Dr. James Chappuis on how to improve OR efficiency and deliver cost-effective spinal fusions

Written by Alan Condon | September 11, 2019 | Print  |

James Chappuis, MD, has been in private practice for over 28 years as the owner and senior orthopedic spine surgeon of Spine Center Atlanta. 

Dr. Chappuis specializes in revision spine procedures and has seen his practice grow to eight locations, with further facilities planned in the future. Here, Dr. Chappuis discusses how spinal fusion can become more cost-effective, the key to OR efficiency and future trends in outpatient fusion procedures.

Note: Responses have been lightly edited for style and clarity.

Question: How can spine surgeons help make spinal fusions more cost-effective without sacrificing quality? How do you see spinal fusions evolving in the future?

Dr. James Chappuis: The most relevant way to make spinal fusions more cost-effective without sacrificing quality is to perform them in an outpatient surgery setting. There is no doubt that you can save money in this type of setting. Overall, your quality can improve because you have control over what you can use, in addition to the choice of who you're working with. I maintain consistency amongst my staff with the same standards of excellence for each case.

If we're talking about the degenerative spine, I am performing less spinal fusion procedures than I did 15 or 20 years ago. If fusions are indicated, we prefer anterior lumbar interbody fusion and have performed more than 100 outpatient procedures over the past four years.

Q: What device has dramatically improved OR efficiency in your practice?

JC: Consistent first class OR staff. I have the same first assistant, the same scrub tech, the same circulating nurse for every case. This significantly improves efficiency and decreases OR time. This is generally not possible in an inpatient setting.

Q: What are the most pressing issues for outpatient spinal fusions?

JC: Number one would be postoperative pain control. For that, we use Exparel and limited narcotics for a short period of time if necessary. 

Q: How do you think robotics will impact spinal fusions in the future?

JC: Robotics are very costly. It will be more difficult to perform surgery in an outpatient setting because of the cost. However, I think robotics will increase the accuracy of surgery, particularly pedicle screw instrumentation. 

Q: In your opinion, what is the next big trend on the horizon in spine?

JC: Endoscopic spine surgery. Today only about 5 percent of adult spine surgery in the U.S. is performed endoscopically, while 15 percent is being performed in Europe and 30 percent in South Korea. Endoscopic surgical procedures, including endoscopic fusions, are the next wave of technology in my opinion. 

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