J. Michael DiMaio M.D.

Moffatt-Bruce, S., S. Clark, M. DiMaio and J. Fann (2018). “Leadership Oversight for Patient Safety Programs: An Essential Element.” Ann Thorac Surg 105(2): 351-356.

Full text of this article.

Leadership in the realm of quality oversight and endorsing a culture of safety is paramount. The stakeholders, ranging from the surgeons to the Chair of the Board have to be engaged and really understand the importance of leadership support. Clarity of leadership support, innovation in process improvement as well as performance management and accountability are the foundational components of a strong culture of safety. Alignment of all stakeholders and continuous improvement that is supported by leadership will ensure the best outcomes for surgical patients.

Moffatt-Bruce, S., S. Clark, M. DiMaio and J. Fann (2017). “Leadership Oversight for Patient Safety Programs: An Essential Element.” Ann Thorac Surg.

Full text of this article.

Leadership in the realm of quality oversight and endorsing a culture of safety is paramount. The stakeholders, ranging from the surgeons to the Chair of the Board have to be engaged and really understand the importance of leadership support. Clarity of leadership support, innovation in process improvement as well as performance management and accountability are the foundational components of a strong culture of safety. Alignment of all stakeholders and continuous improvement that is supported by leadership will ensure the best outcomes for surgical patients.

Squiers, J. J., K. W. Lobdell, J. I. Fann and J. M. DiMaio (2017). “Physician burnout: Are we treating the symptoms instead of the disease?” Ann Thorac Surg 104(4): 1117-1122.

Full text of this article.

Despite increasing recognition of physician burnout, its incidence has only increased in recent years, with nearly half of physicians suffering from symptoms of burnout in the most recent surveys. Unfortunately, most burnout research has focused on its profound prevalence rather than seeking to identify the root cause of the burnout epidemic. Health care organizations throughout the United States are implementing committees and support groups in an attempt to reduce burnout among their physicians, but these efforts are typically focused on increasing resilience and wellness among participants rather than combating problematic changes in how medicine is practiced by physicians in the current era. This report provides a brief review of the current literature on the syndrome of burnout, a summary of several institutional approaches to combating burnout, and a call for a shift in the focus of these efforts toward one proposed root cause of burnout.

Arsalan, M., J. J. Squiers, M. A. Herbert, J. C. MacHannaford, T. Chamogeorgakis, S. L. Prince, B. L. Hamman, C. Knoff, D. O. Moore, K. B. Harrington, J. M. DiMaio, M. J. Mack and W. T. Brinkman (2017). “Comparison of outcomes of operative therapy for acute type a aortic dissections provided at high-volume versus low-volume medical centers in north texas.” Am J Cardiol 119(2): 323-327.

Full text of this article.

Immediate surgery is standard therapy for acute type A aortic dissections (TAAD). Because of its low incidence, many smaller cardiac surgery programs do not routinely perform this procedure because it may negatively affect outcomes. Many high-risk, low-volume (LV) surgical procedures are now preferentially performed in reference centers. We compared the outcomes of surgery for TAAD in high-volume (HV) and LV centers in a single metropolitan area to determine the optimal setting for treatment. Thirty-five of the 37 cardiac surgery programs in the Dallas Ft. Worth metropolitan area participate in a regional consortium to measure outcomes collected in the Society of Thoracic Surgeons Adult Cardiac Database. From January 01, 2008, to December 31, 2014, 29 programs had treated TAAD. Those programs performing at least 100 operations for TAAD were considered HV centers and the others LV. Surgery for TAAD was performed in 672 patients over the 7-year study period with HV centers performing 469 of 672 (70%) of the operations. Despite similar preoperative characteristics, operative mortality was significantly lower in HV versus LV centers (14.1% vs 24.1%; p = 0.001). There was no significant difference in postoperative paralysis rates (2.6% vs 4.5%; p = 0.196), stroke rates (10.7% vs 9.4%; p = 0.623), or 30-day readmission rates (12.1% vs 15.5%; p = 0.292). An improved survival rate in HV centers was maintained over a 5-year follow-up period. Surgery for TAAD in a single large metropolitan area was most commonly performed in HV centers. In conclusion, the treatment of acute thoracic aortic dissection is recommended to be performed in reference centers because of lower early and midterm mortality.

Squiers, J. J., B. Lima and J. M. DiMaio (2017). “A call for standardized end point definitions regarding outcomes of extracorporeal membrane oxygenation.” J Thorac Cardiovasc Surg 153(1): 147-148.

Full text of this article.

We read with great interest the letter from Darocha and colleagues1 regarding our recent review2 of extracorporeal membrane oxygenation (ECMO). It is clear that Darocha and colleagues1 deserve congratulations for their pioneering work toward implementing venoarterial ECMO to resuscitate patients with accidental deep hypothermia complicated by hemodynamic instability or cardiac arrest. Less clear, however, is whether the presented data truly “completes” a comprehensive review of contemporary ECMO, as they contend in their letter.