Becker's ASC Review

84 ORTHOPEDICS Stryker's Q1 orthopedics sales jump 21.4% By Alan Condon S tryker posted $1.5 billion in first-quarter orthopedics sales, a 21.4 percent increase compared to the first quarter of 2020. Six notes: 1. Neurotechnology and spine net sales increased 14 percent year over year to $848 million in the first quarter. 2. Net sales in the first quarter were $4 billion, a 10.2 per- cent increase compared to the same period in 2020. 3. While the orthopedic segment showed significant growth, the recovery was mixed among procedure types. 4. Year over year for the first quarter, knee sales de- creased 4.5 percent to $412 million; hip sales decreased 2.2 percent to $309 million; trauma and extremities sales increased 63.1 percent to $640 million; and other sales increased 48.6 percent to $123 million. 5. Business picked up significantly at the end of the first quarter, and CEO Kevin Lobo expects that momentum to continue. 6. Mr. Lobo also said April 27 that he is "encouraged by the Wright Medical integration, which is pacing ahead of our expectations." Stryker completed the acquisition of Wright Medical in November. n Which spine procedures are surgeons migrating to the ASC in 2021? By Alan Condon F rom endoscopic techniques to multilevel disc replacement and awake spinal fu- sion, nine surgeons discuss what proce- dures they are migrating to the ASC this year. Note: e following responses were lightly edited for style and clarity. Question: What procedure(s) are you considering migrating to your surgery center? Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): As we become more comfortable with our awake spinal fusion protocol, we will be looking to migrate one- level lumbar fusions (i.e. minimally invasive transforaminal lumbar interbody fusion) to the surgery center. Performing the surgery under regional anesthesia will reduce a lot of the risks of the procedure and result in a faster recovery. is will allow us to perform the procedure in an ASC and feel comfortable discharging them home within a few hours. Brian Gantwerker, MD. Craniospinal Cen- ter of Los Angeles: We are looking forward to the purchase of an endoscopic surgery system for the ASC setting. It would be won- derful to recruit patients from other places to a center of endoscopic spine excellence. As more patients realize its benefits and legitimacy as a procedure, the more patients will be looking for someone to perform it. Also, I think multilevel cervical arthroplasty can be performed in the ASC setting, pro- vided there is a 24-48 hour hold ability. With the excellence of nursing care at the ASC, I would feel very comfortable doing a two- level arthroplasty in the ASC setting. Jeremy Smith, MD. Hoag Orthopedic Institute (Irvine, Calif.): As outpatient surgery center cases become more com- monplace, we will see more complex spinal reconstructions performed in this setting. Safety measures and protocol, coupled with the latest in MIS technology, make this possible. Currently, I perform all of my ACDFs, cervical total disc replacemnts and simple posterior lumbar decompressions in an outpatient center. Lateral technology has been optimized and can now be performed in a single position, either prone or lateral. is approach limits both surgical time and so tissue trauma, making this an optimal option. Additionally, the use of navigation and robotic technology maximizes accuracy while allowing for minimal incision size. Safety is paramount and in order to grow outpatient spine surgery, this needs to be at the forefront of thought and further clinical studies are needed to reinforce its utility. Ali Mesiwala, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Our tran- sition from hospital-based to ASC-focused spine care began in 2006, with a focus on safe, simple, reproducible and cost-effective cases, such as laminectomies, discectomies and noninstrumented operations. Assum- ing that one could perform an operation in a time-efficient and complication-free manner, the rate-limiting step in migrating cases to the ASC was, and still is, insurance coverage and payer restrictions. e first instrumented case I performed in our ASC was a cervical disc replacement in 2006,on a young man with a herniated disc who refused to have an anterior cervical dis- cectomy and fusion. He was denied coverage by his insurance and did not want to travel abroad for his care. is was a cash case. Success in this one instance opened the door to others, and eventually insurance coverage caught up to our reality. Now single and mul- tilevel cervical and lumbar decompressions, fusions, disc replacements and combined anterior and posterior cases are the norm. As Medicare changes CPT coding restric- tions and lis hospital-only constraints, the majority of elective spine cases will be done in ASCs. Only those patients who have

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