Dr. Adam Bruggeman: A spine surgeon's most important OR trait and bundled benchmarks in spine

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Adam Bruggeman, MD, is an orthopedic spine surgeon at Texas Spine Care Center in San Antonio. 

Before medical school, Dr. Bruggeman earned his masters in hospital administration at Trinity University in San Antonio. He completed a spine surgery fellowship at San Antonio-based South Texas Spinal Clinic and has been in private practice with TSCC for over five years.

Dr. Bruggeman shares his insight on the future of spine care, his non-negotiable patient safety rules and the most important trait for a spine surgeon to exhibit in the operating room. 

Question: What changes would you like to see in spine care over the next five to 10 years?

Dr. Adam Bruggeman: The future of spine care over the next five to 10 years will depend on a better understanding of the cost of care and participating in bundles. Spine surgery will be significantly impacted by bundled payments within the next decade. Without an understanding of what factors lead towards lower (or higher) costs of care, surgeons will be at significant risk of missing their bundled benchmarks. In addition, I would like to see a significant shift in implant use. The data is strongly in favor of titanium and post-processed titanium, yet our profession continues to overwhelmingly use various forms of PEEK products. We cannot continue to ignore the evidence that indicates best practices.

Q: Can you tell me some of your non-negotiable patient safety rules?

AB: I am board-certified in both orthopedics as well as addiction medicine with a special interest in reducing the use of opiates. We refer out and begin working on opiate reduction in all of our surgical patients regardless of the amount of opiates the patient is on prior to surgery.  

Q: What in your opinion is the most important trait for a spine surgeon to exhibit in the OR?

AB: Surgeons must be calm, cool and collected. I have been in ORs with classic surgeon behavior where they are demanding, yell, throw instruments and are generally difficult to be around. This behavior creates an environment where everyone is afraid to make a mistake, leading to poor choices as well as a lack of communication within the OR. Today's surgeons must take the cockpit mentality where the surgeon is in charge, but anyone at any time can provide input and potentially divert a disaster, regardless of their position or training. I find that a calm, cool, and collected surgeon not only demands more respect than those who are difficult, but they also encourage a team mentality in the OR.

Q: What do you see as the next big trend in spine?

AB: I don't think we are done with innovation in the intervertebral space. The next steps are refining the post-processing of titanium implants, balancing the right biologic graft with the right biologic implant, and understanding how porosity and surface technologies can work together to provide an optimal environment for fusion.  

While it is not a new trend, I also see a significant shift in the landscape of spine surgery. Many practices will be moving to over 50 percent outpatient surgeries, with some moving exclusively to outpatient procedures in hospitals or ambulatory surgery centers. 

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