How Dr. John Bendo has grown NYU Langone's Spine Center to 18 surgeons + where the center is headed


John Bendo, MD, is the interim chief of the division of spine surgery and department of orthopedic surgery as well as co-director of the Spine Center at New York City-based NYU Langone Health.

He has focused his practice on treating spinal disease and deformities, and his research includes expertise in bundled payments in spine. Here, Dr. Bendo shares his experience as a leader and growing the spine department as well as discusses the biggest challenges that lie ahead.

Question: How has your role as a spine department leader evolved over the past two to three years? How have your responsibilities changed?

Dr. John Bendo: One of the biggest changes to my responsibilities has entailed developing new ways to address the massive expansion in the division of spine surgery within the past five to 10 years, to where we now have 18 orthopedic spine surgeons at NYU Langone's Spine Center. The growth of our program has brought with it additional administrative, clinical, research and educational responsibilities and as a division chief, it is my role to ensure care continues to be standardized regardless of who a patient sees, in order to ensure optimal outcomes.

To address our expansion, I recently created an executive committee that contains eight of our spine surgeons who all hold different director roles in the division — including directors of innovation and technology, quality and safety, research, etc. — where we will meet on a regular basis and get everyone involved in the decision-making process in order to maximize efficiencies in our spine service. The intention is to create a "team approach" to ensure unified decisions are made in order to benefit patients and [to] move the division of spine surgery forward.

Additionally, I have applied this team collaboration model to treating our most high-risk, complex cases. We have developed a set of clinical and/or radiographic criteria to determine a 'high-risk' surgical patient, and if a patient meets them, the case gets presented before a multidisciplinary group of spine specialists at a weekly case conference, and appropriate recommendations are then made. These efforts are part of our division's underlying goal to standardize care and maximize outcomes.

Q: What do you consider your No. 1 priority to ensure departmental success?

JB: The bottom line is that our No. 1 priority for NYU Langone's Spine Center is to maximize the 'value' of the care we offer to patients. This will be accomplished by building on efforts that foster collaboration and integration of services between our departments of orthopedic surgery and neurosurgery.

One major way this is accomplished is by developing clinical pathways utilized before, during and after spine surgeries. For example, our surgeons focus on medically optimizing patients before their surgery, making sure their blood sugar, blood pressure and nutritional status, for example, are in good standing, all through creating perioperative pathways every patient goes through throughout their hospitalization. This standardization can help ensure we deliver optimal care and maximize surgical outcomes.

Ongoing efforts in creating these elaborate care pathways have led to the development of a successful same-day discharge program for anterior cervical discectomy and fusion surgery. Our data indicated that we did not have higher rates of readmissions for patients going home the same day as compared to patients who stayed overnight.

Q: What is the biggest challenge you are facing as head of the department and how are you overcoming that?

JB: With shifts toward value-based medicine, a major challenge moving forward for our spine center, and many spine programs, is maximizing our patient outcomes within the realm of cost containment.

Q: What are the department's goals for 2019 and what is your vision moving forward?

JB: One of the main goals for 2019 is to continue our integration with our department of neurosurgery colleagues at NYU Langone's Spine Center, with our groups moving together to a state-of-the-art location in the new Kimmel Pavilion next year. This location will not only foster more collaboration, but [also] allow our surgeons to utilize the latest operating room technology, including Intraoperative MRI and CT, computer-assisted and virtual reality-assisted navigation as well as robotic technology. Many of these collaborative efforts have already been underway since the 2016 launch of this multidisciplinary center; however, moving the spine center to one fully integrated location where we share staff and nurse practitioners, will enable a more standardized experience for our patients.

The spine center's goal each year is to maximize the value of the care we offer patients and maximize outcomes. An ongoing goal is to develop standardized treatment algorithms and pathways for the most common surgical procedures, in addition to moving toward standardizing the use of spinal implants in the operating room. We also plan to continue to expand our adoption of minimally invasive spine surgery throughout our spine center through navigation and robotics, in an effort to decrease length of hospital stay, improve patient outcomes and provide responsible technological innovation to our patients.

We also plan to continue our strong spine fellowship program, which is a combined program with orthopedic surgery and neurosurgery provided for five fellows each year. Our fellowship program is a perfect example of the collaboration and integration of services of orthopedic surgery and neurosurgery, which we aim to build on. In addition, we will continue to expand our comprehensive didactic educational program for our orthopedic residency, where we currently train 14 orthopedic residents per year.

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