A Commitment to Excellence in Thoracic Surgery

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Kaiser Permanente Northern California centers dedicated to thoracic surgery increase surgical expertise and reduce complications and length of hospital stays.

The pain in Dr. Susan Brim’s chest started in December 2017. An emergency department physician at the Kaiser Permanente San Francisco Medical Center, Brim, 38, knew something wasn’t quite right, when, no matter what she did, the discomfort persisted.

After a CT scan showed a large lesion in her lung, she and her doctors assumed it was likely an infection — she was a young mother of 3, after all, and a non-smoker. But when initial tests didn’t show an infection, her doctors recommended a navigational biopsy, which she quickly scheduled with Melissa Tukey, MD, an interventional pulmonologist at the Kaiser Permanente Oakland Medical Center, the region’s largest of 3 Centers of Excellence for thoracic surgery.

Dr. Brim’s biopsy revealed lung cancer.

“It was a shock,” she recalled. “But my pulmonologist was able to immediately schedule a PET scan, and then referred me to see Dr. Jeffrey Velotta, a thoracic surgeon, who spearheads the Center of Excellence in Oakland.”

The Results

The National Cancer Institute estimates that lung cancer has a high mortality rate, accounting for 13.5 percent of all new cancer cases and 25.3 percent of all cancer deaths in the United States.

Dr. Brim is one of 1,600 patients who have benefited from Kaiser Permanente Northern California’s shift in 2014 to manage all thoracic cancer surgeries in designated specialty care Centers of Excellence — located in Oakland, South Sacramento, and Santa Clara. Kaiser Permanente Northern California is one of the first health care organizations in the country to implement this regionalized approach.

Recent research led by Dr. Velotta showed that regionalizing thoracic surgery in 3 centers resulted in the increased use of minimally invasive, video-assisted thoracoscopic surgery from 57% to 86%, contributing to lower complication rates, less postoperative pain, and higher quality of life compared to patients who had open surgery. In addition, the study showed that there was an overall decrease in length of stay and overall complication rates after patients were operated on at the centers.

“We wanted to pick the places with the highest number of thoracic surgeon specialists and where we were already doing a significant amount of lung cancer operations,” Dr. Velotta said of the locations. “Any patient from around the region can be referred to one of the centers. And our research shows that by regionalizing lung cancer surgery into 3 centers with highly trained, board-certified thoracic surgeons doing these surgeries, we were able to improve outcomes for our patients.”

‘Pioneering Work’

Hours after her surgery, which removed nearly half of her left lung, Dr. Brim was encouraged to get up and start walking, which is part of the Enhanced Recovery After Surgery (ERAS) program, a proven method to reduce complications such as blood clots and muscle atrophy, and a key part of the centers’ philosophy of care. She also received a long-lasting nerve block at the incision site, which greatly helped her manage the pain.

The following evening, Dr. Brim was able to go home to her family. “While the recovery was difficult, it made it so much better by being able to be at home,” she recalled.

Within a couple of months, she was back at work part-time and slowly resuming her usual activities; within 6 months, Dr. Brim felt close to fully recovered.

And since her doctors caught the mass at an early stage, she was considered cured after the surgery.

“I am so grateful for my experience with Dr. Velotta and the entire Oakland thoracic surgery team. They saved my life. As both a patient and a physician, I have such a huge appreciation for the pioneering work they are doing to take care of patients like me.”

Read more about Kaiser Permanente’s commitment to thoracic excellence.

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