Becker's ASC Review

23 SPINE ADVERTISINGINDEX Note: Ad page number(s) given in parentheses e point is not that open surgery is better than minimally invasive surgery. It is that invasiveness is only one measure of an operation, and reducing it should not become an end in itself. A surgeon's invasiveness profile e same measurement could eventually give surgeons a new way to examine their own practice. Dr. Härtl has begun looking at what he calls his "invasiveness profile," how his cases score across the classification and how that profile may have changed over the course of his career. "I'm sure I was probably more invasive 10 years ago than I am now," he said. Tracked over time, those scores could show how a surgeon's practice evolves with experience, new techniques and technology. Paired with outcomes and cost data, they could eventually allow researchers to compare how surgeons approach similar patients with similar pathology, not to assume that the lowest score is best, but to understand what differences in invasiveness actually mean. A surgeon operating less invasively may have higher costs. Another may perform more invasive operations but achieve fewer revisions or better outcomes. Any meaningful comparison would also have to account for the pathology being treated. For Dr. Härtl, the opportunity is not to create another surgeon scorecard. It is to give spine surgery another objective variable to study. He points to cardiac surgery, where mortality provides a clear, measurable outcome that surgeons and hospitals can track. Spine surgery has no comparable single metric. Success is oen reflected in pain, function and quality of life, outcomes that matter enormously to patients but are more difficult to quantify. "ere's not much that we can quantify in the spine world," Dr. Härtl said. "Because we're dealing with pain, and we're dealing with patients who are suffering, and that's very, very difficult to quantify." Invasiveness, he believes, is different. "is is something that we can quantify," he said. MISS-INC (L) remains preliminary. Researchers still need to establish how reliably it performs across institutions and whether its scores predict outcomes, complications, costs or revision rates. But Dr. Härtl sees the ability to measure invasiveness as the beginning of a different kind of conversation, one that moves beyond whether an operation qualifies as "minimally invasive" and asks what being less invasive actually changes. "I think it really opens up a totally different field of research," Dr. Härtl said. "It opens up the ability to compare procedures." e comparisons, however, will have to be made among similar cases. "You have to be comparing apples to apples," Dr. Härtl said. "But right now, we haven't been able to do that." n Accurate Accreditation. accurateaccreditation.com / (313) 552-3241 (pg. 20) ECG Management Consultants. ecgmc.com (pg 2-3) Eckert Wordell. eckert-wordell.com (pg. 10) Flagship Healthcare Properties. flagshiphp.com (pg. 17) Holland&Knight. hklaw.com (pg 6)

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