Becker's ASC Review

54 ORTHOPEDICS Robots keeping the next generation of spine surgeons out of ASCs By Laura Dyrda R obotic technology is growing among spine surgeons, and fellows are learn- ing to use the technology for more precise outcomes. But if they become too reliant on robotics for spine surgery, the transition to outpatient surgery centers could be problematic. Most spine ASCs don't have the budget for robotic technology since it increases the cost per procedure without commanding higher reimbursement from payers. Hospitals are willing to pay for the robotic systems to at- tract surgeons and patients to their spine centers, but that isn't an option for ASCs operating on thin margins, especially if the technology is proven to provide only mini- mal value for experienced surgeons. "Currently advanced enabling technology, including intraoperative 2D imaging, navi- gation, robotics and augmented reality, are cost-prohibitive in the ASCs," said Frank Phillips, MD, director of the division of spine surgery at Rush University Medical Center in Chicago. "Many younger spine surgeons are dependent on these technologies to perform more complex spinal procedures. Evolution of these platforms with an eye on the ASC will undoubtedly allow for more migration of more complex cases to the ASC." Kern Singh, MD, co-director of the Mini- mally Invasive Spine Institute at Rush said he thinks it will be challenging for young surgeons to transition spine cases to the ASC unless they are confident performing the procedures without robotics, which could hinder spine's overall outpatient migration. "If you become too heavily reliant on expen- sive technology, then the transition to the outpatient arena will be very difficult," said Dr. Singh. "ASCs don't have the resources or capital to spend a million dollars on the ro- bot when the procedures can be performed without that system. Unless the price drops, which I doubt since hospitals are willing to pay it, the transition will be more painful." ere are seven spine robots on the market today competing for surgeons' attention. e technology aims to limit radiation exposure and improve precision for less invasive spine procedures, which means quick recovery for patients. Beyond the high costs, there is a steep learning curve for spine surgeons in- corporating the technology into their prac- tices. n 10 most common complications after ASC spine surgery: Study By Alan Condon T he most common com- plications after spine sur- gery at ASCs are gastro- intestinal, with vascular being the most infrequent, according to a study published in Clinical Spine Surgery in April. The analysis is based on sev- eral studies that total 11,245 patients who had spine surgery at a surgery center. Studies reported techniques including open, minimally invasive sur- gery, endoscopic, microsurgery and combined techniques. Here are the 10 most common complications patients experi- ence after undergoing spine surgery at an ASC, based on a percentage of the cases identi- fied in the study: 1. Gastrointestinal: 1.12 percent 2. Urologic: 0.80 percent 3. Wound site: 0.68 percent 4. Transient neurological: 0.67 percent 5. persistent neurological: 0.61 percent 6. Pulmonary: 0.60 percent 7. Musculoskeletal/spine/opera- tive: 0.59 percent 8. Pain related: 0.57 percent 9. Cardiac: 0.29 percent 10. Vascular: 0.25 percent n Devicemaker sued over hip replacement implants By Marcus Robertson T hree hip replacement recipients are suing surgical devicemaker Exactech, Law Firm Newswire reported March 11. The Exactech Connexion GXL recipients say their implants are defective and allege the company knew, but never warned them or their surgeons, according to the report. All three plaintiffs say they suffered severe pain, decreased motion and bone and tissue destruction because of early device failure. All three hip replacement recipients will need corrective surgery, according to the report. The FDA recalled the device in June 2021 after Exactech told its sales agents there was an increased risk of premature wear, the report said. Before that, Exactech told surgeons that the device had been phased out and replaced by a newer product, but didn't mention pending recalls, according to the report. n

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