David McAneny, MD, FACS, is Professor of Surgery and Associate Dean for Clinical Affairs at the Boston University School of Medicine (BUSM) and Chief Medical Officer and Senior Vice President of Medical Affairs at Boston Medical Center (BMC). Dr. McAneny’s clinical practice is devoted to endocrine surgery and surgical oncology, including operations for thyroid conditions (e.g., thyroid cancers, nodules, Graves’ disease, and goiters), parathyroid disease (e.g., primary hyperparathyroidism and renal hyperparathyroidism), adrenal tumors (e.g., aldosterone- and cortisol-secreting adenomas, pheochromocytomas, and adrenocortical cancers), pancreas tumors (e.g., cancers, neuroendocrine tumors, and cysts), and tumors and benign conditions of the gallbladder, bile duct, and upper gastrointestinal tract.
Dr. McAneny is the recipient of the 2005 Grant V. Rodkey Award, bestowed by the Massachusetts Medical Society for “outstanding contributions to medical education and medical students.” He was also the sole 2008 BUSM faculty selection for Alpha Omega Alpha, the national honor medical society. Dr. McAneny received the Erwin F. Hirsch, MD, Teaching Award from graduating Boston University Surgery Chief Residents in both 2009 and 2014; the Stanley L. Robbins Award for Excellence in Teaching, presented at the 2010 graduation to the “outstanding educator at the Boston University School of Medicine”; and the Educator of the Year Award in Clinical Sciences, conferred at the 2013 BUSM graduation ceremony. Dr. McAneny is the current President of the New England Surgical Society Scholars Foundation Board, a member of the Executive Committee of the New England Surgical Society, President of the Boston Surgical Society, Past President of the Massachusetts Chapter of the American College of Surgeons (ACS), and a former member of the Board of Governors of the ACS.
Under Dr. McAneny’s leadership, the Department of Surgery Quality and Patient Safety team seeks to develop a national model for providing high-quality care, particularly in a safety-net environment. The team successfully adapted, standardized, and even mandated Dr. Joseph Caprini’s venous thromboembolism (VTE) risk assessment model in the electronic medical record more than a decade ago. This protocol provides risk-based prophylaxis to minimize the chances of a patient developing a post-operative VTE, specifically deep vein thromboses and pulmonary emboli. This effort also includes extended courses of VTE prophylaxis beyond hospital discharge for selected high-risk patients. The VTE outcomes for General Surgery at BMC promptly improved from the 10th decile in 2008, in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), to the first decile (most favorable) during multiple reporting periods. The VTE odds ratios have remained less than 1.0 since 2011, most recently 0.76 (first decile) in 2020. Dr. Caprini refers to the BUSM/BMC program as the “Benchmark for the Nation.” The team has disseminated this formal VTE prophylaxis model among nearly all surgery services at BMC. The team is also developing a formal, electronic medical record-based protocol for “enhanced” VTE prophylaxis among patients identified as being at particularly high risk of suffering a post-operative VTE despite the Caprini protocol—those with combinations of emergency operations, multiple operations, and perioperative sepsis. These factors have been corroborated by a published analysis of NSQIP data incorporating more than 1.6 million patients.
In addition, the Quality and Patient Safety team created the “I COUGH” initiative for peri-operative pulmonary care, reducing the risk-adjusted likelihood of the NSQIP post-operative pulmonary complications (pneumonia, unplanned intubation, and duration of ventilatory support over 48 hours) among General Surgery patients at BMC from an odds ratio over 2.0 (10th decile) to below 1.0. The NSQIP odds ratio of a post-operative pneumonia is currently 0.69 (second decile in 2020). More than 100 medical centers and healthcare systems in the United States, the United Kingdom, Canada (7 medical centers from Nova Scotia to Vancouver), Australia (2), and India (1) have adopted this model. The Manchester University NHS Foundation Trust in England has adopted “I COUGH-UK” in its hospitals as a pilot for the National Health Service.
In General Surgery, the NSQIP odds ratio of any post-operative complication at BMC has declined from 1.05-1.22 (2009–2012) to 0.53-1.0 (2013–2020). The latest odds ratio, 0.77 in calendar year 2020, translates to the second decile of NSQIP (versus the 10th decile for overall complications at the inception of the Caprini and I COUGH initiatives). The efforts outlined above have supported four research fellows and have generated numerous manuscripts and presentations.
The Department of Surgery Quality and Safety team has been recognized with: the Massachusetts Hospital Association 2015 Accountable Care Compass Award for “excellence and innovation in the delivery of high-quality, safe, and efficient care”; America’s Essential Hospitals 2016 Honorable Mention winner of the Gage Award in the Quality category; and the ECRI Institute 2018 Health Devices Achievement Award “for excellence in health technology management and patient safety."