From left: Grant Bochicchio, MD, MPH, and Steven Jarman, RN, BSN.

Acute and Critical Care Surgeons at Barnes-Jewish Hospital, a regional referral center for critically ill patients and designated Level I Trauma Center by the State of Missouri, specialize in traumatic injuries, emergency surgeries, geriatric trauma, general surgeries, burn and wound care, and critical care. These surgeons collaborate with intensivists from the Washington University Department of Anesthesiology and Division of Emergency Medicine. Trainees are exposed to a large, diverse patient population, treating complicated cases on several intensive care units. 

6,813

Operating room cases

55,889

Visits

33

Faculty

2,060

Office procedures

79

Clinical research studies

$898,106

Research funding

Section of Acute and Critical Care Surgery | 2021 Annual Report

Training Leaders in Surgical Critical Care

The Surgical Critical Care (SCC) Fellowship at Washington University School of Medicine and Barnes-Jewish Hospital, led by Program Director Sara Buckman, MD, PharmD, provides advanced training in the treatment of the most critically ill patients. Buckman became fellowship director in 2020, continuing the high level of training offered by Professor of Surgery Douglas Schuerer, MD, who was program director for 11 years. Schuerer and Melissa Stewart, MD, serve as associate program directors. 

ACCS Steps Up for COVID Care

In the early days of the pandemic, when elective surgical procedures were paused, leaders from every division and section came together to ensure that the Department of Surgery safely continued its mission as a national leader in surgical innovation, research, training and health equity. For ACCS surgeons, this meant stepping up to face the challenges of COVID patients and other emergency cases head-on. 

Section of Acute and Critical Care Surgery Highlights | 2021 Annual Report

Surgeon operating DaVinci robot.

Clinical 

The use of robotic surgery at Washington University has been on the rise in recent years. Specialties including bariatrics, hernia repair and urologic surgery have adopted the technology for its smaller incisions, enhanced visualization and range of motion. ACCS surgeons at the medical school are among the first in the country to investigate the role of robotics in acute and critical care surgery. Obeid Ilahi, MD, has introduced robotics for select surgeries, while Kelly Vallar, MD, pursues further fellowship training in robotic surgery. “If this cutting-edge technology ultimately proves beneficial to what we do as emergency surgeons, we will be at the forefront in adopting robotics to our practice,” says ACCS Section Chief Grant Bochicchio, MD, MPH. 

Grant Bochicchio, MD, MPH.

Research 

The Prehospital Airway Control Trial (PACT) is now enrolling randomized patients to investigate two strategies for airway management. PACT is a clinical trial funded by the United States Department of Defense to study the use of endotracheal tubes and supraglottic airways to help trauma patients breathe. Chief of Acute and Critical Care Surgery Grant Bochicchio, MD, MPH, is the Washington University Principal Investigator for this national trial, which includes study sites across the LITES (Linking Investigations in Trauma and Emergency Services) Network. PACT began enrolling patients this year and will continue for four years. 

From left: Jessica Kramer, MD, and Piroska Kopar, MD.

Education 

The Washington University Center for Humanism and Ethics in Surgical Specialties (CHESS) has introduced a new Surgical Ethics Fellowship. This year-long academic program, led by CHESS and Surgical Ethics Fellowship Program Director Piroska Kopar, MD, prepares fellows for difficult situations in which they must determine what ought to be done for a patient. Inaugural fellow Jessica Kramer, MD, who is a member of the Barnes-Jewish Hospital ethics committee, received the 2020-21 Evarts A. Graham Teaching Award for her commitment to surgical residency education and training. Kramer is joined by CHESS fellowship graduates Kelly Vallar, MD, Leah Conant, MD, and Paul Kepper, MD. 

Sara Buckman, MD, PharmD.
Douglas Schuerer, MD.

Training Leaders in Surgical Critical Care

The Surgical Critical Care (SCC) Fellowship at Washington University School of Medicine and Barnes-Jewish Hospital, led by Program Director Sara Buckman, MD, PharmD, provides advanced training in the treatment of the most critically ill patients. Buckman became fellowship director in 2020, continuing the high level of training offered by Professor of Surgery Douglas Schuerer, MD, who was program director for 11 years. Schuerer and Melissa Stewart, MD, serve as associate program directors. 

Jordan Kirsch, DO, completed the fellowship in 2021 and joins the faculty as an instructor of surgery while he continues his advanced training with an Acute Care Surgery fellowship. 

“Our program’s goal is to train general and specialty surgeons as leaders in surgical critical care,” says Buckman. “Dr. Kirsch was very accomplished during his SCC fellowship. Despite his busy clinical schedule, he was able to work on several projects, publish papers and hold committee positions in national organizations.” 

At Barnes-Jewish Hospital, Kirsch collaborated with Stewart and Obeid Ilahi, MD, on the development of the ACCS non-elective small and large bowel pathway. His abstract titled “ROTEM versus Conventional Assays in Prediction of Worsening Traumatic Intracranial Hemorrhage” was accepted for presentation at the Society of Critical Care Medicine. Another project, focused on predicting the need for tracheostomy after cervical spinal cord injury, was accepted for presentation at the Western Surgical Association Annual Meeting in November 2021. 

Kirsch is a member of the Guidelines Committee of the Eastern Association for the Surgery of Trauma (EAST), where he is currently involved in several clinical trials. He is also a member of the research and publications committees of the Chest Wall Injury Society. During fellowship, Kirsch published work in high impact journals including Injury and the Journal of Trauma and Acute Care Surgery. 

“The opportunity to work with the renowned multidisciplinary faculty and the privilege to care for such a diverse patient population make this fellowship experience unparalleled,” says Kirsch. “Beyond the clinical realm, I was constantly challenged and mentored to develop my leadership, research and teaching skills.” 

The Surgical Critical Care Fellowship continues to grow as a leader in acute and critical care surgical training. Beginning in the 2022-2023 academic year, the fellowship will offer two training options: a one-year Surgical Critical Care fellowship and a two-year Surgical Critical Care/ Acute Care Surgery fellowship. 

From left: Tiffany Osborn, MD, MPH, and Shawn Reynolds, MSPA, PA-C.

ACCS Steps Up for COVID Care

“Our faculty were in the trenches from day one,” Section Chief Grant Bochicchio, MD, MPH, says of Washington University acute and critical care surgeons treating COVID-19 patients at Barnes- Jewish Hospital. 

In the early days of the pandemic, when elective surgical procedures were paused, leaders from every division and section came together to ensure that the Department of Surgery safely continued its mission as a national leader in surgical innovation, research, training and health equity. For ACCS surgeons, this meant stepping up to face the challenges of COVID patients and other emergency cases head-on. 

“We were in the ICU and the trauma bay,” says Bochicchio. “We were staffing COVID ICUs in addition to our usual staffing model. Trauma cases increased. Little was known about the transmissibility of the virus when COVID first hit. It was an extremely stressful time, but our faculty faced these challenges with strength and dedication to our patients.” 

Among those on the front lines of COVID care was Professor of Surgery and Emergency Medicine Tiffany Osborn, MD, MPH. While working in the ICU and emergency department, Osborn witnessed firsthand the devastating impact of COVID-19. In March 2020, Osborn purchased an RV, where she lived for an entire year to protect her family from risk of exposure to the virus. 

Over the past year, Osborn has been featured on NPR and CNN, as well as in radio interviews and local media, where she educates the public and advocates for health-care workers. She co-directs the COVID Critical Care Committee, the Convalescent Plasma Program, and Contingency and Crisis Standard of Care at Barnes- Jewish Hospital. Earlier this year, Osborn wrote a feature for the Riverfront Times, reflecting on the experience of working in a COVID ICU during the January 6 Capitol insurrection. 

“We are not defined by what occurred. We are defined by how we respond,” she wrote. In a conversation with St. Louis Public Radio, Osborn described the response she saw to COVID and political unrest as “everyday people, in and out of medicine, creating good with what they have: strength, integrity, civility, kindness. People who were coming together and standing shoulder to shoulder to do what they needed to do for thecommunity.” 

The section continues its commitment to COVID care through innovative clinical investigations to improve outcomes for COVID-positive patients. Bochicchio, who is the Harry Edison Professor of Surgery, is Washington University Principal Investigator of the NIH-funded ACTIV-4 clinical trial comparing the effectiveness of antithrombotic strategies to prevent adverse outcomes in COVID patients. The School of Medicine is the only site in Missouri enrolling patients in the trial, which aims to improve COVID care through an evolving study of anticoagulation therapies.