'The only constant is change': What we heard in November

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Spine and orthopedic experts and leaders in November spoke with Becker's Spine Review about topics from controversial industry trends to advice for young surgeons.

1. "Seek out collaborative partners who share the same vision. So while they may not be able to deliver those resources under their own roof, they can certainly collaborate with colleagues in their area who share the same goals and vision for achieving the highest outcomes over an episode of care. It's critical because I want to emphasize this notion that we're in this "outcomes economy" now. I know that we've been driving towards better value and better outcomes, and the payers are still trying to figure out the business model on that. But I think even more so, patients are so much more aware of it now post-COVID-19 that they want to have surgery on an outpatient basis. They want to limit opioid use after surgery. And they want an enhanced/faster recovery. Patients themselves are so much more sensitive to achieving an outcome beyond just getting rid of their pain and having a successful surgery," Alok Sharan, MD, on how spine groups can improve holistic care for patients.

2. "By far, the participation of non surgeons in spine surgery remains a for controversial topic. Both the AAOS, NASS, and AANS/CNS joint section on Spine and Peripheral Nerves have put out statements discouraging nonsurgeon colleagues from performing fusions. It is unfortunate some will operate on patients, creating abnormal motion segments, causing iatrogenic deformity, fractures, or even serious infections and then refer the patients to surgeons, sometimes without warning, and avoiding accountability. The main thing to remember in surgery is that if you cannot fix the complication, do not do the operation. We need partners in caring that are not engaging in questionable or even dangerous operations that can harm patients in the name of revenue generation," Brian Gantwerker, MD, on what he believes is the most controversial trend in spine surgery.

3. "Keeping the patient at the center of everything we do comes naturally as physicians, but there are so many forces that push us towards increasing volumes, increasing productivity. At the end of the day, the most important thing is doing what is right for every patient. Whether joining a health system or private practice, look for that cultural fit that helps you succeed, stay true to your values, and supports you as you build your practice. The only constant is change. We are likely to face many changes in the coming years and decades to how we practice and even how we are compensated. Find the opportunities in those changes to continue growing as a surgeon," Vijay Yanamadala, MD, on his advice for graduating spine residents and fellows.

4. "AI and machine learning will drive better outcomes in spine surgery within the next 10 years. The most difficult aspect of spine surgery is deciding on the correct operation for the correct patient. There are many variables at play that determine a successful surgical outcome for a patient. AI/machine learning will use these variables to help support our surgical decision making. Reducing the variability in decision making will help drive better patient outcomes, reduce complications, and reduce healthcare spending," James Dowdell, MD, on his predictions for AI and machine learning in spine surgery.

5. "The future of spine surgery in the inpatient setting remains promising as it has been throughout its history. Although many spine procedures are transitioning to the ambulatory or outpatient setting, the beauty and uniqueness of spine surgery is its variety and complexity. There will always be spine surgeries that should remain in the inpatient setting for the safety of the patient. Some examples include deformity correction, malignancy, and complex trauma. Such cases require the appropriate equipment, operating room technology, and multi-specialty support staff that primarily reside in the inpatient setting. With that being said, I believe that hospitals and health systems should prioritize healthy relationships with spine surgeons by supporting both inpatient and ambulatory surgery endeavors. This can be accomplished, and in some already existing circumstances, by supporting spine surgeons and patients with both clinical and technological support in both [inpatient and ambulatory] settings. By doing so, spine surgeons would be able to reliably perform outpatient surgeries when appropriate, minimizing costs to our healthcare system, maximizing patient care efficiency and ultimately optimizing inpatient utilization for more complex spine surgeries," Emeka Nwodim, MD, on the future of inpatient spine surgery.

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