'Orthopedics has always been on the cutting edge': What we heard in May

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Spine and orthopedic experts in May spoke with Becker's about topics from patient questions to trends in innovation.

"The word that I would use to describe my outlook on the spine and orthopedic industry is "optimistic." I believe this is true both from the perspective of the spine and orthopedic industry manufacturers as well as from the perspective of the patient, physician and healthcare system. From the standpoint of the medical device and implant manufacturers, longer life expectancies and an aging population are expected to drive continued and accelerated growth of both of these arenas, increasing the need for orthopedic surgeries to address pathologies driven by degenerative changes, such as hip and knee arthritis or lumbar spinal stenosis. This is expected to lead to market sales reaching nearly $50 billion by 2028, with a compound annual growth rate of 3.3 percent by some estimates. Certainly, by this metric, the outlook for the industry and demand for orthopedic devices and implants is very optimistic. 

The outlook of the physician and the patient, however, is also similarly optimistic when exploring the nuances of the issue further. The increasing adoption of value-based care and, more recently, the COVID-19 pandemic, has spurred changes in how orthopedic surgeons practice and deliver care, with increasing attention paid to reducing costs, adhering to evidence-based treatments and devices, transitioning to outpatient surgeries or ASCs and streamlining implant and instrument needs in the operating room. This in turn has put pressure on the orthopedic and spine industries to cut costs for medical device design, manufacture and delivery." — Alexander Vaccaro, MD, PhD, of Philadelphia-based Rothman Orthopaedic Institute on one word to describe the spine industry.

"Patients in nearly all of our first initial encounters voice that they don’t understand the "why" of the surgery. I will start out by saying that not every patient should get a surgery, in even the busiest spine surgeon's office (i.e. the Oprah approach to surgery). The patients that do need an operation really need to understand what they are having done and the reason I or anyone is going to do it. Surgeons should be comfortable enough to be able to explain the philosophy of the operation and the reason why it is being done. The patients are entrusting their surgeon, their well-being in the hands of a stranger, more or less. Honesty and mutual respect is a great foundation for a good patient-doctor relationship. The trust established therein is a very strong bond, and it is the right thing to do for the patient." — Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles on common questions he hears from patients.

"Orthopedics has always been on the cutting edge as far as implementing the newest techniques and technology …. The ones that I foresee that are right around the corner or presently being implemented and touching patients revolve around biologics. I think that we are going to be thinking highly about how we are literally touching things at the molecular and cellular level and not always traditionally with our hammers and saws and chisels for what orthopedists are known for. I also think partnering with our data is important, and that could have a couple manifestations. As we move into a brand new realm of having a way to turn information into insight, this could help us render better care at the right time and monitor patient-reported outcomes. We in orthopedics have long prided ourselves of being the technocrats and the early adopters, developers and pioneers when it comes to bringing innovation," Thomas Graham, MD, of Lehigh Valley Orthopedic Institute in Allentown, Pa., on trends he sees growing in orthopedics.

"Over the past few years I have been transitioning my practice towards primarily outpatient procedures and performing them at ambulatory surgery centers. At this point the majority of patients in my practice who need a lumbar fusion, laminectomy, or a cervical fusion are able to go home the same day. Using our awake spine surgery protocols, we are able to discharge patients home the same day and have them take opioids for only a few days.

Many payers are pushing cost-cutting measures by changing the site of service of cases towards ambulatory settings. Doing a case in an ASC instead of a hospital requires more than a change in the site of service. It requires educating the patient properly, optimizing their health, and making sure they will be safe at home. In anticipation of payers using the ASC as a cost-cutting measure, I have been constantly refining our protocols to make the surgical process a great experience for the patient so that they recover safer, better and faster." Alok Sharan, MD, of Spine and Performance Institute in Edison, N.J. on cost-saving measures he's taking at his practice.

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