Degenerative spine disease is a growing problem and will become even more prevalent as baby boomers age. In response, healthcare providers are on the lookout for procedures that provide reliable relief to patients, while minimizing surgical risk and optimizing profit.
At Becker's 17th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago in June, Neo Medical hosted a workshop that explored new surgical options for spine procedures. Dr. Yasser Abdalla, chief of neurosurgery at Nordwest Sanderbusch in Germany, shared his experiences using an innovative spinal implant technology that could be a gamechanger for hospitals worldwide.
Traditional approaches to spine surgery have human and economic costs
Conventional spine surgery has several challenges. The procedures are complex, with three to five trays per surgery and as many as 10 for scoliosis interventions. The sterilization processes for the surgical equipment are costly and time consuming. From a facility perspective, turnover in the operating room is crippled by unforeseen delays. However, facilities must ensure effective sterilization processes are in place and adhered to for the purpose of mitigating the risk of surgical site infections.
"Over the past decade, the published literature has cited surgical site infection rates between 2 percent and 13 percent1, which are unacceptably high. These infections often result in prolonged and expensive hospital stays," explained Dr. Abdalla. The cost for a patient with SSI increased by $21,000 when compared with patients without SSI.2
Reprocessing surgical devices contaminated with soap, fat and carbohydrates may cause increased infection rates. A 2018 study published in Spine shows patients with surgeries delayed more than an hour were at a significantly higher risk of SSI.3 Patients undergoing more complex procedures may require additional setup time for monitoring and positioning. Another factor contributing to OR delays are damaged devices or equipment that needs to be resterilized.4
Research has found that up to 56 percent of sterilized trays opened and left untouched in an operating room were contaminated after four hours.
Value-based lumbar technology can help
Value-based lumbar technology improves clinical outcomes and offers quantum leaps in cost reductions. Neo integrates lumbar pedicle screw fixation into the perioperative process through a single-use system that provides surgeons the same feel and functionality they are used to along with improved control of biomechanical forces compared to conventional systems.
"The Neo system is a universal, streamlined one," Dr. Abdalla explained. "If you are performing spinal fusion surgery, you don't need five or 10 trays. You need five instruments and each one is multifunctional. Rather than 400 types of screws, there are 14 universal screws that can deal with every pathology in the thoracolumbar spine."
In a traditional spinal surgery, the surgeon inserts screws, performs a decompression, and places the cage. In contrast, when using the Neo system, the surgeon performs a decompression, releases the facet joints, inserts the cage and then inserts the screws and rods without applying any unnecessary (and potentially harmful) biomechanical forces onto the spine. Dr. Abdalla has noticed that this approach has resulted in fewer complications than using conventional systems and techniques with his patients.
Surgeons appreciate that Neo simplifies and shortens procedures. "In my center, we have seen preoperative savings of 20 minutes, a savings of one to two minutes per screw in the OR and postoperative savings of 20 minutes," Dr. Abdalla said. "If you use the average per minute cost in our hospital of 50 euros per minute, you would save around 2,400 euros per procedure."
"A new study concluded that single-use instrumentation could reduce SSIs to acceptable levels of 2 percent, leading to fewer infection-related hospital readmissions. Single-use instruments also reduce hospital sterilization costs and enable physicians to perform surgeries 24/7. With Neo, I'm no longer dependent on the capacity of the hospital's sterile processing department," said Dr. Abdalla.
Neo's value-based approach addresses the perioperative risks associated with spine surgery, such as lost time, wasted money and potential of infection. Using Neo technology provides a solution to all the stakeholders involved in the surgical process to significantly reduce operating costs and create savings while supporting positive clinical outcomes, according to Dr. Abdalla.
"We were the first center in Germany to use Neo and the second center in Europe," Dr. Abdalla said. "We have seen good pain control and functional capacity in patients. Their deficits improved well, and we have seen improved fusion rates. Our experience shows that the Neo system is safe, efficient and suitable for pathologies from T4 to S1."
1. Agarwal A, MacMillan A, Goel V, Agarwal AK, Karas C. A Paradigm Shift Toward Terminally Sterilized Devices. Clin Spine Surg. 2018 Aug;31(7):308-311.
2. Reference: Lissovoy G., Fraeman K, Hutchins V, et al. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387-97.
3. Radcliff KE, Rasouli MR, Neusner A, et al. Preoperative delay of more than 1 hour increases the risk of surgical site infection. Spine. 2013;38:1318–1323.
4. Agarwal A, MacMillan A, Goel V, Agarwal AK, Karas C. A Paradigm Shift Toward Terminally Sterilized Devices. Clin Spine Surg. 2018 Aug;31(7):308-311.