Archive Megatrends 2018

Adapt or Be Left Behind

Follow these 5 trends to prepare for surgery's exciting future.

Mark Talamini

Mark Talamini, MD, MBA


Robot Hand
DOCTOR DROID Robots won't replace surgeons, but they might dramatically alter how they perform procedures and provide access to previously unreachable anatomy.

Change seems to happen in the blink of an eye, doesn't it? Think about what you've already witnessed over the course of your career. Surgeons who used to perform disabling open procedures are entering joints, abdomens and organs laparoscopically and endoscopically. Robot-assisted surgery is smarter and more automated. It's getting harder to tell the difference between surgical images and actual anatomy. Patients who used to spend days recovering in hospitals after joint replacements are walking out of outpatient facilities hours after they hobbled in. Surgery's infection point? We've already witnessed a series of them, but there are even more on the horizon that will once again transform surgical care.

1 Robotic surgery expands
The da Vinci surgical robot has been instrumental in the development of robotic surgery, but it's the story of one company and one machine that's mostly used for performing prostatectomies. The market is set to expand significantly based on the broad concept of placing advanced robotics and cutting-edge imaging between surgeon and patient. Numerous companies are investing in the development of smaller, more affordable platforms for abdominal surgery, spine and orthopedics.

That increased competition in the marketplace will drive down the cost of robotics, making it more affordable for surgery centers and health systems with smaller capital equipment budgets. But I think the future of robotics will be even more disruptive and offer the same game-changing potential as the da Vinci did before it entered the mainstream. For instance, I believe microrobots and flexible robots will be able to operate from within the body, which will create seemingly endless possibilities about the technology's future applications.
2 Preemptive care
Surgeons will be able to treat diseases before they cause patients harm. An example: General surgery is moving toward assessing genetic profiles to target individuals who are at increased risk of developing gastric cancer. Those patients could undergo an endoscopic procedure during which surgeons identify patches of stomach tissue that are on the cusp of becoming cancerous. Surgeons would then be able to remove the pre-cancerous tissue and suture the area closed from inside the stomach. The entire extirpative procedure would be done endoscopically. That type of preemptive surgery will become commonplace.
3 Reallocation of resources
The movement of complex procedures from inpatient to outpatient facilities will continue as surgical technologies evolve, surgeons perform surgery less invasively through smaller incisions and natural orifices, and post-op pain control practices improve. Much of the outpatient migration will be driven by the worthy goal of decreasing healthcare expenses through the elimination of costly post-op hospital stays.

That will be only part of the story. We're limiting our focus on current inpatient procedures that could shift to outpatient facilities without considering the development of new invasive and complex procedures, which will require care in the acute hospital setting. We're going to see movement of cases in both directions to the outpatient and inpatient ends of the surgical spectrum. The trend will involve performing cases in clinically appropriate settings that maximize surgical efficacy, efficiency, safety and cost-savings.
If your rate of internal change is less than the rate of external change, you've already become irrelevant.
4 Big data and transparency
Pulling back the curtain on the cost and safety of surgical care is inevitable and needed, although it has some inherent challenges, including the reliance on data sets that are used to judge surgical quality and outcomes. Is it possible to assess those parameters with numbers alone? I'm not so sure.

In the past, powerful chiefs of surgery controlled quality of care by determining which surgeons were skilled and which ones weren't, and using their authoritative power to deal with the outliers. That management model is no longer acceptable. We're currently trying to establish unbiased determinations of surgeon skill and the variables that impact surgical outcomes through the use of big data. However, there is no perfect correlation between the outcome stories presented in numbers and the care that's provided in real-world ORs.

Moving forward, we have to harness the analytical power of surgical data, but must also be wary of the potential unintended consequences of holding surgeons accountable for safe care through current reporting systems and transparency practices that don't necessarily tell the whole story.
5 Opioid-free pain control
When the Joint Commission identified pain as the fifth vital sign in 2001, surgeons were told to work toward performing pain-free surgery. Most surgeons knew that was an unrealistic expectation, but were also aware that that was the standard by which they'd be measured. Many surgeons have relied on opioids ever since to make their patients as comfortable as possible, so surgery's contribution to today's epidemic comes as no surprise to those of us who have watched and perhaps contributed to the troubling over-prescribing trend. The biggest hope of minimizing post-op opioid addiction potential is to increase the awareness and implementation of the alterative means available for managing surgical pain, including nerve blocks, epidurals and IV acetaminophen. When all of those modalities are maximized, it's truly incredible how comfortable patients feel after even the most invasive procedures. If multimodal pain control becomes common practice before, during and after all surgeries, opioid use will drop precipitously. Of course, the hope is that pharmaceutical researchers will also continue their search for more effective non-opioid pain control options.

Forward momentum

Jack Welch, the former CEO of GE, once said if your rate of internal change is less than the rate of external change, you've already become irrelevant. That's a sobering thought. Change is inevitable; the only question is whether your facility will be ahead or behind the evolution curve. If you're simply maintaining your current standing, you're actually falling further and further behind the competition. OSM

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