Thoracic Surgery

Jessica Donington, MD, MSCR
Professor of Surgery
Chief, Section of Thoracic Surgery
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Maria Lucia Madariaga, MD, is an expert thoracic surgeon who specializes in complex airway disorders, lung cancer, lung transplantation and esophageal disease. Dr. Madariaga also has considerable experience in transplant immunology and large animal research. Moreover, she is the principal investigator of the Organ Perfusion Laboratory at the University of Chicago.

Sewing Together the Inner Workings of Thoracic Surgery:
Dr. Maria Lucia Madariaga Prehabilitates Patients Prior to Cancer Treatment

Sewing it all together

For Dr. Madariaga, the desire to be a surgeon began at an early age. As a child, she had a keen interest in anatomy. “I like cutting and working with my hands and sewing things,” she said. “As a kid, I dissected my pet goldfish when they died.” Dr. Madariaga’s ardent interest in the craft of sewing manifested a profound realization. As she got older, she made the striking correlation between sewing and healing, the patient aspect of it and how a surgeon establishes a deep connection to a patient—one to one.

As a surgeon, it’s a colossal responsibility to take a patient through a surgery; Dr. Madariaga was drawn to that relationship. “I also valued the fact that it’s teamwork,” she said.

“I really liked the fact that surgery is a team effort. We’re interdependent and we’re doing operations with high stakes.”

Maria Lucia Madariaga, MD
Assistant Professor of Surgery

Prehabilitation and partnership

Lung cancer prehabilitation is a fundamental opportunity to increase treatment options, reduce treatment-related morbidity, and improve physical and mental health outcomes. After a patient receives a cancer diagnosis, the prehabilitation process can include physical and mental health assessments to prepare the body and mind for the intensity of cancer treatment. Pinpointing current areas of concern and anticipating future complications are the first vital steps in improving surgical outcomes.

Since Dr. Madariaga arrived in the Section of Thoracic Surgery, she and her colleague, Professor of Surgery Mark K. Ferguson, MD, have been researching frailty and prehabilitation. “We recognize frailty as a syndrome where patients have different levels of strength or robustness going into their operation or hospital stay, and there are lots of different (intricate) ways to measure frailty,” she said.

In the field of thoracic surgery, patients tend to be older and have other pre-existing medical conditions; to that end, surgery is extremely detrimental to fragile bodies. Although minimally invasive, it’s still a serious surgery; it’s imperative that Dr. Madariaga and her team make sure the patient is fit for surgery. There are various measurements to determine, as fitness can be interpreted in different ways. “So, you have to put all these pieces together for how they function in their daily lives, how they can climb the staircase and how they can perform in different physical tests,” she said. “The number one thing to do is to establish how we identify frailty.”

Once established, Dr. Madariaga and Dr. Ferguson partner with anesthesiologist Daniel Rubin, MD, who is immensely interested in frailty and using technology to address it. “Anesthesia is the other half of the surgical coin; they see all of our patients,” said Dr. Madariaga. “They help us take the patient through a surgery.” Drs. Madariaga and Ferguson also partner with geriatrician Megan Huisingh-Scheetz, MD, who comprehensively evaluates vulnerable patients, from their cognitive ability and frailty status to their functionality. Together, they discuss the issues that surface with thoracic patients, identify who is frail and design a custom-made plan of care for each patient—a key factor to the program’s successful progression forward is partnership.

Dr. Madariaga can be seen here holding a Kelly clamp (left hand) which is used to probe the chest. In addition, she is holding ring forceps (right hand), which used to grasp the lung during surgery.

The collaborative nature of a multidisciplinary team makes for creative and methodical planning to care for thoracic patients. “I think that collaboration between all these different specialties is very helpful, because everyone has a different background coming into it,” said Dr. Madariaga. “You know, we might have a different approach of how we want to address and identify frailty.” The overall goal is to have a way to standardize frailty identification through screening. Once it’s identified that patients are at risk, Dr. Madariaga joins forces with her team of experts to determine what can be done before surgery, in the hospital and after surgery. As frailty is associated with worse outcomes post-surgery, she and her team scrutinize each case carefully and design a plan that will enhance the patient’s physical condition prior to treatment.

In the UChicago Medicine thoracic surgery clinic, frailty screening is performed for any patient coming in for surgery who is over the age of 50. While there is no ideal time to initiate prehabilitation prior to surgery, the general stance is that any bit of prehabilitation is better than none at all, and here at UChicago Medicine we have a mixture of prehabilitation options for patients.

We’re currently launching a monitored physical therapy program that incorporates high-intensity interval training (HIIT), which is a program that patients can have at home. There is an app that patients can download to their smartphones that sends them reminders to do daily exercise. The app has links and interactive videos to aid in improving their endurance, strength and flexibility, which is critical to optimizing surgical outcomes. “Through our working group we are establishing different options,” said Dr. Madariaga. “Different surgical specialties might have different requirements for prehabilitation, like orthopaedic surgery versus vascular surgery, so I think the options for prehab are wide.”

For the love of the game

Along with her clinical and academic pursuits, Dr. Madariaga is zealous about mentoring future surgical leaders and providing direction, insight and guidance as they move through their budding careers; a true mentor fortifies an educational ecosystem with ample encouragement and inspiration.

“A large part of the reason why I went into the field is because of my mentors; I was blessed by mentors who looked out for me.”

Maria Lucia Madariaga, MD
Assistant Professor of Surgery

For the up-and-coming surgeon, it is crucial to be situated amongst like-minded mentors who value excellence in patient care and surgical skills, and who collectively allow a safe educational space, like Chief of Thoracic Surgery Jessica Donington, MD, MSCR, whom Dr. Madariaga describes as “warm, down-to-earth, supportive and the best chief ever.”

“One of the things that a good mentor gives you is a safe space to make mistakes,” said Dr. Madariaga. “To make mistakes, it’s OK. It’s not the end of the world, you’re not a bad person and you gotta try again.” What she teaches trainees are valuable lessons from her own mistakes. “Like placing a chest tube, for example. Very simple procedure, but you could do it really well or not well at all, and there’s lots of different tips and tricks along the way to doing that, and I learned those because I made mistakes and then corrected them, and now, I pass it forward,” she said.

The winding road to the operating room requires a steady grip strengthened by passion, a sharp focus on the destination and the unrelenting desire to not only educate, but learn from others. “What I like to do is reassure them that anyone can really do it, as long as you love it,” said Dr. Madariaga. “Love for something can take you a long way through, and most things can be taught and improved with practice.”

Julian T. Owens
Department of Surgery Core Operations Manager
The University of Chicago Medicine

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faculty listing

Professor of Surgery
Jessica Donington, MD, MSCR, Professor of Surgery; Chief, Section of Thoracic Surgery
Mark K. Ferguson, MD, Professor of Surgery; Program Director, Cardiothoracic Fellowship

Assistant Professor of Surgery
Maria Lucia Madariaga, MD, Assistant Professor of Surgery

faculty honors

Jessica Donington, MD, MSCR, was honored as a Distinguished Leader in Program Innovation by the BSD. This award recognizes outstanding faculty leaders who have developed innovative programs that have improved the quality of the BSD and/or the Medical Center. She was chosen as a member of the American Surgical Association and as a Senior Faculty Scholar in the Bucksbaum Institute for Clinical Excellence.

Mark K. Ferguson, MD, successfully completed the third edition of Difficult Decisions in Thoracic Surgery: An Evidence-Based Approach.

Maria Lucia Madariaga, MD, served as founder and leader of the UChicago Medicine Convalescent Plasma Project. This NIH-sponsored effort collected plasma from more than 100 recovered COVID-19 patients for transfusion into severely ill COVID-19 patients and included research efforts with UChicago Medicine’s antibody laboratory. She now heads the Convalescent Plasma Working Group. She has several manuscripts under review or in publication in Nature, Immunology, Journal of Medical Ethics, and Journal of Internal Medicine for her research in convalescent plasma. Dr. Madariaga received a 2021 Respiratory Health Association Lung Cancer Research Award and a Carolyn Reed Traveling Fellowship. She was awarded the HDSI Innovation Grant for fall 2020. The grant will support her efforts around creating a frailty app that is custom-built to enable frailty screening and implement frailty-mitigation measures.

select publications

Jessica Donington, MD, MSCR

Chen M, Rosenberg J, Cai X, Hsuan Lee AC, Shi J, Nguyen M, Wignakumar T, Mirle V, Edobor AJ, Fung J, Donington JS, Shanmugarajah K, Lin Y, Chang E, Randall G, Penaloza-MacMaster P, Tian B, Madariaga ML, Huang J. Nanotraps for the containment and clearance of SARS-CoV-2. Matter. 2021 Jun: 4 (1-24).

Guthmiller JJ, Stovicek O, Wang J, Changrob S, Li L, Halfmann P, Zheng NY, Utset H, Stamper CT, Dugan HL, Miller WD, Huang M, Dai YN, Nelson CA, Hall PD, Jansen M, Shanmugarajah K, Donington JS, Krammer F, Fremont DH, Joachimiak A, Kawaoka Y, Tesic V, Madariaga ML, Wilson PC. SARS-CoV-2 Infection Severity Is Linked to Superior Humoral Immunity against the Spike. mBio. 2021 Jan 19;12(1):e02940-20. doi: 10.1128/mBio.02940-20. PMID: 33468695.

Jansen MO, Angelos P, Schrantz SJ, Donington JS, Madariaga MLL, Zakrison TL. Fair and equitable subject selection in concurrent COVID-19 clinical trials. J Med Ethics. 2021 Jan;47(1):7-11. doi: 10.1136/medethics-2020-106590.

Madariaga MLL, Guthmiller JJ, Schrantz , Jansen MO, Christensen C, Kumar M, Prochaska M, Wool G, Durkin-Celauro A, Oh WH, Trockman L, Vigneswaran J, Keskey R, Shaw DG, Dugan H, Zheng NY, Cobb M, Utset H, Wang J, Stovicek O, Bethel C, Matushek S, Giurcanu M, Beavis KG, di Sabato D, Meltzer D, Ferguson MK, Kress JP, Shanmugarajah K, Matthews JB, Fung JF, Wilson PC, Alverdy JC, Donington JS. Clinical predictors of donor antibody titre and correlation with recipient antibody response in a COVID-19 convalescent plasma clinical trial. J Intern Med. 2021 Apr;289(4):559-573. doi: 10.1111/joim.13185.

Mark K. Ferguson, MD

Best TD, Mercaldo SF, Bryan DS, Marquardt JP, Wrobel MM, Bridge CP, Troschel FM, Javidan C, Chung JH, Muniappan A, Bhalla S, Meyers BF, Ferguson MK, Gaissert HA, Fintelmann FJ. Multilevel body composition analysis on chest computed tomography predicts hospital length of stay and complications following lobectomy for lung cancer: A multicenter study. Ann Surg. 2020 Jul 8. doi: 10.1097/SLA.0000000000004040.

Chaddha U, Agrawal A, Bhavani SV, Sivertsen K, Donington DJ, Ferguson MK, Murgu S. Thoracic ultrasound as a predictor of pleurodesis success at the time of indwelling pleural catheter removal. Respirol. 2020;26:249-54. doi: 10.1111/resp.13937.

Madariaga ML, Guthmiller J, Schrantz S, Jansen M, Christenson C, Kumar M, Prochaska M, Wool G, Durkin-Celauro A, Oh WH, Trockman L, Vigneswaran J, Keskey R, Shaw DG, Dugan H, Zheng NY, Cobb M, Utset H, Wang J, Stovicek O, Bethel C, Matushek S, Giurcanu M, Beavis KG, di Sabato D, Meltzer D, Ferguson MK, Kress JP, Shanmugarajah K, Matthews JB, Fung JF, Wilson PC, Alverdy JC, Donington JS. Clinical predictors of donor antibody titer and correlation with recipient antibody response in a COVID-19 convalescent plasma clinical trial. J Int Med. 2020;289:559-73. doi: 10.1111/joim.13185. 228.

Bryan DS, Ferguson MK; members of the Delphi Lobectomy Cooperative. Consensus for thoracoscopic left upper lobectomy—essential components and targets for simulation. Ann Thorac Surg. 2020 Oct 27:S0003-4975(20)31739-2. doi: 10.1016/j.athoracsur.2020.06.152.

Chaddha U, Agrawal A, Feller-Kopman D, Kaul V, Shojaee S, Maldonado F, Ferguson MK, Blyth KG, Grosu HB, Corcoran JP, Sachdeva A, West A, Bedawi EO, Majid A, Mehta RM, Folch E, Liberman M, Wahidi MM, Gangadharan SP, Roberts ME, DeCamp MM, Rahman NM. Use of fibrinolytics and deoxyribonuclease in adult patients with pleural empyema: a consensus statement. The Lancet Resp Med. 2021 Feb 2:S2213-2600(20)30533-6. https://doi.org/10.1016/S2213-2600(20)30533-6. 230.

Rubin DS, Huisingh-Scheetz M, Ferguson MK, Nagele P, Peden CJ, Lauderdale DS. U.S. trends in elective and emergent major abdominal surgical procedures from 2002-2014 in older adults. J Am Geriatr Soc. 2021 May 10. doi: 10.1111/jgs.17189.

Maria Lucia Madariaga, MD

Dugan HL, Stamper CT, Li L, Changrob S, Asby NW, Halfmann PJ, Zheng NY, Huang M, Shaw DG, Cobb MS, Erickson SA, Guthmiller JJ, Stovicek O, Wang J, Winkler ES, Madariaga ML, Shanmugarajah K, Jansen MO, Amanat F, Stewart I, Utset HA, Huang J, Nelson CA, Dai YN, Hall PD, Jedrzejczak RP, Joachimiak A, Krammer F, Diamond MS, Fremont DH, Kawaoka Y, Wilson PC. Profiling B cell immunodominance after SARS-CoV-2 infection reveals antibody evolution to non-neutralizing viral targets. Immunity. 2021 Jun 8;54(6):1290-1303.e7. doi: 10.1016/j.immuni.2021.05.001. Epub 2021 May 6. PMID: 34022127.

Madariaga MLL, Soni ML, Mathisen DJ, Wright CD, Li S, Lee H, Davies D, Knoll S, Muniappan A, Lanuti M, Ott H, Gaissert HA. Evaluation Of Release Maneuvers After Airway Reconstruction. Ann Thorac Surg. 2021 Mar 6:S0003-4975(21)00453-7. doi: 10.1016/j.athoracsur.2021.03.001. PMID: 33689735.

Udelsman BV, Madariaga ML, Chang DC, Kozower BD, Gaissert HA. Concordance of Clinical and Pathological Nodal Staging in Resectable Lung Cancer. Ann Thorac Surg. Aug 24:S0003-4975(20)31355-2. PMID 32853566.

residents & fellows

View the Cardiothoracic Residents and Fellows here.