation, and open repair groups (40% vs. 83.3%, 61.5%, 83.3%; P = .005).

“Based on our results and others, we’d like to suggest that the Sugarbaker approach should be the primary option for treating parastomal hernia,” Mr. DeAsis said.

The study provides “further proof that no other technique available results in a durable repair compared to the Sugarbaker technique for these challenging hernias,” senior study author Dr. Michael Ujiki, director of minimally invasive surgery at NorthShore, said in an interview.

The Sugarbaker technique typically involves a laparoscopic mesh sublay over the fascial defect and lateralization of the stoma limb. Modifications at NorthShore included use of polytetrafluoroethylene mesh with a 5-cm overlap of the defect and, if possible, primary closure of the defect. A catheter is occasionally used to identify the correct ostomy limb, but most importantly, a laparoscopic approach is utilized in order to decrease wound infections and quicken the return to daily activities, Dr. Ujiki said. “We also avoid cautery and diligently look for other incidental hernias at the prevision incisions.”

Ileus (> 3 days) was the most common complication in all groups: Sugarbaker (4/25), keyhole (9/18), relocation (3/13), and open (1/6). Only one death occurred; in the open group.

Discussant Dr. Matthew Goldblatt, with the Medical College of Wisconsin in Milwaukee, questioned how many patients also had ventral hernias and whether this was a complicating factor in ileus or length of stay and whether the fascia was closed primarily during keyhole repair or the mesh simply placed as a bridge, as this can impact failure rates.

Dr. Ujiki responded that some patients had concomitant ventral hernias and that they simply used a larger piece of mesh to cover both hernias. Primary closure was not part of the keyhole repair early in the 10-year series, spanning 2004 to 2014, but ultimately was performed in about half of patients in the keyhole group.

“I don’t think that there’s going to be a difference between the two in terms of recurrence, but I can’t say for sure,” he added.

At this point, the group does not use prophylactic mesh placement at the time the ostomy is created, to avoid infections.

Finally, the audience asked whether the investigators are willing to accept a 16% recurrence rate, a fourfold increase over the best reported result with a modified Sugarbaker technique.

“With these hernia repairs, to me a 16% recurrence rate is outstanding and I think it will only get better,” Dr. Ujiki said.

The series includes every patient on which they’ve performed a Sugarbaker and thus, represents their learning curve, which may not be the case with other series, he noted.

Dr. Ujiki left the audience with two bits of advice to hasten the learning curve: leave at least 5 cm of overlap because the mesh will shrink down and keep the stitches close to the mesh without cutting off the bowel.

[email protected]

CHICAGO – Patients who underwent modified laparoscopic Sugarbaker parastomal hernia repair were a third less likely to experience recurrence as those repaired with other surgical techniques in a multicenter, retrospective study in 62 patients.

The recurrence rate was 16.6% for the modified Sugarbaker technique, compared with 61% for keyhole repair, 69.2% for ostomy relocation, and 33.3% for open repair (P value < .001). Median follow-up was 16.6 months, 19.6 months, 16.4 months, and 27.2 months (P = .748).

In an adjusted Cox proportional hazards regression model, the Sugarbaker technique (hazard ratio, 0.28; P = .021) and body mass index (HR, 1.09; P = .013) were the only significant predictors of time to hernia recurrence.

Using the Kaplan-Meier method, 80% of Sugarbaker patients would be recurrence free at 2 years vs. about 60% of those in the other groups (log-rank P = .021), Mr. Francis DeAsis, a research assistant from NorthShore University Health in Evanston, Ill., reported at the annual meeting of the Central Surgical Association.

The findings are in keeping with prior Sugarbaker studies involving 177 repairs between 2005 and 2013, reporting recurrence rates between 4% and 20% and morbidity of 12%-43%, he said.

Morbidity was 40% among the 25 Sugarbaker repairs in the current analysis, significantly lower than that in the Keyhole, relocation, and open repair groups (40% vs. 83.3%, 61.5%, 83.3%; P = .005).

“Based on our results and others, we’d like to suggest that the Sugarbaker approach should be the primary option for treating parastomal hernia,” Mr. DeAsis said.

The study provides “further proof that no other technique available results in a durable repair compared to the Sugarbaker technique for these challenging hernias,” senior study author Dr. Michael Ujiki, director of minimally invasive surgery at NorthShore, said in an interview.

The Sugarbaker technique typically involves a laparoscopic mesh sublay over the fascial defect and lateralization of the stoma limb. Modifications at NorthShore included use of polytetrafluoroethylene mesh with a 5-cm overlap of the defect and, if possible, primary closure of the defect. A catheter is occasionally used to identify the correct ostomy limb, but most importantly, a laparoscopic approach is utilized in order to decrease wound infections and quicken the return to daily activities, Dr. Ujiki said. “We also avoid cautery and diligently look for other incidental hernias at the prevision incisions.”

Ileus (> 3 days) was the most common complication in all groups: Sugarbaker (4/25), keyhole (9/18), relocation (3/13), and open (1/6). Only one death occurred; in the open group.

Discussant Dr. Matthew Goldblatt, with the Medical College of Wisconsin in Milwaukee, questioned how many patients also had ventral hernias and whether this was a complicating factor in ileus or length of stay and whether the fascia was closed primarily during keyhole repair or the mesh simply placed as a bridge, as this can impact failure rates.

Dr. Ujiki responded that some patients had concomitant ventral hernias and that they simply used a larger piece of mesh to cover both hernias. Primary closure was not part of the keyhole repair early in the 10-year series, spanning 2004 to 2014, but ultimately was performed in about half of patients in the keyhole group.

“I don’t think that there’s going to be a difference between the two in terms of recurrence, but I can’t say for sure,” he added.

At this point, the group does not use prophylactic mesh placement at the time the ostomy is created, to avoid infections.

Finally, the audience asked whether the investigators are willing to accept a 16% recurrence rate, a fourfold increase over the best reported result with a modified Sugarbaker technique.

“With these hernia repairs, to me a 16% recurrence rate is outstanding and I think it will only get better,” Dr. Ujiki said.

The series includes every patient on which they’ve performed a Sugarbaker and thus, represents their learning curve, which may not be the case with other series, he noted.

Dr. Ujiki left the audience with two bits of advice to hasten the learning curve: leave at least 5 cm of overlap because the mesh will shrink down and keep the stitches close to the mesh without cutting off the bowel.

[email protected]

CHICAGO – Patients who underwent modified laparoscopic Sugarbaker parastomal hernia repair were a third less likely to experience recurrence as those repaired with other surgical techniques in a multicenter, retrospective study in 62 patients.

The recurrence rate was 16.6% for the modified Sugarbaker technique, compared with 61% for keyhole repair, 69.2% for ostomy relocation, and 33.3% for open repair (P value < .001). Median follow-up was 16.6 months, 19.6 months, 16.4 months, and 27.2 months (P = .748).

In an adjusted Cox proportional hazards regression model, the Sugarbaker technique (hazard ratio, 0.28; P = .021) and body mass index (HR, 1.09; P = .013) were the only significant predictors of time to hernia recurrence.

Using the Kaplan-Meier method, 80% of Sugarbaker patients would be recurrence free at 2 years vs. about 60% of those in the other groups (log-rank P = .021), Mr. Francis DeAsis, a research assistant from NorthShore University Health in Evanston, Ill., reported at the annual meeting of the Central Surgical Association.

The findings are in keeping with prior Sugarbaker studies involving 177 repairs between 2005 and 2013, reporting recurrence rates between 4% and 20% and morbidity of 12%-43%, he said.

Morbidity was 40% among the 25 Sugarbaker repairs in the current analysis, significantly lower than that in the Keyhole, relocation, and open repair groups (40% vs. 83.3%, 61.5%, 83.3%; P = .005).

“Based on our results and others, we’d like to suggest that the Sugarbaker approach should be the primary option for treating parastomal hernia,” Mr. DeAsis said.

The study provides “further proof that no other technique available results in a durable repair compared to the Sugarbaker technique for these challenging hernias,” senior study author Dr. Michael Ujiki, director of minimally invasive surgery at NorthShore, said in an interview.

The Sugarbaker technique typically involves a laparoscopic mesh sublay over the fascial defect and lateralization of the stoma limb. Modifications at NorthShore included use of polytetrafluoroethylene mesh with a 5-cm overlap of the defect and, if possible, primary closure of the defect. A catheter is occasionally used to identify the correct ostomy limb, but most importantly, a laparoscopic approach is utilized in order to decrease wound infections and quicken the return to daily activities, Dr. Ujiki said. “We also avoid cautery and diligently look for other incidental hernias at the prevision incisions.”

Ileus (> 3 days) was the most common complication in all groups: Sugarbaker (4/25), keyhole (9/18), relocation (3/13), and open (1/6). Only one death occurred; in the open group.

Discussant Dr. Matthew Goldblatt, with the Medical College of Wisconsin in Milwaukee, questioned how many patients also had ventral hernias and whether this was a complicating factor in ileus or length of stay and whether the fascia was closed primarily during keyhole repair or the mesh simply placed as a bridge, as this can impact failure rates.

Dr. Ujiki responded that some patients had concomitant ventral hernias and that they simply used a larger piece of mesh to cover both hernias. Primary closure was not part of the keyhole repair early in the 10-year series, spanning 2004 to 2014, but ultimately was performed in about half of patients in the keyhole group.

“I don’t think that there’s going to be a difference between the two in terms of recurrence, but I can’t say for sure,” he added.

At this point, the group does not use prophylactic mesh placement at the time the ostomy is created, to avoid infections.

Finally, the audience asked whether the investigators are willing to accept a 16% recurrence rate, a fourfold increase over the best reported result with a modified Sugarbaker technique.

“With these hernia repairs, to me a 16% recurrence rate is outstanding and I think it will only get better,” Dr. Ujiki said.

The series includes every patient on which they’ve performed a Sugarbaker and thus, represents their learning curve, which may not be the case with other series, he noted.

Dr. Ujiki left the audience with two bits of advice to hasten the learning curve: leave at least 5 cm of overlap because the mesh will shrink down and keep the stitches close to the mesh without cutting off the bowel.

[email protected]

During 5 years of follow-up, cancer arose in only 0.3% of thyroid nodules that were cytologically and sonographically benign at baseline, according to a large prospective study published online March 3 in JAMA.

Furthermore, only two of the five nodules that became cancerous had grown beforehand, reported Dr. Cosimo Durante of the Sapienza University of Rome and his associates. “These data suggest that the American Thyroid Association’s recommendation for indication for repeat cytology should be revised. Clinical and sonographic findings should probably play larger roles in the decision-making process,” the researchers said (JAMA 2015;313:926-35).

©Sebastian Kaulitzki/Fotolia.com

Advances in diagnostic imaging have increased the detection of thyroid nodules, the great majority of which are found to be benign. For such nodules, the ATA recommends repeating thyroid ultrasonography at 6-18 months and then every 3-5 years thereafter, as long as nodules do not significantly grow (defined as at least a 20% increase in two nodule diameters, with a minimum increase of at least 2 mm [Thyroid 2009;19:1167-214]). But little is known about rate, extent, or predictors of nodule growth, the researchers noted. Therefore, they performed annual thyroid ultrasound examinations on 992 patients who had one to four asymptomatic subcentimeter thyroid modules that were cytologically or sonographically benign at baseline.

After 5 years of follow-up, just 15.4% of patients had experienced significant nodule growth according to the ATA definition, the researchers reported. Average growth was 4.9 mm, and 9.3% of patients developed new nodules, of which one was found to be cancerous. Growth was least likely when a patient’s largest nodule measured 7.5 mm or less and was significantly more likely when patients had multiple nodules instead of one; had baseline nodule volume greater than 0.2 mL; were up to 45 years old, compared with at least 60 years of age; and were male, the investigators said.

Among older patients, having a body mass index of 28.6 kg/m² more than doubled the odds of nodule growth, in keeping with recent reports linking obesity and insulin resistance with nodular thyroid disease, they added.

The findings suggest that repeat thyroid ultrasonography could be safely extended to 12 months for initial follow-up and to every 5 years thereafter for most patients, as long as nodule size remained stable, Dr. Durante and his associates said. “This approach should be suitable for about 85% of patients, whose risk of disease progression is low. Closer surveillance may be appropriate for nodules occurring in younger patients or older overweight individuals with multiple nodules, large nodules (greater than 7.5 mm), or both,” they added.

The Umberto Di Mario Foundation, Banca d’Italia, and the Italian Thyroid Cancer Observatory Foundation funded the study. The authors reported having no conflicts of interest.

During 5 years of follow-up, cancer arose in only 0.3% of thyroid nodules that were cytologically and sonographically benign at baseline, according to a large prospective study published online March 3 in JAMA.

Furthermore, only two of the five nodules that became cancerous had grown beforehand, reported Dr. Cosimo Durante of the Sapienza University of Rome and his associates. “These data suggest that the American Thyroid Association’s recommendation for indication for repeat cytology should be revised. Clinical and sonographic findings should probably play larger roles in the decision-making process,” the researchers said (JAMA 2015;313:926-35).

©Sebastian Kaulitzki/Fotolia.com

Advances in diagnostic imaging have increased the detection of thyroid nodules, the great majority of which are found to be benign. For such nodules, the ATA recommends repeating thyroid ultrasonography at 6-18 months and then every 3-5 years thereafter, as long as nodules do not significantly grow (defined as at least a 20% increase in two nodule diameters, with a minimum increase of at least 2 mm [Thyroid 2009;19:1167-214]). But little is known about rate, extent, or predictors of nodule growth, the researchers noted. Therefore, they performed annual thyroid ultrasound examinations on 992 patients who had one to four asymptomatic subcentimeter thyroid modules that were cytologically or sonographically benign at baseline.

After 5 years of follow-up, just 15.4% of patients had experienced significant nodule growth according to the ATA definition, the researchers reported. Average growth was 4.9 mm, and 9.3% of patients developed new nodules, of which one was found to be cancerous. Growth was least likely when a patient’s largest nodule measured 7.5 mm or less and was significantly more likely when patients had multiple nodules instead of one; had baseline nodule volume greater than 0.2 mL; were up to 45 years old, compared with at least 60 years of age; and were male, the investigators said.

Among older patients, having a body mass index of 28.6 kg/m² more than doubled the odds of nodule growth, in keeping with recent reports linking obesity and insulin resistance with nodular thyroid disease, they added.

The findings suggest that repeat thyroid ultrasonography could be safely extended to 12 months for initial follow-up and to every 5 years thereafter for most patients, as long as nodule size remained stable, Dr. Durante and his associates said. “This approach should be suitable for about 85% of patients, whose risk of disease progression is low. Closer surveillance may be appropriate for nodules occurring in younger patients or older overweight individuals with multiple nodules, large nodules (greater than 7.5 mm), or both,” they added.

The Umberto Di Mario Foundation, Banca d’Italia, and the Italian Thyroid Cancer Observatory Foundation funded the study. The authors reported having no conflicts of interest.

During 5 years of follow-up, cancer arose in only 0.3% of thyroid nodules that were cytologically and sonographically benign at baseline, according to a large prospective study published online March 3 in JAMA.

Furthermore, only two of the five nodules that became cancerous had grown beforehand, reported Dr. Cosimo Durante of the Sapienza University of Rome and his associates. “These data suggest that the American Thyroid Association’s recommendation for indication for repeat cytology should be revised. Clinical and sonographic findings should probably play larger roles in the decision-making process,” the researchers said (JAMA 2015;313:926-35).

©Sebastian Kaulitzki/Fotolia.com

Advances in diagnostic imaging have increased the detection of thyroid nodules, the great majority of which are found to be benign. For such nodules, the ATA recommends repeating thyroid ultrasonography at 6-18 months and then every 3-5 years thereafter, as long as nodules do not significantly grow (defined as at least a 20% increase in two nodule diameters, with a minimum increase of at least 2 mm [Thyroid 2009;19:1167-214]). But little is known about rate, extent, or predictors of nodule growth, the researchers noted. Therefore, they performed annual thyroid ultrasound examinations on 992 patients who had one to four asymptomatic subcentimeter thyroid modules that were cytologically or sonographically benign at baseline.

After 5 years of follow-up, just 15.4% of patients had experienced significant nodule growth according to the ATA definition, the researchers reported. Average growth was 4.9 mm, and 9.3% of patients developed new nodules, of which one was found to be cancerous. Growth was least likely when a patient’s largest nodule measured 7.5 mm or less and was significantly more likely when patients had multiple nodules instead of one; had baseline nodule volume greater than 0.2 mL; were up to 45 years old, compared with at least 60 years of age; and were male, the investigators said.

Among older patients, having a body mass index of 28.6 kg/m² more than doubled the odds of nodule growth, in keeping with recent reports linking obesity and insulin resistance with nodular thyroid disease, they added.

The findings suggest that repeat thyroid ultrasonography could be safely extended to 12 months for initial follow-up and to every 5 years thereafter for most patients, as long as nodule size remained stable, Dr. Durante and his associates said. “This approach should be suitable for about 85% of patients, whose risk of disease progression is low. Closer surveillance may be appropriate for nodules occurring in younger patients or older overweight individuals with multiple nodules, large nodules (greater than 7.5 mm), or both,” they added.

The Umberto Di Mario Foundation, Banca d’Italia, and the Italian Thyroid Cancer Observatory Foundation funded the study. The authors reported having no conflicts of interest.

Hospitals should carefully monitor equipment for hepatitis C virus contamination and the possibility of health care transmission, according to a Feb. 27 report from the Centers for Disease Control and Prevention.

Jezperklauzen/ThinkStock.com

The CDC report focuses on two specific cases of health care–transmitted HCV. In 2010, a patient without HCV in a New Jersey hospital was treated by an anesthesiologist who had immediately beforehand treated someone with HCV. Despite the single commonality between the two patients, patient A contracted HCV.

In 2011, a patient in Wisconsin with a history of diabetes and chronic renal disease was diagnosed with HCV-4, a subtype of the disease that is rare in that part of the world. The infection occurred in 2009, when this patient had a kidney transplant at the same time as a patient with HCV-4 also was having a kidney transplant. The two transplants shared a surgeon, but the source of infection was likely a perfusion machine where an HCV-positive kidney and an HCV-negative kidney were both stored without cleaning the machine.

“These cases illustrate the importance of partnerships and communication between public health and health care professionals to ensure that basic infection control and injection safety practices are optimized wherever health care is delivered,” the CDC investigators concluded.

Read the full report in the MMWR (2015;64:165-70).

Hospitals should carefully monitor equipment for hepatitis C virus contamination and the possibility of health care transmission, according to a Feb. 27 report from the Centers for Disease Control and Prevention.

Jezperklauzen/ThinkStock.com

The CDC report focuses on two specific cases of health care–transmitted HCV. In 2010, a patient without HCV in a New Jersey hospital was treated by an anesthesiologist who had immediately beforehand treated someone with HCV. Despite the single commonality between the two patients, patient A contracted HCV.

In 2011, a patient in Wisconsin with a history of diabetes and chronic renal disease was diagnosed with HCV-4, a subtype of the disease that is rare in that part of the world. The infection occurred in 2009, when this patient had a kidney transplant at the same time as a patient with HCV-4 also was having a kidney transplant. The two transplants shared a surgeon, but the source of infection was likely a perfusion machine where an HCV-positive kidney and an HCV-negative kidney were both stored without cleaning the machine.

“These cases illustrate the importance of partnerships and communication between public health and health care professionals to ensure that basic infection control and injection safety practices are optimized wherever health care is delivered,” the CDC investigators concluded.

Read the full report in the MMWR (2015;64:165-70).

Hospitals should carefully monitor equipment for hepatitis C virus contamination and the possibility of health care transmission, according to a Feb. 27 report from the Centers for Disease Control and Prevention.

Jezperklauzen/ThinkStock.com

The CDC report focuses on two specific cases of health care–transmitted HCV. In 2010, a patient without HCV in a New Jersey hospital was treated by an anesthesiologist who had immediately beforehand treated someone with HCV. Despite the single commonality between the two patients, patient A contracted HCV.

In 2011, a patient in Wisconsin with a history of diabetes and chronic renal disease was diagnosed with HCV-4, a subtype of the disease that is rare in that part of the world. The infection occurred in 2009, when this patient had a kidney transplant at the same time as a patient with HCV-4 also was having a kidney transplant. The two transplants shared a surgeon, but the source of infection was likely a perfusion machine where an HCV-positive kidney and an HCV-negative kidney were both stored without cleaning the machine.

“These cases illustrate the importance of partnerships and communication between public health and health care professionals to ensure that basic infection control and injection safety practices are optimized wherever health care is delivered,” the CDC investigators concluded.

Read the full report in the MMWR (2015;64:165-70).

The Food and Drug Administration has approved the antibacterial drug ceftazidime-avibactam (Avycaz) on Feb. 25 for complicated intra-abdominal infections in combination with metronidazole, and for complicated urinary tract infections including pyelonephritis in adults.

“It is important that the use of Avycaz be reserved for situations where there are limited or no alternative antibacterial drugs for treating a patient’s infection,” Dr. Edward Cox, director of the FDA’s Office of Antimicrobial Products in the Center for Drug Evaluation and Research, said in a statement.

Avycaz is a fixed-combination drug containing ceftazidime, a previously approved cephalosporin with in vitro activity against certain gram-negative and gram-positive bacteria, and avibactam, a beta-lactamase inhibitor.

The addition of avibactam to ceftazidime protects ceftazidime from breakdown by extended spectrum beta-lactamases, Klebsiella pneumoniae carbapenemase (KPC), and AmpC-producing pathogens, according to David Nicholson, Ph.D., executive vice president of branded research and development at Actavis, which is jointly developing the drug with AstraZeneca.

“The FDA approval of Avycaz is an important step forward in enhancing our ability to respond to serious pathogens caused by difficult-to-treat gram-negative pathogens,” he said in a statement.

The recent rise in the incidence of multidrug-resistant gram-negative pathogens poses a significant threat to patients and places a tremendous strain on the U.S. health care system, Dr. Jose Vazquez, chief of infectious disease at Georgia Regents University in Augusta, Ga., commented in the same statement.

“The increasing prevalence of KPC-producing Enterobacteriaceae in particular, has become a major therapeutic challenge for physicians managing these infections. Unfortunately, there are currently a limited number of safe and effective antimicrobials to treat these serious infections,” he said.

Avycaz was granted priority review and named a Qualified Infectious Disease Product (QIDP), a designation given to antibacterial products to treat serious or life-threatening infections.

Its efficacy was supported in part by findings of the efficacy and safety of ceftazidime for the treatment of complicated intra-abdominal infections (cIAI) and complicated urinary tract infections (cUTI). The contribution of avibactam to Avycaz was based on data from in vitro studies and animal models of infection. Avycaz was also studied in two phase II trials, one each in cIAI and cUTI.

The most common side effects are vomiting, nausea, constipation, and anxiety. The FDA advises health care professionals to inform patients of these risks and that decreased efficacy, seizures, and other neurologic events were seen in patients with renal impairment. Serious skin reactions and anaphylaxis may occur in patients with penicillin allergies.

The recommended dosage for patients with normal renal function is 2.5 g administered every 8 hours by intravenous infusion over 2 hours in adults aged 18 years and older. For patients with changing or impaired renal function (creatinine clearance < 50 mL/min), CrCL should be monitored at least daily and the dosage adjusted accordingly.

In a phase III trial of intra-abdominal infections, clinical cure rates were lower in the subgroup of patients with CrCL of 30-50 mL/min, compared with those with CrCL greater than 50 mL/min, according to the company. The reduction in cure rates was more marked in patients treated with Avycaz plus metronidazole vs. meropenem-treated patients.

Avycaz will be available in the second quarter of 2015, according to the company. Phase III studies evaluating Avycaz for the treatment of cIAI and cUTI are ongoing and targeted for completion in late 2015.

[email protected]

The Food and Drug Administration has approved the antibacterial drug ceftazidime-avibactam (Avycaz) on Feb. 25 for complicated intra-abdominal infections in combination with metronidazole, and for complicated urinary tract infections including pyelonephritis in adults.

“It is important that the use of Avycaz be reserved for situations where there are limited or no alternative antibacterial drugs for treating a patient’s infection,” Dr. Edward Cox, director of the FDA’s Office of Antimicrobial Products in the Center for Drug Evaluation and Research, said in a statement.

Avycaz is a fixed-combination drug containing ceftazidime, a previously approved cephalosporin with in vitro activity against certain gram-negative and gram-positive bacteria, and avibactam, a beta-lactamase inhibitor.

The addition of avibactam to ceftazidime protects ceftazidime from breakdown by extended spectrum beta-lactamases, Klebsiella pneumoniae carbapenemase (KPC), and AmpC-producing pathogens, according to David Nicholson, Ph.D., executive vice president of branded research and development at Actavis, which is jointly developing the drug with AstraZeneca.

“The FDA approval of Avycaz is an important step forward in enhancing our ability to respond to serious pathogens caused by difficult-to-treat gram-negative pathogens,” he said in a statement.

The recent rise in the incidence of multidrug-resistant gram-negative pathogens poses a significant threat to patients and places a tremendous strain on the U.S. health care system, Dr. Jose Vazquez, chief of infectious disease at Georgia Regents University in Augusta, Ga., commented in the same statement.

“The increasing prevalence of KPC-producing Enterobacteriaceae in particular, has become a major therapeutic challenge for physicians managing these infections. Unfortunately, there are currently a limited number of safe and effective antimicrobials to treat these serious infections,” he said.

Avycaz was granted priority review and named a Qualified Infectious Disease Product (QIDP), a designation given to antibacterial products to treat serious or life-threatening infections.

Its efficacy was supported in part by findings of the efficacy and safety of ceftazidime for the treatment of complicated intra-abdominal infections (cIAI) and complicated urinary tract infections (cUTI). The contribution of avibactam to Avycaz was based on data from in vitro studies and animal models of infection. Avycaz was also studied in two phase II trials, one each in cIAI and cUTI.

The most common side effects are vomiting, nausea, constipation, and anxiety. The FDA advises health care professionals to inform patients of these risks and that decreased efficacy, seizures, and other neurologic events were seen in patients with renal impairment. Serious skin reactions and anaphylaxis may occur in patients with penicillin allergies.

The recommended dosage for patients with normal renal function is 2.5 g administered every 8 hours by intravenous infusion over 2 hours in adults aged 18 years and older. For patients with changing or impaired renal function (creatinine clearance < 50 mL/min), CrCL should be monitored at least daily and the dosage adjusted accordingly.

In a phase III trial of intra-abdominal infections, clinical cure rates were lower in the subgroup of patients with CrCL of 30-50 mL/min, compared with those with CrCL greater than 50 mL/min, according to the company. The reduction in cure rates was more marked in patients treated with Avycaz plus metronidazole vs. meropenem-treated patients.

Avycaz will be available in the second quarter of 2015, according to the company. Phase III studies evaluating Avycaz for the treatment of cIAI and cUTI are ongoing and targeted for completion in late 2015.

[email protected]

The Food and Drug Administration has approved the antibacterial drug ceftazidime-avibactam (Avycaz) on Feb. 25 for complicated intra-abdominal infections in combination with metronidazole, and for complicated urinary tract infections including pyelonephritis in adults.

“It is important that the use of Avycaz be reserved for situations where there are limited or no alternative antibacterial drugs for treating a patient’s infection,” Dr. Edward Cox, director of the FDA’s Office of Antimicrobial Products in the Center for Drug Evaluation and Research, said in a statement.

Avycaz is a fixed-combination drug containing ceftazidime, a previously approved cephalosporin with in vitro activity against certain gram-negative and gram-positive bacteria, and avibactam, a beta-lactamase inhibitor.

The addition of avibactam to ceftazidime protects ceftazidime from breakdown by extended spectrum beta-lactamases, Klebsiella pneumoniae carbapenemase (KPC), and AmpC-producing pathogens, according to David Nicholson, Ph.D., executive vice president of branded research and development at Actavis, which is jointly developing the drug with AstraZeneca.

“The FDA approval of Avycaz is an important step forward in enhancing our ability to respond to serious pathogens caused by difficult-to-treat gram-negative pathogens,” he said in a statement.

The recent rise in the incidence of multidrug-resistant gram-negative pathogens poses a significant threat to patients and places a tremendous strain on the U.S. health care system, Dr. Jose Vazquez, chief of infectious disease at Georgia Regents University in Augusta, Ga., commented in the same statement.

“The increasing prevalence of KPC-producing Enterobacteriaceae in particular, has become a major therapeutic challenge for physicians managing these infections. Unfortunately, there are currently a limited number of safe and effective antimicrobials to treat these serious infections,” he said.

Avycaz was granted priority review and named a Qualified Infectious Disease Product (QIDP), a designation given to antibacterial products to treat serious or life-threatening infections.

Its efficacy was supported in part by findings of the efficacy and safety of ceftazidime for the treatment of complicated intra-abdominal infections (cIAI) and complicated urinary tract infections (cUTI). The contribution of avibactam to Avycaz was based on data from in vitro studies and animal models of infection. Avycaz was also studied in two phase II trials, one each in cIAI and cUTI.

The most common side effects are vomiting, nausea, constipation, and anxiety. The FDA advises health care professionals to inform patients of these risks and that decreased efficacy, seizures, and other neurologic events were seen in patients with renal impairment. Serious skin reactions and anaphylaxis may occur in patients with penicillin allergies.

The recommended dosage for patients with normal renal function is 2.5 g administered every 8 hours by intravenous infusion over 2 hours in adults aged 18 years and older. For patients with changing or impaired renal function (creatinine clearance < 50 mL/min), CrCL should be monitored at least daily and the dosage adjusted accordingly.

In a phase III trial of intra-abdominal infections, clinical cure rates were lower in the subgroup of patients with CrCL of 30-50 mL/min, compared with those with CrCL greater than 50 mL/min, according to the company. The reduction in cure rates was more marked in patients treated with Avycaz plus metronidazole vs. meropenem-treated patients.

Avycaz will be available in the second quarter of 2015, according to the company. Phase III studies evaluating Avycaz for the treatment of cIAI and cUTI are ongoing and targeted for completion in late 2015.

[email protected]

The American College of Surgeons’ NSQIP surgical risk calculator was effective for evaluating patients at average surgical risk undergoing laparoscopic colectomy at a single institution, but did not accurately predict outcomes in a small percentage of patients when one or more serious complications occurred, a new study has found.

Specifically, the actual length of stay (LOS) was significantly longer than predicted by the calculator (4.22 days vs. 4.11 days; P = .0001), with four outliers with multiple complications having an LOS more than 3 standard deviations from the mean. After removing the outliers, the actual LOS was significantly shorter than that predicted (3.31 days vs. 4.05 days; P = .002). Occurrence of any complication was also significantly lower than predicted (17.3% vs. 19.4%; P = .05).

“Addition of surgeon- and patient-specific data via the American College of Surgeons case-logging system could better adjust for these areas,” study author Dr. Kyle Cologne and his colleagues recommend.

Read the full article at J. Am. Coll. Surg. 2015;220:281-6.

The American College of Surgeons’ NSQIP surgical risk calculator was effective for evaluating patients at average surgical risk undergoing laparoscopic colectomy at a single institution, but did not accurately predict outcomes in a small percentage of patients when one or more serious complications occurred, a new study has found.

Specifically, the actual length of stay (LOS) was significantly longer than predicted by the calculator (4.22 days vs. 4.11 days; P = .0001), with four outliers with multiple complications having an LOS more than 3 standard deviations from the mean. After removing the outliers, the actual LOS was significantly shorter than that predicted (3.31 days vs. 4.05 days; P = .002). Occurrence of any complication was also significantly lower than predicted (17.3% vs. 19.4%; P = .05).

“Addition of surgeon- and patient-specific data via the American College of Surgeons case-logging system could better adjust for these areas,” study author Dr. Kyle Cologne and his colleagues recommend.

Read the full article at J. Am. Coll. Surg. 2015;220:281-6.

The American College of Surgeons’ NSQIP surgical risk calculator was effective for evaluating patients at average surgical risk undergoing laparoscopic colectomy at a single institution, but did not accurately predict outcomes in a small percentage of patients when one or more serious complications occurred, a new study has found.

Specifically, the actual length of stay (LOS) was significantly longer than predicted by the calculator (4.22 days vs. 4.11 days; P = .0001), with four outliers with multiple complications having an LOS more than 3 standard deviations from the mean. After removing the outliers, the actual LOS was significantly shorter than that predicted (3.31 days vs. 4.05 days; P = .002). Occurrence of any complication was also significantly lower than predicted (17.3% vs. 19.4%; P = .05).

“Addition of surgeon- and patient-specific data via the American College of Surgeons case-logging system could better adjust for these areas,” study author Dr. Kyle Cologne and his colleagues recommend.

Read the full article at J. Am. Coll. Surg. 2015;220:281-6.

The emergence of African Americans as acclaimed leaders in the field of surgery over the last century is a triumph of personal struggle, brilliant minds, and sheer determination.

Disparities in educational and professional opportunities related to racial/ethnic identity persist, but LaSalle D. Leffall, Jr., MD, FACS, fondly recalls a favorite quote from pioneering African American surgeon Charles Drew: “Excellence of performance will transcend artificial barriers created by man.” The goals and abundant talent shared by the membership of the American College of Surgeons (ACS) and Society of Black Academic Surgeons (SBAS) are testimony to the ongoing dissolution of these artificial barriers.

Parallels are evident between the history of organized surgery in America and African American efforts to achieve health care equity. While the spectrum of surgical procedures mushroomed in the late 19th century, surgical training was characterized by inconsistency and instability. The ACS was established in 1913 with the mission of “improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.”

Significant disparities in medical and surgical care existed for African Americans in this era. During the decades following the Civil War, black citizens were routinely denied care or they received substandard care delivered in segregated hospitals. Medical education opportunities for African Americans were nearly nonexistent.

Nonetheless, African Americans mobilized their talent and energy to address the same threats to quality medical care as those faced by the ACS founders, but having to overcome even greater obstacles in the form of systematic racism and exclusion.

Courtesy NLM

Chicago’s Provident Hospital and Training School (the first African American-owned and -operated hospital) was established in 1891. Howard University College of Medicine in Washington, and Meharry Medical College in Nashville, Tenn., founded in 1868 and 1876, respectively, remained the predominent options for prospective African American medical students for several decades. Because African American medical professionals were denied membership in the American Medical Association, they formed their own professional society, the National Medical Association, in 1895.

In contrast, Dr. Daniel Hale Williams, founder of the Provident Hospital and founding member of the National Medical Association, was a charter member of ACS in 1913. However, more than 20 years passed before another African American surgeon (Louis Tompkins Wright, MD, FACS) became a Fellow of the College.

Courtesy National Library of Medicine

The number of African American surgeons in the College grew steadily after World War II, and in the past 3 years, approximately 6% of ACS inductees have been African Americans.

The value of race/ethnic diversity in optimizing quality of care is summarized by Dr. Otis Brawley, Chief Medical Officer for the American Cancer Society and past Director of the Office for Special Populations Research at the National Institutes of Health: “The practice of surgery is both a science and an art. Part of the art is understanding the patient’s needs and communicating well. Modern medicine has used the phrase ‘cultural competence’ to describe this. While a physician of one race certainly can and often does provide excellent service to a patient of another, diverse membership in the surgical community is essential for cultural competence of that community.”

Pioneering black surgeons

The following lists a few of the many African American surgical luminaries who fought incredible obstacles in order to improve health outcomes for all:

• Daniel Hale Williams, MD, FACS (1856-1931): Founder of Provident Hospital; performed one of the first successful open heart surgeries; charter member of the ACS.

Courtesy National Library of Medicine

• Louis Tompkins Wright, MD, FACS (1891-1952): Second African American admitted to ACS Fellowship (in 1934) amid much debate and controversy, despite graduating cum laude from Harvard Medical School and having an illustrious career as a decorated Army surgeon. Dr. Wright was the son of a slave (Ceah Ketcham Wright, MD) who pursued medical education at Meharry after obtaining his freedom.

• Charles Richard Drew, MD, FACS (1904-1950): Pioneer transfusion researcher; first American Red Cross Blood Bank director. Dr. Leffall, a Drew trainee, recalls, “After several applications for fellowship in ACS, Drew was approved for admission at the annual convocation October 1950. He was killed in an automobile accident April 1, 1950, en route to a medical meeting in Tuskegee, Ala. In a highly unusual action, the College’s Board of Regents approved him for posthumous fellowship October 1951.”

Courtesy NLM

• Vivien Thomas (1910-1985): surgical technical assistant to Dr. Alfred Blalock at Vanderbilt, and supervisor of surgical laboratories at Johns Hopkins for 35 years; became pioneer in cardiac surgery despite having no formal education beyond high school and awarded honorary doctorate at Hopkins in 1976.

• Samuel Kountz, MD, FACS (1930-1981): Pioneer transplant surgeon; performed first successful human non-identical twin kidney transplant; developed Belzer kidney perfusion prototype.

• Claude Organ, MD, FACS (1926-2005): Professor of surgery at the University of California, Davis, and University of California, San Francisco East; editor of JAMA Archives of Surgery; founding member and President of SBAS (1995-1997) and second African American President of ACS (2003-2004).

• LaSalle D. Leffall, Jr., MD, FACS: Charles R. Drew Professor of Surgery and former chairman of surgery at Howard University; former chairman of the President’s Cancer Panel; SBAS president (1997-1998); first African American president of the American Cancer Society; first African American president of the ACS (1995-1996).

• Levi Watkins, MD: Professor of cardiac surgery, Johns Hopkins University; performed first human implantation of automatic implantable defibrillator; carried out landmark efforts to strengthen diversity among health care professionals. Dr. Watkins commented: “On the occasion of the national holiday of my former pastor, Dr. Martin Luther King, Jr., I am happy to say that given the opportunity the African American surgeon has shown very well that he or she is capable and worthy to serve and lead this nation in health equity and well-being. We must, however, not allow this progress and opportunity to slip from us using slogans to replace direct action on our part. I must compliment the ACS for its role in helping to bring about change in this area.”

Courtesy Johns Hopkins University

• Harold P. Freeman, MD, FACS: Past president, American Cancer Society; past chairman, President’s Cancer Panel; pioneer architect of patient navigation programs; founder and president/CEO, Harold P. Freeman Patient Navigation Institute.

• Haile Debas, MD, FACS: Past chairman, University of California, San Francisco (UCSF) department of surgery; past dean, School of Medicine; founding executive director, UCSF Global Health Sciences; president, the American Surgical Association (2002-2003).

• Benjamin S. Carson, Sr., MD: Emeritus professor of neurosurgery, Johns Hopkins School of Medicine; president/CEO American Business Collaborative, LLC; awarded Presidential Medal of Freedom; renowned for historic 1987 surgical procedure separating craniopagus conjoined twins.

He recalled: “Twins joined at the back of the head had never before been separated with both surviving. The 22-hour operation which combined advanced neurosurgical techniques with hypothermic cardiac arrest proved successful. I intentionally remained in the background and did not reveal my role as the primary neurosurgeon until the press conference several hours after the completion of the operation. Historically, the accomplishments of Blacks in scientific endeavors have not been heavily covered by the news media. In order to inspire millions of Black youngsters who lacked scientific role models, I waited until the story was so big that the media could not back off. Thankfully our society has advanced to the point that this kind of thing is no longer necessary.”

Courtesy carsonscholars.org

• Alexa Canady, MD, FACS: First African American female neurosurgery resident (University of Minnesota); became chief of neurosurgery at the Children’s Hospital of Detroit at age 36.

• Henri R. Ford, MD, FACS: Past surgeon-in-chief, Children’s Hospital of Pittsburgh; past vice-president, chief of surgery, University of California, Los Angeles (UCLA); vice-dean for Medical Education, Keck School/UCLA; SBAS president (2010-2011).

• L.D. Britt, MD, MPH, D.Sc (Hon), FACS, FCCM, FRCSEng (Hon), FRCSEd (Hon), FWACS (Hon), FRCSI (Hon), FCS(SA) (Hon), FRCS(Glasg) (Hon):

Chairman, department of surgery at Eastern Virginia Medical School; past president of numerous academic societies (American College of Surgeons, 2010-2011; Southern Surgical Congress; American Association of Trauma; Halsted Society, SBAS 1999-2001; American Surgical Association; Society of Surgical Chairs); current SBAS executive director; Robert J. Glaser Distinguished Educator Award recipient (highest teaching award granted by Association of American Medical Colleges).

Professional and personal challenges

Many of these African American professionals tackle the same barriers to productive longevity as the African American general population – disparities in professional promotion opportunities, socioeconomic disadvantages, and reduced life expectancy (National Vital Statistics Reports; vol. 61 no. 4., National Center for Health Statistics 2013).

Black physicians are less likely to receive academic promotion in university programs and are underrepresented within the full professorship rank (JAMA 2000; 284:1085-92); African American researchers are less likely to receive NIH research funding (Science 2011;333:1015-19); and society has lost many academically accomplished African American surgeons to premature death from cancer and other illnesses as well as trauma. Icons Dr. Charles Drew and Dr. Sam Kountz both died in the prime of their professional careers. More recently, the surgical oncology community mourned the losses of Keith Amos, MD, FACS, assistant professor of surgery, University of North Carolina and Yvedt Matory, MD, FACS, assistant professor of surgery, Harvard Medical School. Both of these talented surgeons died before reaching age 50.

Socioeconomic disparities and downstream effects on the pipeline of African American students and trainees remain apparent in the pool of surgeons available to pursue academic careers. These inequities are poignantly described by Sha’shonda Revels, MD, chief resident in general surgery at the University of Michigan, Ann Arbor, with plans to pursue an academic career in cardiothoracic surgery: “I consider myself truly blessed to have the opportunity to learn a tangible skill that I can use to effect change in the lives of others. … I appreciate the struggles that others have made for me to have this opportunity. Those not so well known ‘others’ include my grandmother who cleaned houses, and took care of me so that my mother could finish high school and attend college. They also include my parents who were tenacious about academics and would not accept a B average.”

Courtesy The Society of Black Academic Surgeons

The SBAS is born

Despite post-WWII gains, opportunities remained limited for black surgeons to achieve prominence and recognition in academic surgical societies. The Society for Black Academic Surgeons was therefore established as a network that would promote the careers of African American surgeons in academia and accelerate their upward professional trajectory.

SBAS founding member and President (1993-1995) Eddie Hoover, MD, FACS, professor of surgery at the State University of New York Buffalo, and Editor-in-Chief for the Journal of the National Medical Association, provides this passionate account of its history and accomplishments: “SBAS was created in a hotel room at the Marriott in New Orleans in 1987 to address the paucity of academic African American surgeons; their poor retention, promotion, and research funding; and lack of a leadership role in American surgery. The hero of academic African American surgeons, Dr. Charles Drew, adorns the shield of SBAS as much for his defiance of ACS for refusing to accept other well-qualified African American surgeons in the 1940’s as for his scientific contributions …With strong ACS support, SBAS has been stunningly successful over the past 27 years with a dozen SBAS members serving as surgical chairs and four as deans of majority schools.”

Courtesy Dr. Eddie Hoover

Dr. Britt, first African American chair of the ACS Board of Regents and later SBAS president, emphasizes that these two organizations have shared goals. “The evolution of the American College of Surgeons, the world’s largest organization for surgeons, and its growing partnership with the Society of Black Academic Surgeons (demonstrated formally, informally, and sometimes tacitly) needs to be recognized, underscored, and continually enhanced. Many of the ideals of SBAS now mirror the ideals and achievements of the ACS, including an ever growing diverse membership, improved diversity at all levels of leadership, meaningful mentorships for underrepresented minorities, and the establishment of several initiatives to address severe health care disparities in the world’s wealthiest nation.”

The 25th Annual Scientific Meeting of the SBAS will be hosted by the University of North Carolina, Chapel Hill, April 9-11, 2015.

Frederick Cason, MD, FACS, professor of surgery and chief, Division of Surgical Education at Morehouse School of Medicine and the SBAS historian and archivist, stated, “With the strong academic activities of SBAS, the networking it fosters, and the partnerships with numerous academic institutions and members of the College… there developed some 10 academic chairmen and at least 4 deans leading our major medical centers in America.”

Courtesy Moorehouse College of Medicine

Andrea Hayes-Jordan, MD, SBAS 2015 Annual Meeting program chair and associate professor of surgery and Pediatrics and Director of Pediatric Surgical Oncology at the University of Texas M.D. Anderson Cancer Center, notes, “At the annual meeting we are not only able to see the results of excellent research efforts from minority surgeons from around the country, but one has the unique opportunity to interact with them on a personal level, at an intimate meeting. This personal interaction with successful chair persons of color is invaluable in receiving pearls of advice, and understanding the nuances of successful academic practice. We hope in the future to increase the membership of SBAS and continue to promote the timely advancement of our members.”

Courtesy MD Anderson Cancer Center

Robert Higgins, MD, FACS, Professor and Chairman of the Department of Surgery, Ohio State University and past SBAS president (2008-2009), commented, “As someone who has benefitted from the progress that the SBAS/ACS relationship has fostered, I think the critical strength of this effort in the future is based upon its ability to create foundations for the development of underrepresented men and women of diverse backgrounds to reach new heights in surgery.”

Gender diversity addressed

Health equity efforts must also address gender imbalance. Edward E. Cornwell III, MD, FACS, LaSalle D. Leffall, Jr. Professor and Chairman of Surgery, Howard University, and SBAS president (2003-2004), reminisced about the first national meeting photo (above) of SBAS leadership and notes the “most obvious sign of the times in April 1989 … no women surgeons in that photo (the woman in the top row wasn’t a physician). Today, at a time when 14 of my 25 categorical surgical residents are women … we stand on the precipice of the next 25 years of career milestones trumpeting gender diversity – that will surpass the explosion we saw over the last 25 years with male surgeons of color.”

Courtesy OSU College of Medicine

Dr. Brawley also commented on the meteoric rise of African American women surgeons: “I take particular pride in the contribution today of black women who have come on strong in the past half-century. I appreciate and celebrate their achievement.”

Patricia Turner, MD, FACS, Director, ACS Division of Member Services, and Associate Professor of Surgery at the University of Chicago, summarized the African American female experience in surgery: “It is indeed a pleasure to note that in the years since the first SBAS photograph in 1989 … the number of women in medicine and surgery continues to surge. This recent growth is as much a reflection of an increased interest in surgery among women who may have been discouraged previously, as it is of a profession that has realized that previously accepted constraints around gender, race, and other factors limited access to colleagues exemplifying excellence in surgery. ACS and SBAS have consistently placed excellence, integrity, and outcomes at the forefront of their mission. Diversity brings quality, and the house of surgery is no different.”

Mentorship and Giving Back

Despite facing myriad obstacles, successful contemporary African American surgeons that are testimony to the mentorship and outreach efforts of SBAS as well as the ACS leadership have been acknowledged by an exhibit developed by the National Library of Medicine titled “Opening Doors: Contemporary African American Academic Surgeons,” and by a chapter contributed by Dr. Britt for the ACS Centennial textbook, “Setting the Course and Establishing Alliances: Fellows of the American College of Surgeons with African American Heritage.” The NLM exhibit specifically highlights the achievements of contemporary surgeons Drs. Alexa Canady; LaSalle Lefall; Claude Organ (1926-2005); Rosalyn Scott; L.D. Britt; Malcolm V. Brock; Karyn L.Butler; Benjamin Carson; Edward Cornwell; Kenneth Davis; Sharon Henry; Carla Pugh; Velma Scantlebury; Claudia Thomas; Errington Thompson; Levi Watkins; Patricia Bath; and Richard Scott. Dr. Britt (a legend in his own right as well as a contemporary icon) also acknowledges the accomplishments of the recent generations of academic surgeons (many of which overlap with the notables listed by the NLM), including Drs. Levi Watkins; Kenneth Forde; Alexa Canady; Clive Callender; Arthur Fleming; Lenworth Jacobs; Velma Scantlebury; Sharon Henry; Patricia Turner; Cato Laurencin; Butch Rossner; Kimberly Joseph; Debra Ford; Robert Higgins; Lisa Newman; Carla Pugh; Electron Kebenew; Terrence Fullum; David Jacobs; Andre Campbell; Kenneth Davis; Rhonda Henry-Tillman; Sherilyn Gordon-Burroughs; Hobart Harris; Michael Watkins; Raphael Lee; Karyn Butler; Edward Barksdale; Orlando Kirton; Jeffrey Upperman; Frederick Cason; Malcolm Brock; and Raymond Bynoe.

African Americans in medicine and surgery remain committed to improving the landscape of health care for underrepresented minority patients, students, and trainees today as in the past. This dedication was expressed by Dr. Daniel Hale Williams many decades ago: “My greatest reward is knowing that I can help my fellow man, especially those of my own race, who so deserve a better way of life.”

Today, trainee Dr. Revels echoes a similar allegiance to eradicating health care disparities by strengthening gender balance as well as racial/ethnic diversity in the health care profession: “I have a responsibility to stand for the next generation of young women of color who may be told that they didn’t need to take that algebra class or that AP classes would be too hard for them.”

Data continue to document that African American physicians are substantially more likely to establish practices that provide care to minority and impoverished patient populations (The Rationale for Diversity in the Health Professions: A Review of the Evidence. Washington, DC: U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions, October 2006).

Transcending artificial barriers

The ACS and the SBAS are in many ways bound together by their shared history, goals, and membership, and both have a critical role to play in the continuing struggle for equity and diversity in the surgical profession. Dr. Britt eloquently stated: “The month of February should not be the only time to highlight these milestones. On the contrary, there should be around-the-clock recognition, along with continual emphasis on even more advances. Let me be one of the first to toast this special partnership.”

Lisa Newman MD, MPH, FACS, FASCO, is Professor of Surgery and Director of the Breast Care Center at the University of Michigan in Ann Arbor.

Her research focus includes studies of high-risk/triple negative breast cancer and breast cancer disparities related to African ancestry. This research involves an international breast cancer registry. Dr. Newman also serves on the Program Committee for the Society of Black Academic Surgeons.

The emergence of African Americans as acclaimed leaders in the field of surgery over the last century is a triumph of personal struggle, brilliant minds, and sheer determination.

Disparities in educational and professional opportunities related to racial/ethnic identity persist, but LaSalle D. Leffall, Jr., MD, FACS, fondly recalls a favorite quote from pioneering African American surgeon Charles Drew: “Excellence of performance will transcend artificial barriers created by man.” The goals and abundant talent shared by the membership of the American College of Surgeons (ACS) and Society of Black Academic Surgeons (SBAS) are testimony to the ongoing dissolution of these artificial barriers.

Parallels are evident between the history of organized surgery in America and African American efforts to achieve health care equity. While the spectrum of surgical procedures mushroomed in the late 19th century, surgical training was characterized by inconsistency and instability. The ACS was established in 1913 with the mission of “improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.”

Significant disparities in medical and surgical care existed for African Americans in this era. During the decades following the Civil War, black citizens were routinely denied care or they received substandard care delivered in segregated hospitals. Medical education opportunities for African Americans were nearly nonexistent.

Nonetheless, African Americans mobilized their talent and energy to address the same threats to quality medical care as those faced by the ACS founders, but having to overcome even greater obstacles in the form of systematic racism and exclusion.

Courtesy NLM

Chicago’s Provident Hospital and Training School (the first African American-owned and -operated hospital) was established in 1891. Howard University College of Medicine in Washington, and Meharry Medical College in Nashville, Tenn., founded in 1868 and 1876, respectively, remained the predominent options for prospective African American medical students for several decades. Because African American medical professionals were denied membership in the American Medical Association, they formed their own professional society, the National Medical Association, in 1895.

In contrast, Dr. Daniel Hale Williams, founder of the Provident Hospital and founding member of the National Medical Association, was a charter member of ACS in 1913. However, more than 20 years passed before another African American surgeon (Louis Tompkins Wright, MD, FACS) became a Fellow of the College.

Courtesy National Library of Medicine

The number of African American surgeons in the College grew steadily after World War II, and in the past 3 years, approximately 6% of ACS inductees have been African Americans.

The value of race/ethnic diversity in optimizing quality of care is summarized by Dr. Otis Brawley, Chief Medical Officer for the American Cancer Society and past Director of the Office for Special Populations Research at the National Institutes of Health: “The practice of surgery is both a science and an art. Part of the art is understanding the patient’s needs and communicating well. Modern medicine has used the phrase ‘cultural competence’ to describe this. While a physician of one race certainly can and often does provide excellent service to a patient of another, diverse membership in the surgical community is essential for cultural competence of that community.”

Pioneering black surgeons

The following lists a few of the many African American surgical luminaries who fought incredible obstacles in order to improve health outcomes for all:

• Daniel Hale Williams, MD, FACS (1856-1931): Founder of Provident Hospital; performed one of the first successful open heart surgeries; charter member of the ACS.

Courtesy National Library of Medicine

• Louis Tompkins Wright, MD, FACS (1891-1952): Second African American admitted to ACS Fellowship (in 1934) amid much debate and controversy, despite graduating cum laude from Harvard Medical School and having an illustrious career as a decorated Army surgeon. Dr. Wright was the son of a slave (Ceah Ketcham Wright, MD) who pursued medical education at Meharry after obtaining his freedom.

• Charles Richard Drew, MD, FACS (1904-1950): Pioneer transfusion researcher; first American Red Cross Blood Bank director. Dr. Leffall, a Drew trainee, recalls, “After several applications for fellowship in ACS, Drew was approved for admission at the annual convocation October 1950. He was killed in an automobile accident April 1, 1950, en route to a medical meeting in Tuskegee, Ala. In a highly unusual action, the College’s Board of Regents approved him for posthumous fellowship October 1951.”

Courtesy NLM

• Vivien Thomas (1910-1985): surgical technical assistant to Dr. Alfred Blalock at Vanderbilt, and supervisor of surgical laboratories at Johns Hopkins for 35 years; became pioneer in cardiac surgery despite having no formal education beyond high school and awarded honorary doctorate at Hopkins in 1976.

• Samuel Kountz, MD, FACS (1930-1981): Pioneer transplant surgeon; performed first successful human non-identical twin kidney transplant; developed Belzer kidney perfusion prototype.

• Claude Organ, MD, FACS (1926-2005): Professor of surgery at the University of California, Davis, and University of California, San Francisco East; editor of JAMA Archives of Surgery; founding member and President of SBAS (1995-1997) and second African American President of ACS (2003-2004).

• LaSalle D. Leffall, Jr., MD, FACS: Charles R. Drew Professor of Surgery and former chairman of surgery at Howard University; former chairman of the President’s Cancer Panel; SBAS president (1997-1998); first African American president of the American Cancer Society; first African American president of the ACS (1995-1996).

• Levi Watkins, MD: Professor of cardiac surgery, Johns Hopkins University; performed first human implantation of automatic implantable defibrillator; carried out landmark efforts to strengthen diversity among health care professionals. Dr. Watkins commented: “On the occasion of the national holiday of my former pastor, Dr. Martin Luther King, Jr., I am happy to say that given the opportunity the African American surgeon has shown very well that he or she is capable and worthy to serve and lead this nation in health equity and well-being. We must, however, not allow this progress and opportunity to slip from us using slogans to replace direct action on our part. I must compliment the ACS for its role in helping to bring about change in this area.”

Courtesy Johns Hopkins University

• Harold P. Freeman, MD, FACS: Past president, American Cancer Society; past chairman, President’s Cancer Panel; pioneer architect of patient navigation programs; founder and president/CEO, Harold P. Freeman Patient Navigation Institute.

• Haile Debas, MD, FACS: Past chairman, University of California, San Francisco (UCSF) department of surgery; past dean, School of Medicine; founding executive director, UCSF Global Health Sciences; president, the American Surgical Association (2002-2003).

• Benjamin S. Carson, Sr., MD: Emeritus professor of neurosurgery, Johns Hopkins School of Medicine; president/CEO American Business Collaborative, LLC; awarded Presidential Medal of Freedom; renowned for historic 1987 surgical procedure separating craniopagus conjoined twins.

He recalled: “Twins joined at the back of the head had never before been separated with both surviving. The 22-hour operation which combined advanced neurosurgical techniques with hypothermic cardiac arrest proved successful. I intentionally remained in the background and did not reveal my role as the primary neurosurgeon until the press conference several hours after the completion of the operation. Historically, the accomplishments of Blacks in scientific endeavors have not been heavily covered by the news media. In order to inspire millions of Black youngsters who lacked scientific role models, I waited until the story was so big that the media could not back off. Thankfully our society has advanced to the point that this kind of thing is no longer necessary.”

Courtesy carsonscholars.org

• Alexa Canady, MD, FACS: First African American female neurosurgery resident (University of Minnesota); became chief of neurosurgery at the Children’s Hospital of Detroit at age 36.

• Henri R. Ford, MD, FACS: Past surgeon-in-chief, Children’s Hospital of Pittsburgh; past vice-president, chief of surgery, University of California, Los Angeles (UCLA); vice-dean for Medical Education, Keck School/UCLA; SBAS president (2010-2011).

• L.D. Britt, MD, MPH, D.Sc (Hon), FACS, FCCM, FRCSEng (Hon), FRCSEd (Hon), FWACS (Hon), FRCSI (Hon), FCS(SA) (Hon), FRCS(Glasg) (Hon):

Chairman, department of surgery at Eastern Virginia Medical School; past president of numerous academic societies (American College of Surgeons, 2010-2011; Southern Surgical Congress; American Association of Trauma; Halsted Society, SBAS 1999-2001; American Surgical Association; Society of Surgical Chairs); current SBAS executive director; Robert J. Glaser Distinguished Educator Award recipient (highest teaching award granted by Association of American Medical Colleges).

Professional and personal challenges

Many of these African American professionals tackle the same barriers to productive longevity as the African American general population – disparities in professional promotion opportunities, socioeconomic disadvantages, and reduced life expectancy (National Vital Statistics Reports; vol. 61 no. 4., National Center for Health Statistics 2013).

Black physicians are less likely to receive academic promotion in university programs and are underrepresented within the full professorship rank (JAMA 2000; 284:1085-92); African American researchers are less likely to receive NIH research funding (Science 2011;333:1015-19); and society has lost many academically accomplished African American surgeons to premature death from cancer and other illnesses as well as trauma. Icons Dr. Charles Drew and Dr. Sam Kountz both died in the prime of their professional careers. More recently, the surgical oncology community mourned the losses of Keith Amos, MD, FACS, assistant professor of surgery, University of North Carolina and Yvedt Matory, MD, FACS, assistant professor of surgery, Harvard Medical School. Both of these talented surgeons died before reaching age 50.

Socioeconomic disparities and downstream effects on the pipeline of African American students and trainees remain apparent in the pool of surgeons available to pursue academic careers. These inequities are poignantly described by Sha’shonda Revels, MD, chief resident in general surgery at the University of Michigan, Ann Arbor, with plans to pursue an academic career in cardiothoracic surgery: “I consider myself truly blessed to have the opportunity to learn a tangible skill that I can use to effect change in the lives of others. … I appreciate the struggles that others have made for me to have this opportunity. Those not so well known ‘others’ include my grandmother who cleaned houses, and took care of me so that my mother could finish high school and attend college. They also include my parents who were tenacious about academics and would not accept a B average.”

Courtesy The Society of Black Academic Surgeons

The SBAS is born

Despite post-WWII gains, opportunities remained limited for black surgeons to achieve prominence and recognition in academic surgical societies. The Society for Black Academic Surgeons was therefore established as a network that would promote the careers of African American surgeons in academia and accelerate their upward professional trajectory.

SBAS founding member and President (1993-1995) Eddie Hoover, MD, FACS, professor of surgery at the State University of New York Buffalo, and Editor-in-Chief for the Journal of the National Medical Association, provides this passionate account of its history and accomplishments: “SBAS was created in a hotel room at the Marriott in New Orleans in 1987 to address the paucity of academic African American surgeons; their poor retention, promotion, and research funding; and lack of a leadership role in American surgery. The hero of academic African American surgeons, Dr. Charles Drew, adorns the shield of SBAS as much for his defiance of ACS for refusing to accept other well-qualified African American surgeons in the 1940’s as for his scientific contributions …With strong ACS support, SBAS has been stunningly successful over the past 27 years with a dozen SBAS members serving as surgical chairs and four as deans of majority schools.”

Courtesy Dr. Eddie Hoover

Dr. Britt, first African American chair of the ACS Board of Regents and later SBAS president, emphasizes that these two organizations have shared goals. “The evolution of the American College of Surgeons, the world’s largest organization for surgeons, and its growing partnership with the Society of Black Academic Surgeons (demonstrated formally, informally, and sometimes tacitly) needs to be recognized, underscored, and continually enhanced. Many of the ideals of SBAS now mirror the ideals and achievements of the ACS, including an ever growing diverse membership, improved diversity at all levels of leadership, meaningful mentorships for underrepresented minorities, and the establishment of several initiatives to address severe health care disparities in the world’s wealthiest nation.”

The 25th Annual Scientific Meeting of the SBAS will be hosted by the University of North Carolina, Chapel Hill, April 9-11, 2015.

Frederick Cason, MD, FACS, professor of surgery and chief, Division of Surgical Education at Morehouse School of Medicine and the SBAS historian and archivist, stated, “With the strong academic activities of SBAS, the networking it fosters, and the partnerships with numerous academic institutions and members of the College… there developed some 10 academic chairmen and at least 4 deans leading our major medical centers in America.”

Courtesy Moorehouse College of Medicine

Andrea Hayes-Jordan, MD, SBAS 2015 Annual Meeting program chair and associate professor of surgery and Pediatrics and Director of Pediatric Surgical Oncology at the University of Texas M.D. Anderson Cancer Center, notes, “At the annual meeting we are not only able to see the results of excellent research efforts from minority surgeons from around the country, but one has the unique opportunity to interact with them on a personal level, at an intimate meeting. This personal interaction with successful chair persons of color is invaluable in receiving pearls of advice, and understanding the nuances of successful academic practice. We hope in the future to increase the membership of SBAS and continue to promote the timely advancement of our members.”

Courtesy MD Anderson Cancer Center

Robert Higgins, MD, FACS, Professor and Chairman of the Department of Surgery, Ohio State University and past SBAS president (2008-2009), commented, “As someone who has benefitted from the progress that the SBAS/ACS relationship has fostered, I think the critical strength of this effort in the future is based upon its ability to create foundations for the development of underrepresented men and women of diverse backgrounds to reach new heights in surgery.”

Gender diversity addressed

Health equity efforts must also address gender imbalance. Edward E. Cornwell III, MD, FACS, LaSalle D. Leffall, Jr. Professor and Chairman of Surgery, Howard University, and SBAS president (2003-2004), reminisced about the first national meeting photo (above) of SBAS leadership and notes the “most obvious sign of the times in April 1989 … no women surgeons in that photo (the woman in the top row wasn’t a physician). Today, at a time when 14 of my 25 categorical surgical residents are women … we stand on the precipice of the next 25 years of career milestones trumpeting gender diversity – that will surpass the explosion we saw over the last 25 years with male surgeons of color.”

Courtesy OSU College of Medicine

Dr. Brawley also commented on the meteoric rise of African American women surgeons: “I take particular pride in the contribution today of black women who have come on strong in the past half-century. I appreciate and celebrate their achievement.”

Patricia Turner, MD, FACS, Director, ACS Division of Member Services, and Associate Professor of Surgery at the University of Chicago, summarized the African American female experience in surgery: “It is indeed a pleasure to note that in the years since the first SBAS photograph in 1989 … the number of women in medicine and surgery continues to surge. This recent growth is as much a reflection of an increased interest in surgery among women who may have been discouraged previously, as it is of a profession that has realized that previously accepted constraints around gender, race, and other factors limited access to colleagues exemplifying excellence in surgery. ACS and SBAS have consistently placed excellence, integrity, and outcomes at the forefront of their mission. Diversity brings quality, and the house of surgery is no different.”

Mentorship and Giving Back

Despite facing myriad obstacles, successful contemporary African American surgeons that are testimony to the mentorship and outreach efforts of SBAS as well as the ACS leadership have been acknowledged by an exhibit developed by the National Library of Medicine titled “Opening Doors: Contemporary African American Academic Surgeons,” and by a chapter contributed by Dr. Britt for the ACS Centennial textbook, “Setting the Course and Establishing Alliances: Fellows of the American College of Surgeons with African American Heritage.” The NLM exhibit specifically highlights the achievements of contemporary surgeons Drs. Alexa Canady; LaSalle Lefall; Claude Organ (1926-2005); Rosalyn Scott; L.D. Britt; Malcolm V. Brock; Karyn L.Butler; Benjamin Carson; Edward Cornwell; Kenneth Davis; Sharon Henry; Carla Pugh; Velma Scantlebury; Claudia Thomas; Errington Thompson; Levi Watkins; Patricia Bath; and Richard Scott. Dr. Britt (a legend in his own right as well as a contemporary icon) also acknowledges the accomplishments of the recent generations of academic surgeons (many of which overlap with the notables listed by the NLM), including Drs. Levi Watkins; Kenneth Forde; Alexa Canady; Clive Callender; Arthur Fleming; Lenworth Jacobs; Velma Scantlebury; Sharon Henry; Patricia Turner; Cato Laurencin; Butch Rossner; Kimberly Joseph; Debra Ford; Robert Higgins; Lisa Newman; Carla Pugh; Electron Kebenew; Terrence Fullum; David Jacobs; Andre Campbell; Kenneth Davis; Rhonda Henry-Tillman; Sherilyn Gordon-Burroughs; Hobart Harris; Michael Watkins; Raphael Lee; Karyn Butler; Edward Barksdale; Orlando Kirton; Jeffrey Upperman; Frederick Cason; Malcolm Brock; and Raymond Bynoe.

African Americans in medicine and surgery remain committed to improving the landscape of health care for underrepresented minority patients, students, and trainees today as in the past. This dedication was expressed by Dr. Daniel Hale Williams many decades ago: “My greatest reward is knowing that I can help my fellow man, especially those of my own race, who so deserve a better way of life.”

Today, trainee Dr. Revels echoes a similar allegiance to eradicating health care disparities by strengthening gender balance as well as racial/ethnic diversity in the health care profession: “I have a responsibility to stand for the next generation of young women of color who may be told that they didn’t need to take that algebra class or that AP classes would be too hard for them.”

Data continue to document that African American physicians are substantially more likely to establish practices that provide care to minority and impoverished patient populations (The Rationale for Diversity in the Health Professions: A Review of the Evidence. Washington, DC: U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions, October 2006).

Transcending artificial barriers

The ACS and the SBAS are in many ways bound together by their shared history, goals, and membership, and both have a critical role to play in the continuing struggle for equity and diversity in the surgical profession. Dr. Britt eloquently stated: “The month of February should not be the only time to highlight these milestones. On the contrary, there should be around-the-clock recognition, along with continual emphasis on even more advances. Let me be one of the first to toast this special partnership.”

Lisa Newman MD, MPH, FACS, FASCO, is Professor of Surgery and Director of the Breast Care Center at the University of Michigan in Ann Arbor.

Her research focus includes studies of high-risk/triple negative breast cancer and breast cancer disparities related to African ancestry. This research involves an international breast cancer registry. Dr. Newman also serves on the Program Committee for the Society of Black Academic Surgeons.

The emergence of African Americans as acclaimed leaders in the field of surgery over the last century is a triumph of personal struggle, brilliant minds, and sheer determination.

Disparities in educational and professional opportunities related to racial/ethnic identity persist, but LaSalle D. Leffall, Jr., MD, FACS, fondly recalls a favorite quote from pioneering African American surgeon Charles Drew: “Excellence of performance will transcend artificial barriers created by man.” The goals and abundant talent shared by the membership of the American College of Surgeons (ACS) and Society of Black Academic Surgeons (SBAS) are testimony to the ongoing dissolution of these artificial barriers.

Parallels are evident between the history of organized surgery in America and African American efforts to achieve health care equity. While the spectrum of surgical procedures mushroomed in the late 19th century, surgical training was characterized by inconsistency and instability. The ACS was established in 1913 with the mission of “improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.”

Significant disparities in medical and surgical care existed for African Americans in this era. During the decades following the Civil War, black citizens were routinely denied care or they received substandard care delivered in segregated hospitals. Medical education opportunities for African Americans were nearly nonexistent.

Nonetheless, African Americans mobilized their talent and energy to address the same threats to quality medical care as those faced by the ACS founders, but having to overcome even greater obstacles in the form of systematic racism and exclusion.

Courtesy NLM

Chicago’s Provident Hospital and Training School (the first African American-owned and -operated hospital) was established in 1891. Howard University College of Medicine in Washington, and Meharry Medical College in Nashville, Tenn., founded in 1868 and 1876, respectively, remained the predominent options for prospective African American medical students for several decades. Because African American medical professionals were denied membership in the American Medical Association, they formed their own professional society, the National Medical Association, in 1895.

In contrast, Dr. Daniel Hale Williams, founder of the Provident Hospital and founding member of the National Medical Association, was a charter member of ACS in 1913. However, more than 20 years passed before another African American surgeon (Louis Tompkins Wright, MD, FACS) became a Fellow of the College.

Courtesy National Library of Medicine

The number of African American surgeons in the College grew steadily after World War II, and in the past 3 years, approximately 6% of ACS inductees have been African Americans.

The value of race/ethnic diversity in optimizing quality of care is summarized by Dr. Otis Brawley, Chief Medical Officer for the American Cancer Society and past Director of the Office for Special Populations Research at the National Institutes of Health: “The practice of surgery is both a science and an art. Part of the art is understanding the patient’s needs and communicating well. Modern medicine has used the phrase ‘cultural competence’ to describe this. While a physician of one race certainly can and often does provide excellent service to a patient of another, diverse membership in the surgical community is essential for cultural competence of that community.”

Pioneering black surgeons

The following lists a few of the many African American surgical luminaries who fought incredible obstacles in order to improve health outcomes for all:

• Daniel Hale Williams, MD, FACS (1856-1931): Founder of Provident Hospital; performed one of the first successful open heart surgeries; charter member of the ACS.

Courtesy National Library of Medicine

• Louis Tompkins Wright, MD, FACS (1891-1952): Second African American admitted to ACS Fellowship (in 1934) amid much debate and controversy, despite graduating cum laude from Harvard Medical School and having an illustrious career as a decorated Army surgeon. Dr. Wright was the son of a slave (Ceah Ketcham Wright, MD) who pursued medical education at Meharry after obtaining his freedom.

• Charles Richard Drew, MD, FACS (1904-1950): Pioneer transfusion researcher; first American Red Cross Blood Bank director. Dr. Leffall, a Drew trainee, recalls, “After several applications for fellowship in ACS, Drew was approved for admission at the annual convocation October 1950. He was killed in an automobile accident April 1, 1950, en route to a medical meeting in Tuskegee, Ala. In a highly unusual action, the College’s Board of Regents approved him for posthumous fellowship October 1951.”

Courtesy NLM

• Vivien Thomas (1910-1985): surgical technical assistant to Dr. Alfred Blalock at Vanderbilt, and supervisor of surgical laboratories at Johns Hopkins for 35 years; became pioneer in cardiac surgery despite having no formal education beyond high school and awarded honorary doctorate at Hopkins in 1976.

• Samuel Kountz, MD, FACS (1930-1981): Pioneer transplant surgeon; performed first successful human non-identical twin kidney transplant; developed Belzer kidney perfusion prototype.

• Claude Organ, MD, FACS (1926-2005): Professor of surgery at the University of California, Davis, and University of California, San Francisco East; editor of JAMA Archives of Surgery; founding member and President of SBAS (1995-1997) and second African American President of ACS (2003-2004).

• LaSalle D. Leffall, Jr., MD, FACS: Charles R. Drew Professor of Surgery and former chairman of surgery at Howard University; former chairman of the President’s Cancer Panel; SBAS president (1997-1998); first African American president of the American Cancer Society; first African American president of the ACS (1995-1996).

• Levi Watkins, MD: Professor of cardiac surgery, Johns Hopkins University; performed first human implantation of automatic implantable defibrillator; carried out landmark efforts to strengthen diversity among health care professionals. Dr. Watkins commented: “On the occasion of the national holiday of my former pastor, Dr. Martin Luther King, Jr., I am happy to say that given the opportunity the African American surgeon has shown very well that he or she is capable and worthy to serve and lead this nation in health equity and well-being. We must, however, not allow this progress and opportunity to slip from us using slogans to replace direct action on our part. I must compliment the ACS for its role in helping to bring about change in this area.”

Courtesy Johns Hopkins University

• Harold P. Freeman, MD, FACS: Past president, American Cancer Society; past chairman, President’s Cancer Panel; pioneer architect of patient navigation programs; founder and president/CEO, Harold P. Freeman Patient Navigation Institute.

• Haile Debas, MD, FACS: Past chairman, University of California, San Francisco (UCSF) department of surgery; past dean, School of Medicine; founding executive director, UCSF Global Health Sciences; president, the American Surgical Association (2002-2003).

• Benjamin S. Carson, Sr., MD: Emeritus professor of neurosurgery, Johns Hopkins School of Medicine; president/CEO American Business Collaborative, LLC; awarded Presidential Medal of Freedom; renowned for historic 1987 surgical procedure separating craniopagus conjoined twins.

He recalled: “Twins joined at the back of the head had never before been separated with both surviving. The 22-hour operation which combined advanced neurosurgical techniques with hypothermic cardiac arrest proved successful. I intentionally remained in the background and did not reveal my role as the primary neurosurgeon until the press conference several hours after the completion of the operation. Historically, the accomplishments of Blacks in scientific endeavors have not been heavily covered by the news media. In order to inspire millions of Black youngsters who lacked scientific role models, I waited until the story was so big that the media could not back off. Thankfully our society has advanced to the point that this kind of thing is no longer necessary.”

Courtesy carsonscholars.org

• Alexa Canady, MD, FACS: First African American female neurosurgery resident (University of Minnesota); became chief of neurosurgery at the Children’s Hospital of Detroit at age 36.

• Henri R. Ford, MD, FACS: Past surgeon-in-chief, Children’s Hospital of Pittsburgh; past vice-president, chief of surgery, University of California, Los Angeles (UCLA); vice-dean for Medical Education, Keck School/UCLA; SBAS president (2010-2011).

• L.D. Britt, MD, MPH, D.Sc (Hon), FACS, FCCM, FRCSEng (Hon), FRCSEd (Hon), FWACS (Hon), FRCSI (Hon), FCS(SA) (Hon), FRCS(Glasg) (Hon):

Chairman, department of surgery at Eastern Virginia Medical School; past president of numerous academic societies (American College of Surgeons, 2010-2011; Southern Surgical Congress; American Association of Trauma; Halsted Society, SBAS 1999-2001; American Surgical Association; Society of Surgical Chairs); current SBAS executive director; Robert J. Glaser Distinguished Educator Award recipient (highest teaching award granted by Association of American Medical Colleges).

Professional and personal challenges

Many of these African American professionals tackle the same barriers to productive longevity as the African American general population – disparities in professional promotion opportunities, socioeconomic disadvantages, and reduced life expectancy (National Vital Statistics Reports; vol. 61 no. 4., National Center for Health Statistics 2013).

Black physicians are less likely to receive academic promotion in university programs and are underrepresented within the full professorship rank (JAMA 2000; 284:1085-92); African American researchers are less likely to receive NIH research funding (Science 2011;333:1015-19); and society has lost many academically accomplished African American surgeons to premature death from cancer and other illnesses as well as trauma. Icons Dr. Charles Drew and Dr. Sam Kountz both died in the prime of their professional careers. More recently, the surgical oncology community mourned the losses of Keith Amos, MD, FACS, assistant professor of surgery, University of North Carolina and Yvedt Matory, MD, FACS, assistant professor of surgery, Harvard Medical School. Both of these talented surgeons died before reaching age 50.

Socioeconomic disparities and downstream effects on the pipeline of African American students and trainees remain apparent in the pool of surgeons available to pursue academic careers. These inequities are poignantly described by Sha’shonda Revels, MD, chief resident in general surgery at the University of Michigan, Ann Arbor, with plans to pursue an academic career in cardiothoracic surgery: “I consider myself truly blessed to have the opportunity to learn a tangible skill that I can use to effect change in the lives of others. … I appreciate the struggles that others have made for me to have this opportunity. Those not so well known ‘others’ include my grandmother who cleaned houses, and took care of me so that my mother could finish high school and attend college. They also include my parents who were tenacious about academics and would not accept a B average.”

Courtesy The Society of Black Academic Surgeons

The SBAS is born

Despite post-WWII gains, opportunities remained limited for black surgeons to achieve prominence and recognition in academic surgical societies. The Society for Black Academic Surgeons was therefore established as a network that would promote the careers of African American surgeons in academia and accelerate their upward professional trajectory.

SBAS founding member and President (1993-1995) Eddie Hoover, MD, FACS, professor of surgery at the State University of New York Buffalo, and Editor-in-Chief for the Journal of the National Medical Association, provides this passionate account of its history and accomplishments: “SBAS was created in a hotel room at the Marriott in New Orleans in 1987 to address the paucity of academic African American surgeons; their poor retention, promotion, and research funding; and lack of a leadership role in American surgery. The hero of academic African American surgeons, Dr. Charles Drew, adorns the shield of SBAS as much for his defiance of ACS for refusing to accept other well-qualified African American surgeons in the 1940’s as for his scientific contributions …With strong ACS support, SBAS has been stunningly successful over the past 27 years with a dozen SBAS members serving as surgical chairs and four as deans of majority schools.”

Courtesy Dr. Eddie Hoover

Dr. Britt, first African American chair of the ACS Board of Regents and later SBAS president, emphasizes that these two organizations have shared goals. “The evolution of the American College of Surgeons, the world’s largest organization for surgeons, and its growing partnership with the Society of Black Academic Surgeons (demonstrated formally, informally, and sometimes tacitly) needs to be recognized, underscored, and continually enhanced. Many of the ideals of SBAS now mirror the ideals and achievements of the ACS, including an ever growing diverse membership, improved diversity at all levels of leadership, meaningful mentorships for underrepresented minorities, and the establishment of several initiatives to address severe health care disparities in the world’s wealthiest nation.”

The 25th Annual Scientific Meeting of the SBAS will be hosted by the University of North Carolina, Chapel Hill, April 9-11, 2015.

Frederick Cason, MD, FACS, professor of surgery and chief, Division of Surgical Education at Morehouse School of Medicine and the SBAS historian and archivist, stated, “With the strong academic activities of SBAS, the networking it fosters, and the partnerships with numerous academic institutions and members of the College… there developed some 10 academic chairmen and at least 4 deans leading our major medical centers in America.”

Courtesy Moorehouse College of Medicine

Andrea Hayes-Jordan, MD, SBAS 2015 Annual Meeting program chair and associate professor of surgery and Pediatrics and Director of Pediatric Surgical Oncology at the University of Texas M.D. Anderson Cancer Center, notes, “At the annual meeting we are not only able to see the results of excellent research efforts from minority surgeons from around the country, but one has the unique opportunity to interact with them on a personal level, at an intimate meeting. This personal interaction with successful chair persons of color is invaluable in receiving pearls of advice, and understanding the nuances of successful academic practice. We hope in the future to increase the membership of SBAS and continue to promote the timely advancement of our members.”

Courtesy MD Anderson Cancer Center

Robert Higgins, MD, FACS, Professor and Chairman of the Department of Surgery, Ohio State University and past SBAS president (2008-2009), commented, “As someone who has benefitted from the progress that the SBAS/ACS relationship has fostered, I think the critical strength of this effort in the future is based upon its ability to create foundations for the development of underrepresented men and women of diverse backgrounds to reach new heights in surgery.”

Gender diversity addressed

Health equity efforts must also address gender imbalance. Edward E. Cornwell III, MD, FACS, LaSalle D. Leffall, Jr. Professor and Chairman of Surgery, Howard University, and SBAS president (2003-2004), reminisced about the first national meeting photo (above) of SBAS leadership and notes the “most obvious sign of the times in April 1989 … no women surgeons in that photo (the woman in the top row wasn’t a physician). Today, at a time when 14 of my 25 categorical surgical residents are women … we stand on the precipice of the next 25 years of career milestones trumpeting gender diversity – that will surpass the explosion we saw over the last 25 years with male surgeons of color.”

Courtesy OSU College of Medicine

Dr. Brawley also commented on the meteoric rise of African American women surgeons: “I take particular pride in the contribution today of black women who have come on strong in the past half-century. I appreciate and celebrate their achievement.”

Patricia Turner, MD, FACS, Director, ACS Division of Member Services, and Associate Professor of Surgery at the University of Chicago, summarized the African American female experience in surgery: “It is indeed a pleasure to note that in the years since the first SBAS photograph in 1989 … the number of women in medicine and surgery continues to surge. This recent growth is as much a reflection of an increased interest in surgery among women who may have been discouraged previously, as it is of a profession that has realized that previously accepted constraints around gender, race, and other factors limited access to colleagues exemplifying excellence in surgery. ACS and SBAS have consistently placed excellence, integrity, and outcomes at the forefront of their mission. Diversity brings quality, and the house of surgery is no different.”

Mentorship and Giving Back

Despite facing myriad obstacles, successful contemporary African American surgeons that are testimony to the mentorship and outreach efforts of SBAS as well as the ACS leadership have been acknowledged by an exhibit developed by the National Library of Medicine titled “Opening Doors: Contemporary African American Academic Surgeons,” and by a chapter contributed by Dr. Britt for the ACS Centennial textbook, “Setting the Course and Establishing Alliances: Fellows of the American College of Surgeons with African American Heritage.” The NLM exhibit specifically highlights the achievements of contemporary surgeons Drs. Alexa Canady; LaSalle Lefall; Claude Organ (1926-2005); Rosalyn Scott; L.D. Britt; Malcolm V. Brock; Karyn L.Butler; Benjamin Carson; Edward Cornwell; Kenneth Davis; Sharon Henry; Carla Pugh; Velma Scantlebury; Claudia Thomas; Errington Thompson; Levi Watkins; Patricia Bath; and Richard Scott. Dr. Britt (a legend in his own right as well as a contemporary icon) also acknowledges the accomplishments of the recent generations of academic surgeons (many of which overlap with the notables listed by the NLM), including Drs. Levi Watkins; Kenneth Forde; Alexa Canady; Clive Callender; Arthur Fleming; Lenworth Jacobs; Velma Scantlebury; Sharon Henry; Patricia Turner; Cato Laurencin; Butch Rossner; Kimberly Joseph; Debra Ford; Robert Higgins; Lisa Newman; Carla Pugh; Electron Kebenew; Terrence Fullum; David Jacobs; Andre Campbell; Kenneth Davis; Rhonda Henry-Tillman; Sherilyn Gordon-Burroughs; Hobart Harris; Michael Watkins; Raphael Lee; Karyn Butler; Edward Barksdale; Orlando Kirton; Jeffrey Upperman; Frederick Cason; Malcolm Brock; and Raymond Bynoe.

African Americans in medicine and surgery remain committed to improving the landscape of health care for underrepresented minority patients, students, and trainees today as in the past. This dedication was expressed by Dr. Daniel Hale Williams many decades ago: “My greatest reward is knowing that I can help my fellow man, especially those of my own race, who so deserve a better way of life.”

Today, trainee Dr. Revels echoes a similar allegiance to eradicating health care disparities by strengthening gender balance as well as racial/ethnic diversity in the health care profession: “I have a responsibility to stand for the next generation of young women of color who may be told that they didn’t need to take that algebra class or that AP classes would be too hard for them.”

Data continue to document that African American physicians are substantially more likely to establish practices that provide care to minority and impoverished patient populations (The Rationale for Diversity in the Health Professions: A Review of the Evidence. Washington, DC: U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions, October 2006).

Transcending artificial barriers

The ACS and the SBAS are in many ways bound together by their shared history, goals, and membership, and both have a critical role to play in the continuing struggle for equity and diversity in the surgical profession. Dr. Britt eloquently stated: “The month of February should not be the only time to highlight these milestones. On the contrary, there should be around-the-clock recognition, along with continual emphasis on even more advances. Let me be one of the first to toast this special partnership.”

Lisa Newman MD, MPH, FACS, FASCO, is Professor of Surgery and Director of the Breast Care Center at the University of Michigan in Ann Arbor.

Her research focus includes studies of high-risk/triple negative breast cancer and breast cancer disparities related to African ancestry. This research involves an international breast cancer registry. Dr. Newman also serves on the Program Committee for the Society of Black Academic Surgeons.