7 Spine Surgeons on Implant Reps in the Operating Room


Here are seven spine surgeons discussing the role of device company representatives in the operating room. Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What is the biggest challenge spine surgeons face today?

Please send responses to Laura Miller at laura@beckershealthcare.com by Wednesday, June 3 at 5pm CST.

Q: On a scale of 1-10, how much do you depend on the device company representative in the operating room?

Jaideep Chunduri, MD, Spine Surgeon, Beacon Orthopaedics & Sports Medicine, Cincinnati:
Currently, for the majority of procedures, I do not need the device representative in the room so I would say a "3."  From a technical standpoint, rarely have I had to ask for help on a particular procedure other than to remove hardware that I may not be familiar with. It helps to have them in the OR since most of the time you do not have the same people working with you on a regular basis. Having them in the room helps the case go much more smoothly from the surgical tech and circulating nurse standpoint and to make sure that all the correct trays are there and opened. In addition, when doing new techniques such as spinal navigation, reps are necessary until you learn all the nuances of the equipment.

Dennis Crandall, MD, Founder and Medical Director of Sonoran Spine Center, Mesa, Ariz.:
If the rep cannot help the surgeon take better care of the patient, they have no real value. Surgeons want their OR to run efficiently, with little wasted time spent under general anesthesia loosing blood. A good rep has the value of between 5 and 10/10, depending on the complexity of the case, in making sure the devices and tools are present for surgery and in proper working order. The valuable rep also assists the scrub tech in anticipating what is needed as the case progresses. A mediocre rep does not anticipate needs well, is not detail oriented, and has a value of 1 – 2/10. A truly bad rep is the equivalent fingernails on a chalkboard and rates a 0/10. Surgeons feel better off without him or her.

Michael Duffy, MD, Spine Surgeon, Texas Back Institute, Plano:
Device representation is extremely important for the surgical staff preparing and setting up for the operative procedure. As a surgeon, we know most nuances of the instrumentation due to our experience. Ideally, the representative for the implant company augments the surgical team and aids in increasing the efficiency of the procedure. Reliance of a surgeon on the representative is directly proportional to the surgeon's experience using the particular implant. For common implant systems, the surgeon has little to no reliance on the representative; however, niche products that are used in rare procedures, the surgeon has increased need for the representative. Preoperative planning and preparation also help the surgeon to have less of a reliance on the representative, but it is always better to have more assistance than less assistance in the operating room. Overall, surgeons' reliance on the representative ranges from a 4-7 out of 10, depending on the uniqueness of the case.

Johnathan Hyde, MD, South Florida Spine Institute:
The device reps are almost an extension of the OR team. Even when using my typical implants, the team really depends upon the rep to ensure patient safety and an efficient operative procedure.

Sometimes there are issues with case sterilization, or even with instrument failure, and the rep is able to get the needed implants to the room (usually faster) than the OR nurse.

Especially with new technologies, the OR staff is probably not accustomed to the implants or hardware. The rep is able to instruct the team in steps required.

As a surgeon, I do not depend on having a rep in the room. But as far as ensuring quality care, I feel that there is an important role for the instrument rep in helping the scrub tech prepare for the intraoperative requirements of the surgery.

Richard Kube, MD, Founder & CEO, Prairie Spine and Pain Institute, Peoria, Ill.:
Clinically 1 and customer service 10.

Michael Steinmetz, MD, Chairman of Neurosciences & Medical Director of the Spine Center, MetroHealth System, Cleveland:
Device representatives are EXTREMELY vital in the operating room for efficiency. The reps are aiding the scrub techs with the next step in the operation, flow of the surgery and if something unexpected happens that changes the operative plan.

Scott Tromanhauser, MD, Spine Surgeon, Boston Spine Group: 
I depend on them much less than the nursing staff. Most of the time I am very familiar with the systems that I use. When new technology comes around, I do need the rep there to help me and the staff. So in general I would say somewhere between 2-10/10.

More Articles on Spine Surgery:

7 Spine Surgeons on Shaping Spine & Healthcare Policy

4 Spine Surgeons on Top Benchmarks for Spine Practices

How Often Should Spine Surgeons Renegotiate Vendor Contracts

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