Increased participation in value-based care, the migration of cases to ASCs and robotic innovations are some of the top trends orthopedic surgeons are following this year.
Six surgeons shared with Becker's the top industry trends they are following in 2023:
Editor's note: Responses were lightly edited for clarity and length.
Adam Bitterman, DO. Chair of the Department of Orthopaedic Surgery at Huntington (N.Y.) Hospital and Assistant Professor at Zucker School of Medicine at Hofstra/Northwell (Hempstead, N.Y.): I believe the trend that is upcoming and most important revolves around technology. Technology branches to the patient experience as well as the physician's ability to maintain an efficient and safe practice environment. With regard to patient experience, technology may be able to improve one's ability to communicate with their surgeon and telehealth should be embraced for certain patient concerns (postoperative wound checks, pain management, etc.) and communication with colleagues.
As for practice management, the ability to maintain efficient volume thus leading to increased productivity is critical. Harnessing the various benefits that technology can provide is key to ensuring appropriate throughput all the while maintaining a high level of quality.
Robin Kamal, MD. Associate Professor in the Department of Orthopaedic Surgery at Stanford (Calif.) University: Orthopedic surgeons will continue to transition higher volumes of cases to ASCs over the next five years, but which types of procedures and which types of patients can safely be transitioned will continue to be refined. I project as more complex cases transition to ASCs, other procedures will also shift to the office setting. I also expect that the projected recession for 2023 will support more scrutiny of healthcare costs, and more specifically, out-of-pocket costs to patients. With patients increasingly engaged in either value-based care insurance plans or high deductible plans, patients will become increasingly interested in understanding the medical necessity and costs of health services and seek care from wherever they perceive [the] highest value.
Matthew Kraay, MD. Professor of Orthopaedic Surgery and Chair in Orthopaedic Surgery at Case Western Reserve University (Cleveland): Continued focus on providing value by improving quality, while simultaneously controlling the costs of care has been a "trend" for the last several years that will be with us indefinitely. Increasing consumer and employer healthcare costs, declining reimbursement to providers, and hospital staff and supply chain shortages should prompt all of us to look at how we can provide safer, higher quality and more efficient care at the most cost effective site possible. This is a never ending process that ideally should result in elimination of waste and unnecessary care, improved quality and patient outcomes and improved healthcare value for our patients.
Suken Shah, MD. Vice Chair of the Department of Orthopaedics, Fellowship Director, Division Chief of the Spine & Scoliosis Center and Professor at Nemours Children's Hospital, Delaware (Wilmington): Trends should only be followed if they make meaningful impacts on the outcomes of patients, provide value, or both. What is the evidence behind the trend or change in practice? How robust is that evidence and has it been vetted by peers without conflicts and is it reproducible? What does it add to healthcare as a whole? If the evidence is lacking, [what] can we do to study it, even as a quality improvement initiative? Even the best intended trends had undesirable consequences, but this may be the price to pay for innovation. Responsible, incremental innovation involving shared decision-making is probably the best way forward to avoid harm, misplaced bets and regrets.
With that in mind, we continue to be interested in:
- Vertebral body tethering (VBT) as a treatment for scoliosis in growing children that could avoid fusion, preserve motion and enhance recovery. Currently, it comes with an increased chance of reoperation compared to fusion, but prospective studies and sharing information has improved outcomes.
- Growth modulation in other areas of orthopedics such as the proximal femur (hip dysplasia), knee and ankle for angular deformities and length differences in children
- [Enhanced Recovery After Surgery] protocols, pain management and opioid avoidance in spine surgery
- Preoperative optimization and perioperative care standardization in our most complex, risk-prone syndromic and neuromuscular orthopedic patients
- Long-term outcomes from our orthopedic and spine surgical interventions from the patient and family’s perspective and what we can do to improve the experience
Francis Shen, MD. Endowed Professor of Orthopaedic Surgery, Professor of Pediatrics, Spine Division Head, Director of Spine Fellowship at the University of Virginia Health Sciences Center (Charlottesville): Advances in implant design and instrumentation have allowed for significant improvements in the surgical care of patients with spinal deformities and degenerative conditions. However, much of this technology presents with significant limitations when utilized in tumor surgery due to imaging artifacts resulting from metal implants. The goals for complex tumor reconstructions remain the same as in other spinal procedures in regards to preserving neurologic function and reconstructing mechanical stability; however, additional needs such as tumor surveillance, radiotherapy planning and radiotherapy treatment make the use of metal implants and partial metal implants less than ideal.
Recent advances in newer full carbon fiber systems such as CarboClear developed by CarboFix has markedly reduced the metal footprint allowing for improved postoperative advance imaging and radiation therapy. Early and intermediate-term studies seem to support these findings. This technology will continue to grow in 2023 and may find a role in other pathologies with frequent imaging requirements such as spinal trauma and infections. Ultimately, there is benefit in extending full carbon fiber systems to all spinal pathologies including degenerative and deformity reconstructions by improving the long-term ability to identify recurrent stenosis, the development of delayed or nonunions and ability to identify infections at the early stages.
Steven Theiss, MD. Professor and Chair of the Department of Orthopaedic Surgery at the University of Alabama at Birmingham: The one trend that excites me is robotics. Currently, there is not great evidence that robotics improves patient outcomes, but as the robots become more sophisticated they will clearly improve surgical accuracy, efficiency and safety. Combining robotics with other emerging technology, such as augmented reality systems, will lead to powerful surgical tools that can transform the way we operate.