The rise of robotics and high-precision instrumentation, and the ongoing development of minimally invasive procedures, leave the hospital environments of just five years ago increasingly far behind.
The evolving technological sophistication of a hospital, and the degree to which that technology is perceived to enhance patient outcomes remains one of the key factors that attract patients to it and its programs.
A 2013 study in the Journal of the American Medical Association, Surgery (JAMA Surgery) supports the proposition that technology-driven, minimally-invasive techniques are in a broad sense better for both patients and society. Analysis of national data on health insurance claims and workplace absenteeism in connection with six types of surgery showed that less invasive procedures resulted in lower costs to the health care payer and fewer days absent from work for patients.
On the other hand, a potential constraint on investment in new health care technology continues to be the need for confirmation of its cost effectiveness. Researchers generally agree that advances in medical technology contribute to rising health care spending in the U.S. A recent example calling into question the use of a high-cost procedure based on new technology was the increase of the total number of robotic prostatectomies performed during a period of decreasing incidence of prostate disease. Commentators have suggested that the demand for such surgery is in some cases induced by marketers of surgical technology, leading to a costly procedure sometimes being chosen even if of comparatively low marginal benefit to the patient. But to evaluate the true cost per patient, health system executives need to consider, among other things, whether the direct costs of investing in new technology reduce or increase other cost factors such as the number of days the patient spends in the hospital or the number of visits the patient makes to the physician's office.
The other factor that will affect the adoption and use of new surgical technologies is regional competition among hospitals. A study published in JAMA Surgery in February 2016 examines the connection between hospital competition, hospital finances, and the use of robotic-assisted surgery. The results show that patients are more likely to receive a robotic-assisted procedure when their surgery was performed in a hospital in a competitive regional market. The researchers conclude that non-clinical factors such as a hospital's market competition influence the decision to purchase a surgical robot. Their conclusion can be extrapolated to technology acquisition decisions in general.
In the context of these trends across the industry, the following are some of the ways advanced technology is expected to arrive in the surgical suite.
The Continuing Rise of Robotic Surgery
Robotic assistance provides increasingly novel pathways to the future of surgical technology. The degrees of freedom and pinpoint precision are a boon in procedures including cardiac surgery, prostate surgery, gynecological surgery, cancer surgery, gallbladder surgery, gastric bypass, hernia repair and more.
Some industry analyses of the drivers of the medical robotic systems market, of which surgical robots are one segment, forecast that global market valuation is expected growing at an annual rate of 16.1 percent from 2013 to 2018. And the robust demand for surgical robots is seen in the sales trends and procedure volumes reported for one of the industry's leaders, Intuitive Surgical, which makes and sells the da Vinci surgical robot system. CNBC reported that da Vinci installations rose by 21 percent in 2012, and that the number of da Vinci procedures performed climbed by 25 percent to a total of 450,000. Analysts report that in the fourth quarter of 2015, the number of da Vinci systems sold grew 15 percent year-over-year, driven by a 15 percent increase in the worldwide number of procedures.
Robotic surgery will likely continue to rise in popularity because physicians and patients both tend to favor it. Robotic surgery systems optimize anatomical access for minimally-invasive procedures: they enable the surgeon to see better, stitch better, and perform all of the procedures through a single, small entry point. A smaller incision produces less bleeding, which reduces the need for blood transfusions, and improves the clarity of video imagery. And patients experience less pain, less scarring, faster healing, and a speedier return to their normal lifestyle.
Another driver of the expansion of robotic surgery will be the development of connectivity with other systems. For example, certain robotic surgery systems can be synchronized with a specifically designed operating table, giving surgeons the ability to easily and efficiently adjust the patient during robot-assisted procedures. Since the table moves, the patient does not have to be manually repositioned, and the instrumentation does not have to be removed from the robotic arms. Instead, table and system work in tandem: as one moves, the other adjusts correspondingly to maintain consistent orientation to the patient.
Integration of Imaging and Navigation
Another type of inter-connective technology that is increasingly widespread in operating rooms is the surgical imaging system. For example, O-arms are systems used to help surgeons visualize anatomy during complex spinal and orthopedic procedures. C-arms are similar in design but useful in a broader range of surgical applications. The patient lies on a table while the arm passes back and forth, taking images using two-dimensional x-ray or three-dimensional fluoroscopy. Imaging technologies like these allow surgeons to use minimally-invasive techniques in cases where large open surgeries used to be required.
These arms allow for better visualization of the spine. In addition, the less accurate the visualization of where therapy hardware will be placed in the spine, the higher the likelihood that revisions may be needed after the patient leaves the operating room. The imaging arm avoids these kinds of inefficiencies and uncertainties by providing the surgeon multi-plane three-dimensional images of the spinal anatomy, continually refreshed. And by providing improved visualization for purposes of pre-planning, imaging arms can reduce or eliminate subsequent surgeries to adjust the hardware placement.
The ability of surgeons to pre-plan is further enhanced through integration of a surgical imaging system with a surgical navigation system. Used as a kind of GPS system in the brain or spine, a surgical navigation system allows the surgeon to accurately identify the area of interest. It communicates with the imaging system to produce three-dimensional representations that the surgeon uses to precisely navigate the instruments relative to the patient's anatomy. In terms of improving the surgical process, the integration between systems streamlines the workflow and creates cost efficiencies. In terms of direct patient benefit, pre-planning results in less time spent in surgery, less exposure during surgery, less risk of infection, and earlier ambulation.
Consolidation of Resources into Specialized Institutes
Combining all aspects of the patient experience in one convenient location can play a role in outcomes; that is, a centralized facility can offer a seamless experience that can be almost as important as the technology itself in optimizing care. Being able to access all services under one roof makes the patient experience less stressful and more manageable, and enhances the patients' sense of security that comes from knowing they are in the right place.
The health care industry operates in a unique environment. Providers must respond to a landscape in which the consolidation and proactive distribution of resources are increasingly important to stay competitive in the marketplace. When a health care provider pools its resources, it can provide more nuanced care for a broader range of diagnoses. In that light, it can be conjectured that health systems and hospitals with significant competition and sufficient resources will invest in specialty centers and institutes to house state-of-the-art technology to pioneer new research and treatments while providing the most options to their patients. The challenge will be to provide access to surgical innovations while avoiding excessive expenditures for procedures which may have less costly alternatives.
In sum, the more advanced surgical technology becomes, the more important it will become that those technologies are integrated with each other, and with the other systems, tools and processes in the operating room. When those synergies are realized, advanced surgical technology increases the quality of health care delivered, makes it easier to deliver that care, and makes operating room processes more accurate.
Integration of advanced technology empowers hospitals and health systems to move toward greater efficiencies and lower readmission rates while providing patients with higher quality care.
Tarek Salaway, MHA, MPH, MA, is the chief operating officer at Mission Hospital located in Mission Viejo, Calif.. Farzad Massoudi, MD, is the medical director of the Neuroscience and Spine Institute at Mission Hospital and a board-certified neurosurgeon. Kate Perlstrom, RN, BSN, CNOR, is the manager of surgical services at the Neuroscience and Spine Institute at Mission Hospital. Mission Hospital is part of St. Joseph Health, a 16-hospital health system founded by the Sisters of St. Joseph of Orange.
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