The Bariatric Surgery Center includes two surgeons, nurse practitioner, three dieticians, nurse coordinator, patient navigator and scheduler, psychologist, physical therapist, personal trainer, and plastic surgeons. Volumes continue to grow, and to meet these needs, a third surgeon joined the team in August 2017.
We have had re-accreditation as a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSQIP) Comprehensive Bariatric Care Center. During our last accreditation we were cited as exemplary practice in multiple areas. One example is reducing readmission rates with emphasis on discharge instructions, early post-discharge phone call follow-ups, and IV hydration in the outpatient clinic. Another example is reducing our urinary tract infections by avoiding catheters in a majority of patients.
We offer Roux-en Y Gastric Bypass, Sleeve Gastrectomy, and Lap Band operations for weight loss, with a slight majority being Sleeve Gastrectomy. We offer revisions of prior surgery and a growing number of patients are tertiary care referrals for weight loss failures or complications. Our inter-disciplinary weight loss program with our Medical and Gastroenterology colleagues offers pharmaceutical and endoscopic options, including the intra-gastric balloon and aspiration tube.
Strong collaboration continues with the Children’s Hospital Colorado. Research focuses on clinical data review and clinical and basic science collaboration with Anesthesiology, Hepatology, and Endocrinology. We obtain tissue samples to evaluate liver, subcutaneous adipose, visceral adipose, and intramuscular fat content.
Dr. Jonathan Schoen is the founding President of the Colorado State Chapter of the American Society of Metabolic and Bariatric Surgeons and successfully lobbied the State Department of Insurance to change the Affordable Care Act benchmark plan to include bariatric surgery. To date, Colorado has been the only state plan to change to coverage. We have been invited to update and reform the Medicaid bariatric coverage, which is scheduled to take place in the fall of 2017.
Our goal remains to provide better patient access, increasing patient volumes, and superb outcomes, with patient safety and satisfaction our highest priority.
The Burn Center at University of Colorado Hospital is the only burn center in the State of Colorado—and the entire Rocky Mountain region—to be verified by the American Burn Association. The Burn Center is the main referral to the surrounding regions including Wyoming, New Mexico, Montana, North and South Dakota, Nebraska, and Kansas.
The program experienced a 25% increase in total new-patient admissions in 2016. The Center has expanded from a nine-bed ICU to 19 inpatient beds with designated ICU, step-down, and floor beds, as well as three outpatient consult rooms within the Center. The Burn Center has also expanded its mid-level provider coverage. Other new additions within the last year include a full-time pharmacist, research assistant, and clinical coordinator. A new dedicated clinical psychologist will join soon.
For patients who arrive within our ED, a new Burn Notification system with Burn Activations and Alerts has been initiated. The five-day-per-week outpatient burn clinic is able to schedule approximately 10% of all patient visits as same-day appointments.
Burn education and prevention is an important part of the Center’s work, with over 150 community outreach activities annually. The team works with groups such as electrical linemen and glassblowers, reaching out to businesses to help educate their staff on the importance of safety procedures, how to care for themselves and co-workers if an injury occurs, and typical treatment in a Burn Center.
We provide continuing education to all levels of providers. The Burn Team provides Advanced Burn Life Support (ABLS) certification courses in the Burn Center as well as on the road. Our format combines online didactic education with high-fidelity, hands-on simulation. In 2016, we certified 96 providers in the Rocky Mountain region.
Burn and fire prevention is a pillar of our Burn Center. The Team participates in campaigns to teach “Stop, Drop, and Roll,” checking smoke detectors, how to extinguish grease fires, and proper temperature settings on hot water heaters. The team partners with local fire departments to identify areas for further reinforcement.
Frostbite is a risk to our community that can be prevented with correct precautions. The team raises money each winter to purchase socks, boots, and other cold-weather apparel to be distributed to our homeless and indigent neighbors.3
The Colorectal Surgery Section experienced continued growth in procedural volume over the past year. Inclusive of the Anschutz inpatient operating rooms, Anschutz outpatient operating rooms, and the Lone Tree Ambulatory Surgery Center, the total number of cases increased from 465 cases in 2015 to 507 cases in 2016 (a 9% increase in case volume).
In September 2017, the Colorectal Surgery Section expanded from two to three surgeons with the addition of Dr. Elisa Birmbaum, MD, who joined the section as a Professor of Surgery and Co-director of the Anorectal Physiology Laboratory at University of Colorado Hospital. She will add extensive experience and expertise in the surgical management of pelvic-floor diseases in addition to all aspects of colorectal surgical care.
The Colorectal Cancer Multidisciplinary Clinic continued to grow and thrive in 2016 with the addition of Whitney Herter, NP-C, as the full-time clinic manager.
Robotic colorectal surgery operations have become standard procedures under the guidance of Dr. Michelle Cowan, MD, Assistant Professor of Surgery, who performed over 20 of these procedures in 2016. Other noteworthy achievements in 2016 include:
- Six surgeons from around the country participated in a laparoscopic colorectal surgery training program that included didactics, live surgery, and cadaver-based training. All of this occurred over 2 days, at the University of Colorado, with support by Applied Medical, Incorporated.
- Dr. Michelle Cowan received her certification in Colorectal Surgery from the American Board of Colorectal Surgery.
- Dr. Vogel initiated a multicenter trial to determine the optimal timing of ileostomy reversal after J-pouch surgery in patients with Ulcerative Colitis.
The Endocrine Surgery section provides expertise and comprehensive care for thyroid nodules and cancer, thyrotoxicosis, hyperparathyroidism, adrenal neoplasms, pancreas neuroendocrine tumors, gastrointestinal neuroendocrine tumors, and multiple endocrine neoplasia.
The Endocrine Section runs multidisciplinary clinics with Endocrinology, Oncology, Radiology, and Nuclear Medicine for adrenal cortical carcinoma and advanced thyroid cancer.
A multidisciplinary pediatric thyroid nodule and cancer program has been developed at Children's Hospital Colorado with Pediatric Surgery and Endocrinology. The program has already grown into one of the largest volume programs in the country. An important component of the program is a smooth transition of the pediatric patient into adult survivorship.
Christopher Raeburn, MD, serves on the Thyroid Carcinoma Guideline Panel for the National Comprehensive Cancer Network. Maria Albuja-Cruz, MD, has developed clinical pathways for outpatient thyroidectomy and prevention of postoperative hypocalcemia, significantly reducing admissions following thyroidectomy and decreasing the length of stay of admitted patients. Community outreach and education have been a major focus over the past two years. Under the lead of Robert McIntyre, Jr., MD, our Endocrine surgeons meet frequently with local endocrinologists and primary care providers as well as giving invited presentations.
Translational research programs in collaboration with Endocrinology utilize large and growing thyroid-tumor and adrenal-neoplasm tissue banks. Along with a comprehensive patient database, observations in the lab are correlated to patient outcome. In the first 4 months of 2017 alone, the Endocrine Surgery section has had research presentations on Hyperparathyroidism at the Academic Surgical Congress in Las Vegas, three different presentations on Adrenocortical Carcinoma at the Endocrine Society in Orlando, and a presentation on Outcomes of Children and Adolescents with Papillary Thyroid Carcinoma at the Southwestern Surgical Congress.6
Patients with common GI diagnoses such as hiatal hernia, gastro-esophageal reflux disease (GERD), and complex hernias are treated by specialty surgeons in this section.
Dr. Paul Montero is specialty trained in minimally invasive approaches to managing serious abdominal-wall problems, including complex primary and recurrent hernias. Using conventional and advanced minimally invasive techniques, he restores abdominal-wall function in the most challenging patients with complex health issues such as liver disease or immunosuppression from chemotherapy or organ transplantation. Hernia-specific training, state-of-the-art materials and technology, and a host of medical specialist consultants enable him to address a wide spectrum of hernia problems with individualized plans, including concomitant cases with other surgical disciplines.
Protocols with our anesthesia colleagues offer advanced, multimodal pain-management plans, including perioperative regional blocks and epidural analgesia. We recently completed a randomized controlled trial studying an absorbable local anesthetic implant during inguinal hernia repairs.
Dr. Montero also instructs surgical trainees in abdominal-wall reconstruction techniques using simulation and tissue labs at our Center for Surgical Innovation. Over the last two years, five surgical-skills labs were dedicated to abdominal-wall-specific training, including component separation and mesh techniques.9
The section of Trauma – Acute Care Surgery (TACS) and Critical Care is one of the busiest services at University of Colorado Hospital. Trauma volume continues to grow as the stature of the UCH trauma program increases in the local Denver metropolitan area, the state of Colorado, and the Rocky Mountain region. Catherine Velopulos, MD, MHS, FACS, and Lisa Ferrigno MD, MPH, most recently joined the program. Both have master’s degrees from the Johns Hopkins School of Public Health and bring years of clinical research experience. Two additional surgeon recruits will be arriving in the fall of 2017.
Emergency-department growth at University of Colorado Hospital (UCH) has also led to significant increase in our Acute Care Surgery practice. New Physician Assistants have increased the capability of the service to meet the patient demand. We are forming a second TACS service at UCH starting in the summer of 2017 to meet demand.
The average daily census for the 24-bed Surgery-Trauma ICU continues to increase and allows the Critical Care Program to provide care for General Surgery, Oncology, Transplantation, Head and Neck, Gynecologic Oncology, Urology, and Spine.
Expansion of the TACS and SCC fellowship program has increased the number of training positions to meet the future workforce needs. The SCC fellowship enjoys close collaboration with other ICU services at University Hospital working with Cardiothoracic Surgery, Neurosurgery, and Burn.
We have also expanded research programs with the addition of Elizabeth Kovacs, PhD, who focuses on advanced age, alcohol intoxication, burn, and radiation exposure on inflammatory responses after injury or infection. Erik Peltz, MD, leads a project within the P50 Trauma Center Grant. Catherine Velopulos MD, MHS, FACS, is a member of the Intentional and Unintentional Violence Workgroups in the CU School of Public Health and has been accepted into the 2017-2019 cohort of the Clinical Faculty Scholars Program. Frank Wright, MD, is spearheading quality-improvement projects to optimize practice standards at UCH. Lisa Ferrigno, MD, is leading our multi-institutional research efforts across the UCHealth System. This work has resulted in numerous publications, presentations, lectures, and outreach activities. The group has successfully executed several recent multicenter trials with the Western Trauma Association and Southwestern Surgical Congress. Our efforts focused on reduction of high-cost, low-value imaging and enhanced recovery after acute general surgical conditions have yielded results, with improved quality and decreased costs driving high-value surgical care.8