Becker's Spine Review

13 THOUGHT LEADERSHIP Why Dr. Alexander Vaccaro is optimistic about the spine, orthopedic industries By Ariana Portalatin L onger life expectancies, increased adoption of value- based care and the streamlining of practices are some of the reasons why Alexander Vaccaro, MD, PhD, says he is optimistic about the spine and orthopedic industries. Dr. Vaccaro is president of Philadelphia-based Rothman Orthopaedic Institute. He recently spoke with Becker's to share his outlook on the industries. Editor's note: Responses were lightly edited for clarity and length. Question: What is one word you'd use to describe your outlook on the spine/orthopedic industry right now, and why? Dr. Alexander Vaccaro: The word that I would use to describe my outlook on the spine and orthopedic industry is "optimistic." I believe this is true both from the perspective of the spine and orthopedic industry manufacturers as well as from the perspective of the patient, physician and healthcare system. From the standpoint of the medical device and implant manufacturers, longer life expectancies and an aging population are expected to drive continued and accelerated growth of both of these arenas, increasing the need for orthopedic surgeries to address pathologies driven by degenerative changes, such as hip and knee arthritis or lumbar spinal stenosis. This is expected to lead to market sales reaching nearly $50 billion by 2028, with a compound annual growth rate of 3.3 percent by some estimates. Certainly, by this metric, the outlook for the industry and demand for orthopedic devices and implants is very optimistic. The outlook of the physician and the patient, however, is also similarly optimistic when exploring the nuances of the issue further. The increasing adoption of value-based care and, more recently, the COVID-19 pandemic, has spurred changes in how orthopedic surgeons practice and deliver care, with increasing attention paid to reducing costs, adhering to evidence-based treatments and devices, transitioning to outpatient surgeries or ASCs and streamlining implant and instrument needs in the operating room. This in turn has put pressure on the orthopedic and spine industries to cut costs for medical device design, manufacture and delivery. In addition, with ever-increasing availability of information and consumer electronics, patients are now more able than ever to scrutinize the validity of medical device claims or the evidence behind physician recommendations, as well as educate themselves on costs and performance related to medical procedures and devices. Orthopedic surgeons similarly are under pressure to streamline their practices and cut costs as well, paying higher attention to implants and manufacturers that provide the most optimal ratio of performance and reliability to cost. As such, the spine and orthopedic industry manufacturers will be pressured to innovate and improve their products both in terms of performance, cost-effectiveness and efficiency in delivery to the benefit of the patient, provider and hospital system alike. n oentimes exaggerated. Most neurosurgeons and spine surgeons are pretty methodical in how they proceed with their work and are generally not involved in the politics and extracurricular drama that many of these shows portray. In addition, the surgeries that are shown are oentimes fairly routine, but made to be more intense and dramatic in order to appeal to the audience. It is striking how oen surgeons are shown without masks or protective eyewear when doing these invasive procedures. In addition, many of the technologies that they highlight are actually old, and the implants that they show are incorrect for the operations they are portraying. All in all, it seems like the lay perspective of a neurosurgeon being an apex specialist is of more importance than the daily reality of what the work entails. Issada ongtrangan, MD. Microspine (Scottsdale, Ariz.): I've rarely watched medical drama shows since I was a resident. In many parts, they almost always get it wrong. Medical shows oen show doctors and surgeons sitting with patients at their bedsides, monitoring their vitals and helping them walk around aer treatment. In real life, however, nurses and other medical staff take care of most of the bedside care. Medical shows don't usually capture the range of providers that are responsible for patient care, from nurse practitioners and physician assistants to respiratory therapists, pharmacists, nutritionists, and occupational and physical therapists. Contrary to what you might see on TV, it's rare for a doctor to completely revive a patient with cardiopulmonary resuscitation (CPR). ough CPR is still one of the best things a bystander can do if someone's heart stops beating, it's not an instant cure. e reality of CPR's effectiveness is much grimmer than what is shown on TV. Although exact statistics are varied, according to a 2016 study, the American Heart Association reports that CPR saves one life for every 30, with a 10 percent decrease in survival with each minute of delay. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): e majority of TV shows depicting neurosurgeons and their care make up in sensationalism contrasts to what they lack in reality. e right is probably the demeanor and intensity of surgeons alike, (from the early sixties, Ben Casey and Dr. Kildare), to the most current programs which get the wrong in the decision-making processes of science and application. Reality shows are contrived snapshots of extravaganza, egalitarian on their face, with attention drawn to emotion and reaction versus disease process and expertise of treatment. Even more far-fetched and stigmatizing is a recent British show associating a neurosurgeon and his emotional weaknesses and his altered ego. Is truth really stranger than fiction? n

• Cover