vsa annual report 2017 - virginia surgery associates · 3.01.2018 · practices serving inova...

EXCEPTIONAL EXPERIENCE.

ADVANCED TECHNOLOGIES.

EFFECTIVE OUTCOMES.

VSA ANNUAL REPORT 2017

2 Virginia Surgery Associates

OUR MISSIONWe pledge to use the most up-to-date surgical practices, combined medical knowledge and the utmost concern for the well-being of our patients.

Quality Care | Compassionate Care | Timely Care

Annual Report 2017 3

CONTENTSWelcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Experience Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Patient Satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Minimally Invasive Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Robotic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Hepatobiliary Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Foregut Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Endocrine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Colorectal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Breast Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Other Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Our Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22


WELCOMEI am very happy to share Virginia Surgery Associates’ (VSA) Annual Report with you . We understand that sharing outcomes and survey data is still rather uncommon for physician practices . However, VSA has always been a leader in the field of surgery and strives to continually improve our processes and outcomes through data review .

VSA is a multi-specialty surgical practice offering advanced comprehensive care for your patients with acute, general, colorectal, gastroenterology, hepatobiliary, and endocrine surgical needs . With seven office locations and privileges at nine Northern Virginia hospitals and four Outpatient Surgery Centers, we provide timely access to surgical care for patients throughout Northern Virginia.

Our surgeons, advanced practitioners and staff are all committed to communicate, collaborate and integrate care with referring physicians

in ways patients want and that improve quality . We have demonstrated this by achieving NCQA’s Recognition as a Patient-Centered Specialty

Practice, the first general surgery practice to do so in the Commonwealth of Virginia .

I am confident you will find this report demonstrates VSA’s commitment to providing quality, cost-effective care for your patients .

Sincerely,

Robert F . Ahmed, MD Managing Partner


FOREWORDIn keeping with our core values, we have spent years honing our collective surgical experience, hand-picking the finest surgeons available to join our group, and providing the best surgical care available to patients in Northern Virginia, Maryland and DC .

We have always believed we provide some of the finest care anywhere, and now we have the numbers to prove it. Although there is no single universal standard to accurately judge quality and cost of care, certain metrics – length of stay and readmission rate, to name a few – are widely accepted as significant benchmarks. This report is meant to illustrate those benchmarks to our referring physicians and patients .

This report is one of the first of its kind for an independent surgical practice in this region. Since a team of researchers, statisticians, and administrative staff is normally required to generate the requisite data, most outcomes reporting is limited to major academic centers and hospital systems. However, the volume of our practice rivals that of many of these institutions . We now have the ability and responsibility to track our progress in achieving our goal to become the premier surgical care provider in the DC area .

This outcomes report covers surgeries performed for calendar year 2016 by Virginia Surgery Associates. It includes volumes for various fields and procedures, metrics for quality and cost of care, patient satisfaction, details of our practice, and programs offered . We hope this will allow our referring physicians and partners in care, the patients we serve, and the insurance providers with valuable information that will demonstrate our unwavering commitment to quality and allow comparison with other practices .

CLOSER LOOK

1,538

“Patient Surveys… show VSA surgeons consistently outperform national benchmarks” Read more in Quality (page 8)

“VSA’s general surgeons were the first to perform robotic surgery in Northern Virginia.” Read more in Minimally Invasive Surgery (page 11)

“VSA is the undisputed regional leader in hernia care,” Read more in Hernia Repair(page 12)

“VSA Surgeons performed 1,538 gallbladder surgeries in 2016, more than some states in the U.S.” Read more in Hepatobiliary Surgery (page 14)


OVERVIEW

About

Virginia Surgery Associates, P .C . (VSA) was founded by Russell P . Seneca, MD, FACS, FCM in 1978 . Since then VSA’s Surgeons have provided state-of-the-art surgical care for our patients with offices located in Annandale, Fairfax, Leesburg, Alexandria, Lorton, Reston, and Dulles . VSA is regarded as one of the premier surgery practices serving INOVA Fairfax Hospital, INOVA Fair Oaks Hospital, INOVA Loudoun Hospital, INOVA Alexandria Hospital, INOVA Mount Vernon Hospital, Sentara Northern Virginia Medical Center, Reston Hospital Center, StoneSprings Hospital Center and Virginia Hospital Center as well as four ambulatory surgery centers throughout the metropolitan area .

We are the only independent surgical practice in the region to offer the complete spectrum of surgical care, ranging from lifesaving trauma care to the most delicate minimally invasive procedures available . Our surgeons perform minimally invasive (Laparoscopic and Robotic) as well as open surgical procedures for the treatment of colorectal diseases, intestinal disorders, endocrine diseases, hepatobiliary diseases, GERD and other foregut issues, hernia repairs, benign and malignant breast diseases, acute care surgery and trauma .

VSA invests in our patients’ well-being through:

• An exceptional team of multidisciplinary and specialized Surgeons• Advanced tools and techniques for a faster recovery• Streamlined systems for an optimal patient experience• Multiple offices to serve you closer to home• More Surgeons for reduced time-to-surgery• Delivering quality outcomes

Leadership & Innovation

VSA physicians proudly uphold a tradition of leadership and innovation . Our surgeons have held important positions in the departments of surgery and in medical staff offices of most local hospitals throughout the history of the practice, in addition to regional and national surgical societies . VSA surgeons are looked upon as decision makers, role models and teachers, having received multiple awards from local and regional institutions, teaching programs, and consumer guides .

Most of our doctors have been involved in training students, residents, and other practicing surgeons in the art and science of surgery for years . Our surgeons are highly regarded educators who often travel to share their insights and skills with other health care professionals . When local surgeons from subspecialties such as gynecology, plastic surgery, urology, vascular surgery, pediatric surgery and orthopedics need help with difficult cases, it is often Virginia Surgery Associates to which they turn .

VSA surgeons are also known for being on the forefront of surgical innovation . Our surgeons have always been leaders in adopting new technology and techniques to provide better care to their patients . VSA physicians were the first locally to perform many minimally invasive procedures, such as gallbladder removal, appendix removal, hernia surgery, colon surgery, pancreas surgery, gastrectomy, spleen removal, spine access, parathyroid surgery and sentinel node biopsy. VSA surgeons were the first in the area to perform robot-assisted procedures. Our practice boasts the largest and most comprehensive hernia care center in the area . We continue to strive to identify and perfect the latest techniques to deliver the highest quality surgical care to our patients .

We are the only independent surgical practice in the region to offer the complete spectrum of surgical care.


EXPERIENCE MATTERSCutting-edge training is essential for surgical excellence . At VSA we hand pick new young surgeons from fully accredited residency and fellowship programs across the country to join our practice. Candidates are selected based on performance, recommendations from their attending surgeons, and demonstration of their commitment to surgery and willingness to participate in a team approach to care .

But at heart, surgery remains a practical discipline . Surgical volumes correlate with outcomes, and the more times your surgeon has done a procedure the better they will be at it . We have become the leaders in surgical care for the area due to our vast experience in treating surgical diseases .

The average surgeon in the US performs approximately 506 cases per year. At VSA our surgeons perform an average of 697 surgical procedures per year .

A common measure of surgical work experience is the wRVU. This stands for Work Relative Value Unit, and is the most used measure of surgical work volume in the US. The average General Surgeon in the US currently reports 6736 wRVUs per year. VSA surgeons report an average of 11,231 wRVUs per surgeon per year.

Unparalleled Experience

Our surgeons performed 7,836 surgical procedures in 2016, making VSA one of the busiest practices in the Mid-Atlantic .

We work with specialist surgeons in various disciplines to provide the best care possible for our patients . With additional training in robotics, minimally invasive procedures, hepatobiliary and pancreatic surgery, colorectal procedures, breast care, transplant surgery, endocrine surgery, trauma care, foregut procedures, hernia and abdominal wall reconstruction, our providers have a vast reservoir of knowledge and experience that we share with each other to enhance our ability to deliver excellent care, every time .

When you look for a surgeon, you want the practice that has the experience necessary to ensure your surgeon is comfortable with your problem . At VSA, we are proud to provide that .

Breast - 228Hernia Procedures - 2,741Stomach - 116Intestinal & Colorectal - 1,868

Average number of WRVUs*

per VSA surgeonin 2016

11,231per general surgeon

per year

6,736Average number of

surgical procedures per year

for a General Surgeon

506VSA Surgeons in 2016

697

7,836Total Proceduresfor VSA in 2016

Cholocystectomy - 1,538Liver, Pancreas & Spleen - 138Abdominal/Peritoneal - 356Thyroid/Parathyroid - 54

*Work Relative Value Unit - the most used measure of surgical work volume in the US.

VSA BY THE NUMBERS


PATIENT SATISFACTIONPatient Satisfaction is of the utmost importance to Virginia Surgery Associates .

The patient’s perspective is everything. No matter how superb the care delivered to a patient, if the patient perceives the physician as being cold, uncaring, or uncommunicative, he or she will not be happy. The days of tolerating the arrogant but talented surgeon are over. Not only is it common courtesy to help patients feel at ease while they experience the stresses of medical care, but studies have also shown an engaged, comfortable patient will feel better, and recover more quickly, even with fewer complications .

At VSA, we have taken this to heart . We have spent thousands of hours creating a library of patient education materials that are clear and informative . Appropriate teaching materials are given out to each surgical patient both before and after surgery to ensure a smooth episode of care. These documents are available for all on our website, free of charge, so that the public will be better educated about the surgical process and their conditions .

Patient Survey

Our office staff is trained in customer relations and their performance audited regularly. We listen to patient suggestions (and, naturally, the occasional complaint) and do our best to make process improvements so that patient concerns are addressed and suboptimal experiences are not repeated .

In the hospital, too, we work hard to make each patient’s stay as comfortable and low-stress as possible . Our mid-level practitioners (PAs and NPs) each concentrate on particular hospitals, ensuring continuity of care and the availability of a knowledgeable, sympathetic ear in the event an inpatient needs extra help navigating the surgical journey to wellness. Educational materials are passed out to our hospital patients explaining the phases of a hospital stay, the mechanics of rounds with the physicians each day, and a picture card so they can recognize the faces of the surgeons they see during their recovery .

The primary tool for accomplishing the goal of patient satisfaction is the patient survey. We participate with hospital-based surveys designed to capture the essence of the inpatient experience, including our performance as surgeons in the larger context of the hospital environment . We also have designed our own survey for our office, to ensure we can deliver the best experience to our patients in that environment as well. Data from these two surveys is exhibited below .

Quality

Quality is an elusive item to track down in an exact way. It is straightforward to see a healthy, satisfied patient whose disease has been cured by surgery, but much more difficult to measure precisely how well we do as surgeons and compare that to our peers. Many metrics have been developed to try to capture some objective measure of “quality,” but these are all somewhat flawed and clearly substitutes for actual quality of care, which is a much more subjective measure. Nevertheless at the present time, all the hard data we can generate revolves around different numbers collected by the hospital systems, outpatient centers, and surgical practices themselves . It is not easy to collect and analyze this information, which is why few independent surgical practices produce reports such as this . At VSA, however, we are committed to constant self-appraisal, analysis

National Average VSA

Communication with doctors

Doctors treat you with courtesy and respect

Doctors listen carefully to you

Doctors explain in a way you understand

Overall PracticeRating

Doctors listen and answer questions

Doctors explain in a way you understand

Quality of your medical care

Courtesy of the person who took your call

Inpatient Satisfaction Survey VSA Patient Satisfaction Survey

50%

50%

50%

50%

89%

79%

95%

77%

95%

94%

95%

95%

95%


of our outcomes, and improvement of our processes and patient care. Therefore we have pledged to produce a yearly assessment of these measures in order to achieve complete transparency for our referring physicians and our patients .

Interpretation of the above information can be tricky, but the bottom line is this: at Virginia Surgery Associates, we can demonstrate that, over an entire year of high-volume patient care, we achieve statistically equal or better results than many high-performing hospitals across the country in the areas of surgical complications and mortality, all while at the same time showing superior 30-day readmission rates, shorter length of stay, and significantly reduced costs to both the hospitals and the patients.

In addition, patient surveys generated by the hospitals and internally show VSA surgeons consistently outperform national benchmarks in communicating with patients, answering their questions, educating them about their diseases, and making them feel safe and well cared-for .

NCQA Recognition

Virginia Surgery Associates received NCQA Recognition as a Patient-Centered Specialty Practice (PCSP) for its responsiveness to patients and medical colleagues, cooperation and integration with other health care groups, and dedication to continuous improvement .

Virginia Surgery Associates met or exceeded national standards for:

• Communicating with primary care clinicians to exchange key information and establish coordinated care plans .

• Providing timely access to care and clinical advice based on patient need .• Using a systematic approach to track referrals and coordinate care. • Measuring and improving performance over time .

VSA is the first general surgery and colorectal surgery practice to achieve NCQA’s Patient-Centered Specialty Practice Recognition in Virginia .

50%Female

50%Male

2016 VSA Hospital Patient Statistics

Inpatient - 2,234Outpatient - 2,579

4,813Total Surgical Procedures

Average Age

Inpatient58

Years

Outpatient48

Years

Average Length of Inpatient Stay

3.90DaysVSA

4.15Days

NationwidePeer Group

30-Day Readmission Rate

9.60%VSA

10.45%NationwidePeer Group

Costs: VSA Nationwide Peer Group

Room and Board $6703 $7482

Pharmacy $1954 $2065

Diagnostic Imaging $628 $789

Central Supply $1118 $2555

Laboratory $586 $789


MINIMALLY INVASIVE SURGERYIn the 1990s, a surgical revolution took place. With technology originally invented by Urologists and General Surgeons, Gynecologists had developed a less invasive method to enter the abdomen and perform surgical procedures. Eventually, the benefits became apparent to other disciplines and suddenly to the public as well. Now everyone wanted the new Laparoscopic surgery. The first procedure to be performed regularly by general surgeons was laparoscopic cholecystectomy, the removal of the gallbladder .

VSA surgeons performed the first laparoscopic cholecystectomy locally, and over 15,000 gallbladders later we have never looked back . We have made a conscious effort from the early days of laparoscopy to push the envelope of minimally invasive procedures available in the Northern Virginia area. We have worked with local hospitals and surgery centers to assist in the design of minimally invasive surgical suites, our surgeons founded the first

laparoscopic simulator lab, and we have taught countless residents in the finer points of laparoscopic surgery. The list of minimally invasive “firsts” in the area that VSA surgeons have performed or participated in is nearly all-encompassing .

Our surgeons have taught students, residents, local surgeons, visiting surgeons, surgeons in other states and even other countries these complex procedures . We continue to help many local physicians in other specialties perform better surgery for their patients when a minimally invasive approach might be helpful . Our goal is to promote the benefits of this continuously evolving discipline for every patient in whom it might be appropriate and beneficial.

Finally, not only do we perform a lot of this kind of surgery, we do it well .It is rare we have to change plans and “convert” a planned laparoscopic surgery into an open one . We have far fewer bile duct injuries for our gallbladder surgeries than average . We also are participating in a nationwide program to make sure our hernias repaired by these methods stay repaired, and that our recurrences are less than average as well . In short, sometimes less surgery means more benefits.

Sometimes less surgery means more benefits.

2016 Minimally Invasive Surgical Procedures by Type

Appendix - 768

Hernia - 1,006

Gallbladder - 1,479

Stomach & Esophagus - 137

Colon - 274

Small Intestine - 67

Liver - 15

Dialysis Catheter - 52

Endocrine - 9

Other - 109

3,916Total


ROBOTIC SURGERYRobotic surgery is a specialized type of minimally invasive surgery that utilizes precision articulating laparoscopic instruments directed by a surgeon who works at a control console in the operating room. This technology has expanded our capabilities in laparoscopic surgery, allowing more freedom of movement for the active part of the instrument, and more controlled, precise actions than the unaided hand can produce . It is not a substitute for an experienced surgeon, just another tool we use in the operating room to provide the best care possible .

VSA’s general surgeons were the first to perform robotic surgery in Northern Virginia, and were early adopters of the da Vinci surgical robot now in use . We have worked hand-in-hand with local hospitals and equipment companies to design appropriate operating suites, ensure smooth rollouts of the platform, and offer novel procedures utilizing this exciting technology . Our physicians have introduced many new robotic procedures to

the area, including transanal robotic surgery, posterior adrenalectomy, and median arcuate ligament release .

Robotic surgery is not for everyone, and during a patient’s surgical consultation, if a minimally invasive approach to their problem is appropriate, suitability for robotic surgery will be assessed . If it makes sense to offer this approach, the surgeon will take the time to describe the procedure in detail, allaying any concerns the patient might have about this sometimes daunting technology . Rest assured: the surgeon is always in the room with the patient, directly controlling the instruments as they work .

Gallbladder - 91

Colorectal - 89

Gastric/Hiatal Hernia/PEH - 26

Inguinal Hernia - 96

Incisional/Ventral Hernia - 51

Other - 3

2016 Robotic Surgeries by Type


HERNIA REPAIRThe crown jewel in our comprehensive general surgery practice is our hernia program. With 2,742 hernia operations performed in 2016, the VSA Hernia Center treats more patients than any other program of its type in the region, and more than many academic programs .

The surgeons at VSA are committed to providing the finest and most up to date care available for the treatment of hernias . All members of our hernia center have received additional training beyond the standard surgical residency in minimally invasive, robotic and/or advanced abdominal wall reconstruction techniques . We frequently collaborate amongst ourselves or with local plastic surgeons to pool our knowledge, achieving a level of care usually only seen in major university settings.

We do our utmost to enhance the full spectrum of hernia care, from preoperative preparation and risk-reduction strategies, through state of the art surgical procedures using cutting edge techniques in a variety of operative settings, to extended postoperative follow up both to ensure our patients’ continued well-being and to monitor the effectiveness of our techniques over time .

We have worked hard to establish relationships with hospitals, surgery centers, equipment vendors and industry thought leaders so that our patients can benefit from a multi-tiered approach to this common but vexing surgical problem . At VSA we pledge to use the most trusted sources of surgical research data, the most innovative operative techniques, and the most efficient care strategies to stay on the forefront of hernia management .

VSA is the undisputed regional leader in hernia care. To the right we present some of our statistics for hernia surgery .

VSA participates in the Americas Hernia Society Quality Collaborative. This is a large group of surgeons throughout the Western Hemisphere with a specific interest in caring for patients with hernias. This unique group is committed to improving the quality of care for patients who undergo hernia surgery .

It requires a little extra effort on our part, and may involve regular contact with our patients to identify any postoperative issues with their hernia repairs, but we feel this initiative is important to advance the practice of hernia care worldwide . Only through the continued diligence of practicing surgeons will we see continued advances in the science of hernia repair for all patients . Only 208 surgeons worldwide so far have begun contributing to this database . We are proud to be members of this elite group .

2016 Hernia Repair Surgeries by Type

Laparoscopic Inguinal Hernia - 869

Open Inguinal Hernia - 471

Laparoscopic Ventral Hernia - 137

Open Ventral Hernia - 457

Epigastric Hernia - 47

Umbilical Hernia - 599

Spigelian Hernia - 4

Hiatal Hernia - 74

Paraeophageal Hernia - 56

2,714Total


How Does The AHSQC Work?During the routine care of your hernia, your surgeon collects information about you, your hernia, and how you do after hernia surgery as part of your confidential health care records.

Your surgeon will input information about you and your surgery into a confidential, secure registry maintained by the AHSQC. Only your surgeon, the AHSQC, and, in limited circumstances, the United States Food and Drug Administration (FDA) will have access to any information that identifies you.

Your identifiable personal health information (such as your name, birthdate, address, and health care treatment information) must be entered into the registry in order to make it useful for your surgeon’s and the AHSQC’s quality improvement efforts and so that the scientific validity of registry data can be tested. If available, your surgeon will also enter your email address, cellular phone number, and mailing address. Your personal health information, in an anonymous form (meaning your identity cannot be matched to your information), is combined with anonymous information from hundreds (or thousands) of hernia patients like you so that it can be used by those interested in improving hernia care other than your surgeon and the AHSQC.


HEPATOBILIARY SURGERY

Gallbladder

The number of gallbladder surgeries performed by VSA surgeons in 2016 – 1,538, to be exact – is greater than that performed by all doctors combined in several states. VSA surgeons were the first in the area to perform a laparoscopic cholecystectomy over 20 years ago, and ever since our surgeons have dedicated themselves to finding better and safer ways to perform this common operation. We currently offer a wide variety of techniques to remove the gallbladder, including:

• Standard laparoscopic cholecystectomy • Dome-down laparoscopic cholecystectomy • Single-site laparoscopic cholecystectomy • Robotic cholecystectomy • Open cholecystectomy

Our conversion rate from laparoscopic to open surgery is less than 1%, much better than the industry standard of 4%. This means shorter hospital stays, quicker recoveries, and happier patients. Our rate of bile duct injury is less than one-third of the typical 0 .2% reported in the literature .

Liver and Bile Duct Surgery

Our two fellowship trained hepatobiliary surgeons and our general surgeons work together to staff one of the most active programs in the area . VSA surgeons are skilled in all aspects of operating on the liver and bile ducts, ranging from minor biopsies of these organs to transplantation . In between these extremes is an array of procedures such as segmental or major liver resections, biliary endoscopy, operations for bile duct tumors, and correction or biliary injuries sustained during gallbladder operations from many area hospitals.

VSA surgeons have been regional pioneers in cryoablation of liver tumors, microwave ablation of masses (both via the open and laparoscopic approach), laparoscopic liver resections, and laparoscopic and robotic bile duct surgery . We have been instrumental in building hepatic surgery programs at multiple local hospitals .

The breadth of experience in hepatobiliary surgery at VSA in Northern Virginia is unequalled . We are committed to providing these services to our patients and referring physicians to maintain world class liver and bile duct care in our local geographic area . Patients can get the specialized care they need without traveling to an unfamiliar location, remaining with their families during their recovery and having access to important follow up care without a difficult commute.

Liver Resection - 33

Liver Biopsy - 36

Other Hepatic Procedures - 21

Major Bile Duct Surgery - 25

Other Bile Duct Procedures - 8

123Total

2016 Liver and Bile Duct Surgeries by Type


FOREGUT SURGERYVirginia Surgery Associates has long been the leader in foregut (esophageal and gastric) surgery in the DC area. With the largest breadth of experience in antireflux surgery, paraesophageal hernia repair and minimally invasive stomach surgery in Northern Virginia, we have spent decades building a program to serve the needs of these patients .

Our surgeons were the first to perform laparoscopic antireflux surgery at several local hospitals, and over the years we have refined the technique to such a degree that select patients are now having the procedure at outpatient centers and not even spending the night in a hospital. The more complex paraesophageal hernia repair, requiring more specialized training to complete, is now performed routinely on the surgical robot, enhancing our ability to reduce operative time and patient discomfort, while at the same time improving outcomes. This technique was perfected locally by VSA surgeons, in accordance with our commitment to always strive to advance surgical care in our area .

Our physicians regularly lecture to the community on these conditions, ensuring that the many individuals who suffer from GERD and potentially life-threatening paraesophageal hernia are made aware of the dangers of letting themselves go untreated .

Other esophageal surgeries include Heller myotomy for achalasia, and resection of gastroesophageal junction tumors. Most of these can be performed with minimally invasive techniques with excellent results .

Our gastric surgery program encompasses the full spectrum of benign and malignant diseases of the stomach . Small gastric masses can be removed with outpatient laparoscopic resections; larger ones may require a hospital stay . Open, laparoscopic and sometimes robotic techniques are part of our armamentarium of treatment options. Gastric cancers requiring major resections and lymph node dissections may be performed by all methods, and include not only partial but total gastrectomies for cure or palliation . All types of ulcer surgery are performed, ranging from emergency repair of perforations or life-saving operations for bleeding, to elective gastric resections or highly selective vagotomies for chronic ulcer disease . With the ability to combine the expertise of two or more surgeons for complex or difficult cases, we can provide the level of care needed for all surgical gastric disorders in the regional patient population .

2016 Foregut Surgeries by Type

249Total

Fundoplication - 74

Paraesophageal Hernia Repair - 55

Heller Myotomy - 2

Esophageal Repair - 2

EGD - 23

G-Tube - 27

Gastric Resection - 12

Repair of Perforation - 26

Other Gastric Procedures - 28


ENDOCRINE SURGERY The Endocrine system is a glandular system that regulates hormones in the body to allow for certain important functions . Endocrine surgery covers a broad array of procedures focused on the many glands that make up this complex system . Our surgeons perform operations on the thyroid and parathyroid glands, the pancreas, the adrenals, and in some cases the ovaries .

Thyroid and Parathyroid:

These important structures in the neck regulate the body’s metabolism and calcium, respectively. Operations on this area are delicate affairs, as there are many blood vessels to these glands, and nearby nerves and other structures are at risk for surgical injury. Several of our physicians are experienced in these procedures, and perform them on a regular basis at several area hospitals . We also boast the area’s only fellowship trained head and neck endocrine surgeon, for when a difficult or complex case presents itself.

Pineal Gland

Pituitary Glandand Hypothalamus

Thyroid andParathyroid Glands

Thymus

Pancreas

Adrenal Glands

Testicle (Male)

Placenta(Female, During Pregnancy)

Ovary (Female)


Some of these surgeries require only a few hours in the hospital, while others are more serious and may involve removal of the related lymph nodes in the neck, an involved procedure in which our head and neck specialist is skilled . VSA has some of the best experience in the world with videoscopic parathyroidectomy, designed to reduce scarring in the neck . While focused open surgery has now largely replaced this technique, it still remains available for select cases .

Regardless of the patient’s need, we have the breadth of experience in neck surgery to successfully treat the issue safely, efficiently, and at the hospital of your choice.

Pancreas

Pancreatic surgery is a highly specialized discipline involving multiple varieties of surgery on this fragile but important and sometimes deadly gland . Operations range from minimally invasive procedures requiring only an overnight stay to multihour two-surgeon cases for major resections . Whatever the problem, rest assured we have the expertise to handle it .

In the past, it was often necessary for patients to travel to large university surgical programs in other states to have these operations . Over the years, we at VSA have painstakingly built a world class pancreatic program here in Northern Virginia, so our patients can get the care they need in their own backyard, and are able to recover with their family members nearby .

Pancreatic cases we perform:

• Minimally invasive resections of low grade or benign lesions • Pancreatic debridement • Cyst jejunostomy• Cyst gastrostomy • Head, body, and tail resections• Whipple procedures• Operations for chronic pancreatitis

While our minimally invasive surgeons have set the standard for reducing the recovery needed for appropriate cases (VSA has the most extensive experience locally with laparoscopic pancreatic surgery), our two pancreatic/hepatobiliary surgeons have become the leaders in the field in Northern Virginia for more involved procedures. With fellowship training in liver, pancreas, and transplant operations, they have revolutionized the practice of pancreatic surgery in this area, and are now the destination for many patients in the surrounding counties and states. With a case volume rivaling many academic centers, you can feel comfortable that patients in NoVa have the care they need at hand .

Our practice also offers the only high risk pancreatic screening program in the area . Patients with multiple risk factors for pancreatic malignancy, such as family history or genetic abnormalities, among others, can meet with

2016 Thyroid Data

45Thyroid Surgeries

9Parathyroid Surgeries

0Recurrent Laryngeal

Nerve Injuries

Open - 19

Laparoscopic - 4

23Total

2016 Pancreatic Surgeries by Type


an experienced professional to discuss testing, long term screening and follow up, and when surgery might be needed . With this program, we hope to catch susceptible individuals before it’s too late for a cure .

Adrenal Glands

The paired adrenal glands sit on top of the kidneys, and are veritable factories of endocrine hormones . Located at very nearly the geographic center of the body, approaching them surgically can be daunting . While some complex cases may require the specialized services of our hepatobiliary/pancreatic surgeons, many adrenal surgeries can be performed via minimally invasive approaches that require less than 24 hours in the hospital . Our minimally invasive surgeons were local pioneers in the anterior laparoscopic approach, and then as other procedures were developed, introduced the posterior laparoscopic approach and most recently the first posterior robotic adrenal surgeries in the Mid-Atlantic region .

No other surgical practice in the area has our track record of experience, innovation, and successful surgical outcomes for adrenal gland surgery . We are happy to see any patients requiring adrenal surgery; we pledge our best to help them .

Ovaries

While normally the province of Gynecologic surgeons, the ovaries may require our attention as well . VSA surgeons are quite comfortable removing the ovaries in conjunction with breast cancer surgery, or as a preventative measure for those patients carrying one of the BRCA gene mutations . We perform these surgeries with laparoscopic techniques, and many patients do not require even an overnight stay . Our surgeons are pleased to offer these procedures to the appropriate patients .

No other surgical practice in the DC area has our track record of experience, innovation, and successful surgical outcomes for adrenal gland surgery.


COLORECTAL SURGERYVSA surgeons have been at the forefront of colorectal surgery in Northern Virginia for over 30 years. Our providers have performed thousands of these procedures, ranging from life-saving colon trauma cases to the most advanced robotic procedures available. We were the first to perform minimally invasive colon surgery in the area, when others said it couldn’t be done. Now laparoscopic colon surgery is routine. We were the first locally to perform robotic transanal surgery . Some day that will be routine, too, but now it is still a rarity and our practice is one of a few to offer it .

While all of our surgeons are fully trained in colorectal surgery and perform these procedures routinely, we also have 2 fellowship-trained colorectal surgeons in our group . These providers offer not only the full spectrum of standard colorectal procedures, but also are skilled in those cases that are out of the ordinary: complex anorectal problems, inflammatory bowel disease, and unusual conditions of the intestines. Together we work as a team to provide the population of Northern Virginia the largest volume of colorectal surgical care of any surgical practice .

We strive to make the stressful journey through these often major surgeries as comfortable and streamlined as possible for our patients . From extensive preoperative educational materials and informative consultations to in-house colonoscopies; from the widest selection of hospitals to the greatest depth of surgical experience, VSA is there to serve the patient as only we can .

We strive to make the stressful journey through these often major surgeries as comfortable and streamlined as possible for our patients.

2016 Colorectal Data

Core Measure VSA National AverageAvg Length of Stay (Days) 4.55 5.79

Post Operative Infections 0.00% 0.26%

Accidential Perforation 0.00% 0.10%

Hospital acquired DVT's 0.00% 0.24%

377Major Resections

626Other Colorectal Procedures


BREAST SURGERYIn our 39 years of service to the communities of Northern Virginia, VSA has always been at the forefront of breast care. Our surgeons have been early adopters of breast conservation surgery, in-office ultrasound and needle biopsies, strategies which have helped countless patients navigate their difficult journey through breast cancer and other diseases with the least disruption in their lives .

VSA introduced sentinel node technology to the area almost 20 years ago, saving countless women from the unpleasant side effects of axillary node dissection . More recently, VSA surgeons introduced partial breast irradiation strategies locally to minimize the effects of radiation on the breast . We constantly strive for ways to make the care of breast conditions more user-friendly for our patients .

With a large portion of our providers experienced in breast care, we can offer the flexibility of multiple offices and hospitals to our patients so that their care can be delivered in the location of their choice, with minimal travelling . We guarantee 24-hour turnaround for new breast patient appointments, reducing the stressful waiting that comes after finding a breast lump. Our certified oncology nurse navigator is truly dedicated to this group of individuals, and strives each day to comfort and care for our breast patients, smoothing their pathway back to health .

In addition, we have done our utmost to maintain a science-based approach to breast care . We have resisted the trend toward unnecessary preventative mastectomies for women who are not carriers of BRCA mutations or other genetic predispositions to breast cancer . We counsel our patients about the realities of this practice, reserving it only when it offers true benefits. We work with our oncology colleagues to provide BRCA genetic testing, genomic testing for chemotherapy sensitivity and recurrence risk stratification, and a seamless transition from surgical to non-surgical aspects of care . We also have a number of talented plastic and reconstructive surgeons we partner with to minimize the negative effects of cancer surgery on the breast . And all of this is done with attention to cost: VSA surgeons treat breast cancer and other diseases with less unnecessary expense compared with many other practices . Patients want the best care, not the most expensive care .

In our 39 years of service to the communities of Northern Virginia, VSA has always been at the forefront of breast care.

1 in 8

U.S. women will develop invasive breast cancerover the course of her lifetime

2017 Expected New Diagnoses

252,710invasive breast cancer

63,410non-invasive (in situ) breast cancer


OTHER PROCEDURESAt VSA we perform many other procedures; too many to list individually . Some types of surgery are worth mentioning .

Skin and Soft Tissue Surgery

This large group of cases includes major procedures for life threatening conditions such as melanoma, sarcoma, and necrotizing fasciitis (the so-called “flesh eating bacteria.”) Many minor procedures are taken care of in the office with no down time, others may require a brief visit to an outpatient center . Regardless of the severity of your diagnosis, rest assured we are proficient at dealing with this diverse group of issues .

Spine Access Surgery

While our Orthopedic colleagues perform the specialized procedures to repair and correct spine injuries and deformities, they often utilize the services of a general surgeon to gain access to the spine. Navigating through the abdominal wall and the separating the delicate vascular and intestinal tissues from the operative site is a service that VSA is known for . Many local spine surgeons rely on our doctors to get them safely to the area they need to operate on . We are the only local surgeons to have participated in laparoscopic spinal access, performing the first procedures at 3 local hospitals . Specialized training is required to perform these procedures, and we have made sure we are fully prepared to help the patients of Northern Virginia get the care they need when it comes to these complex operations .

Peritoneal Dialysis Access Surgery

For patients with renal failure who require life-saving dialysis, often the preferred choice is peritoneal dialysis . This process requires an implanted abdominal catheter for instillation of dialysis fluid into the belly cavity, after which it is then removed, taking with it the necessary waste products. Unlike traditional hemodialysis, this can be performed at home, often during sleep .

Our Nephrology colleagues rely on us to insert these catheters, and VSA provides this service at all area hospitals. VSA surgeons have pioneered and refined the least invasive methods to place these devices, typically avoiding any hospital stay or prolonged disability . With minimally invasive surgery, primary function is increased, and there are fewer wound complications in these fragile patients .

Splenectomy

When the relatively unusual operation for removal of the spleen is required, VSA surgeons have the experience and know-how to perform the procedure safely and quickly. We performed the first minimally invasive splenectomies at many of the hospitals in the area, dramatically reducing pain, wound complications, length of stay, and recovery time .

2016 Skin & Soft Tissue Surgeries by Type

Melanoma - 12

Other Cancers - 12

Pilonidal Disease - 123

Deep Soft Tissue Tumors - 82

229Total


OUR PROVIDERS

Physicians

Robert F . Ahmed, M .D ., F .A .C .S .

Barry F . Walter, M .D ., F .A .C .S .

Richard V . Brenner, M .D ., F .A .C .S .

Enoch M . Sanders, Jr ., M .D ., F .A .C .S .

Timothy R. Shaver, M.D., F.A.C.S.

Kathleen M . Cleland, M .D ., F .A .C .S .

Leonardo R . Espinel, Jr ., M .D ., F .A .C .S .

Hiral K . Patel, M .D ., F .A .C .S .

Ambar Matta, M .D ., F .A .C .S .

Laureen Forgione-Rubino, M .D ., F .A .C .S .

George J . Younan, M .D .

Paul E . Savoca, M .D ., F .A .C .S ., F .A .S .C .R .S .

Othon Wiltz, M .D ., F .A .C .S ., F .A .S .C .R .S .

Matthew H . Scriven, M .D .

Advanced Practitioners

Josilu Portella, PA-C

Kevin S . Fuller, PA-C

Alison K. Rude, ANP-BC

Lois K. Lee, FNP-BC

Danielle M . Eganhouse, PA-C

We always find the least invasive path to surgery so patients experience less pain, reduced complications, and shorter recovery times.

CONTACT US

Telephone 703-359-8640 Fax 703-591-6105

CONNECT WITH US

vasurgery

virginiasurgeryassociates

To request a patient appointment or for more information, visitwww.vasurgery.com

OFFICES

Fair Oaks 3620 Joseph Siewick Drive, Suite 406 Fairfax, VA 22033 Located on the campus of Inova Fair Oaks Hospital.

Annandale 3301 Woodburn Road, Suite 306 Annandale, VA 22003 Located near and within walking distance to INOVA Fairfax Hospital.

Leesburg 44055 Riverside Parkway, Suite 226 Leesburg, VA 20176 Located on the campus of INOVA Loudoun Hospital.

Alexandria 1800 N. Beauregard St, Suite 40 Alexandria, VA 22311

Lorton-Market Place 9455 Lorton Market Street, Suite 202 Lorton, VA 22079

Reston Office 1800 Town Center Drive, Suite 216 Reston, VA 20190 Located on the campus of Reston Hospital Center.

StoneSprings Office 24430 StoneSprings Boulevard, Suite 345 Dulles, VA 20166 Located on the campus of StoneSprings Hospital Center.

vsa annual report 2017 - virginia surgery associates · 3.01.2018 · practices serving inova...

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