The Top Trends in Surgery Today

Looking back at last year to put 2023 into focus.

Major change doesn’t happen overnight — especially in the world of surgery. Little by little the trends of today mold and shape the industry of tomorrow. For facility leaders, keeping up with these changes is an absolute imperative.

That’s where we come in. Throughout the year, we listened closely to surgery’s top leaders, clinicians and innovators in an effort to highlight the emerging issues that are most likely to impact your facility down the road. Here are 10 trends that should be on the radar of surgical leaders in 2023.

Recruitment, retention issues

What you need to know: Whenever we ask readers about their biggest challenges, they put staffing at the very top. While the specifics may differ, you’d be hard-pressed to find a surgical leader who isn’t struggling with recruitment, retention or both. Staffing was an issue for many facilities long before COVID-19 became part of our collective vernacular. That said, a global pandemic that temporarily shut down elective surgery and caused a host of supply-chain issues in the process was akin to pouring gasoline on the fire. Ultimately, however, COVID-19 led to a staggering backlog of delayed cases and increased the demand for same-day, outpatient care — and facilities everywhere are struggling to keep up. The nursing shortage certainly gets the most coverage, but it’s far from the only area where facilities face staffing issues. For instance, surgical techs are also in short supply in many areas, and an increase in states requiring certification isn’t helping with the gap. From a recruitment standpoint, we’re seeing facilities lean on attractive referral bonuses, travel nurses, niche recruitment firms and relationships with local schools aimed at building a talented pipeline to bring in new staff and an even wider array of creative tactics — many of which wind up in our Ideas That Work section — to keep them there.

Expert Insight: “The one aspect of recruiting and retention facilities can control is their own environment, creating a positive, upbeat culture with strong leadership from the top down,” says Greg DeConciliis, PA-C, CASC, administrator at Boston Out-Patient Surgical Suites in Waltham, Mass.

A Surge in ASC-Based Cardiology  

What you need to know: In an ASC setting, outpatient cardiac care generally costs anywhere from 30% to 40% of what it does in a hospital setting — savings that benefit both payers and patients. As data continues to show that certain routine interventional cardiology procedures can safely and efficiently be handled in a surgery center, CMS has responded accordingly. The agency has already added several cardiology procedures to the ASC Covered Procedure List (CPL) — including diagnostic and interventional coronary procedures, peripheral vascular interventions and placement of pacemakers and defibrillators — and that trend is only likely to continue moving forward.

Expert Insight: “We’ve seen a sure and steady migration of cardiovascular procedures to a safe and more convenient outpatient setting,” says Kelly Bemis, RN, BSN, chief clinical officer at Azura Vascular Care & National Cardiovascular Partners, an outpatient network headquartered in Malvern, Pa. “That trend will most certainly continue into 2023 and beyond, as more and more procedures like Cardiac Ablations, Transcatheter Aortic Valve Replacement (TAVR) and Left Atrial Appendage Occlusion (Watchman Device) are likely to be approved, and more ASCs become interested in expanding into cardiology.” 

The Physician-Owned ASC Drop

What you need to know: ASC ownership models have steadily been changing for years, and we’re witnessing a marked shift from physician-owned ASCs that once dominated the landscape. These physician-owned ASCs are facing pressure to sell, led by an increase in private equity physician practice management firms buying stakes in ASCs that are already in joint ventures with hospitals or ASC management companies. When a third party is added to this type of deal, the management company typically keeps their percentage stake, generally 51%, and the physician practice relinquishes a portion of its ownership. 

While acquisitions, mergers and multi-party joint ventures are taking place with increased regularity and altering the overall surgery center ownership landscape, freestanding ASCs aren’t going anywhere. The top physician-owned ASCs are still well-positioned in their respective communities, with strong relationships with local payers. These facilities aren’t overly reliant on the financial infusion large national management firms provide and will likely survive on their own. However, their percentage — especially in certain service lines — is expected to continue to shrink.

Expert Insight: “The biggest thing I watch is the consolidation with private equity buying up independent ASCs,” says T. Hunter Newsom, MD, of Newsom Eye and Laser Center in Tampa. “In ophthalmology, it seems the independent ASCs will be much smaller, possibly a single-digit percentage entity. It will be the next three to five years as private equity is bought and then sold again that will really change my competing ASCs and ophthalmology practices.”

Anesthesia Service Consolidation

What you need to know: Just as more formerly independent “mom and pop” ASCs are joining larger national and regional organizations, so too are anesthesia providers. The calculus of how to do business with anesthesia firms, including ensuring those providers are there to staff all surgeries, is in flux, and many ASCs are struggling to find the right fit right now. Consolidation isn’t the only factor creating an anesthesia crisis. It’s a multifactorial issue that’s forcing the surgical industry to think about a critical service differently.

Of primary concern for facilities: Managing the anesthesia costs in this shifting environment. Paying through daily or monthly stipends provides cost certainty, but if volume doesn’t meet expectations, facilities can lose money. Administrators also worry about patient safety as many deal with new anesthesia groups with whom they need to build trust.

On the plus side, larger anesthesia groups are generally managed more professionally than many local groups while benefitting from the latest tools and technologies. But they may provide less flexibility — such as covering last minute add-on cases — and less of a personal touch than nimbler local groups. In response to this uncertainty, many facilities are focused on increasing operational efficiencies while adjusting their payer mixes, with some going as far as to employ predictive algorithms for anesthesia scheduling to ensure revenues will cover costs. Some even are exploring the feasibility of bringing anesthesia entirely in-house as a cost center.

Virtual Reality Training 

What you need to know: Tech-savvy providers have been touting the potential of virtual reality (VR) for years, but cost, compatibility and ease of use have kept this training tool largely out of reach for average facilities — until recently. Increasingly, we’re seeing facilities use VR to train their staff, particularly in orthopedics. 

For instance, UConn Health’s Musculoskeletal Institute in Farmington, Conn., made the decision to incorporate VR training into its orthopedic residency program right before the start of the pandemic. The VR platform UConn Health uses places residents in realistic OR environments and allows them to practice their hand-eye coordination and visual spatial awareness in a variety of surgeries. Residents can break down each segment of surgeries like hip fracture repairs in minute, step-by-step detail — determining where to stabilize bones, figuring out where nails and screws should go — so they can focus the bulk of their training where it would benefit them most. The technology also helps educators focus on the residents who need the most help and create an individualized improvement plan focusing on the specific skills and techniques residents need to work on most. Of course, surgeons aren’t the only clinicians that can benefit from VR. For instance, there are VR platforms available that provide nurses and other members of surgical teams with immersive training in a host of clinical scenarios, including emergency response protocols like Malignant Hypothermia.

Offsite SPD Care 

What you need to know: When surgical facilities expand, clinical needs such as additional ORs often get first dibs on the new square footage, so departments such as sterile processing, while vital, are left to handle more volume in the same amount of space they’ve always had. Enter the concept of large health systems locating their sterile processing departments at separate locations and trucking the instruments to their surgical facilities, or ASCs contracting with third parties to clean, disinfect and sterilize their instruments at remote locations.

More healthcare providers in the U.S. are expected to opt into third-party instrument care services in the next few years, according to a report from Frost & Sullivan, a research and consulting firm in San Antonio. If you opt into this relatively new industry, your soiled instruments will be picked up, transported to a large reprocessing facility where they will be cleaned and sterilized and repackaged trays will be delivered ready for reuse. There are also companies who will arrive at your facility in trucks that serve as mobile maintenance labs, where techs will clean, inspect and repair your instruments, as well as make recommendations on ones that need replacement immediately or in the near future.

Patient Apps Everywhere 

TOP DOCS Despite a drop, physician-owned ASCs will always have a place in the right communities.

What you need to know: While some ASCs still rely on phone calls to remind patients when to arrive and hand out printouts with discharge instructions, most use automation to handle the calls, and phone apps or web platforms to detail what patients should do postoperatively. Early research shows that many patients prefer to have their instructions in a place they can access with their phone or computer. The data suggests apps improve outcomes, reduce surgical cancellations, decrease patient misunderstanding and increase compliance with instructions. 

These technologies are also growing. Remote patient monitoring and physical therapy are now facilitated via patient apps as well, according to Jayson S. Marwaha, MD, MSc, a general surgery resident at Beth Israel Deaconess Medical Center in Boston and a postdoctoral fellow in informatics at Harvard Medical School in Cambridge, Mass.

Resistance from technologically challenged patients is lower than ever, says Joseph C. Kvedar, MD, a Harvard Medical School professor and board chairman of the American Telemedicine Association, a nonprofit that provides clinical practice guidelines for virtual care. “If technology makes it easier to do something, people will learn to adapt to that technology,” says Dr. Kvedar. “They’ll do it enthusiastically because it makes their lives easier and it makes it easier for them to take care of themselves.”

Expert Insight: “With phones constantly at patients’ fingertips, I believe patient apps are the future and having multiple touchpoints with patients and their families is key,” says Mr. DeConciliis. “As we become ‘rated’ more and more on our patient satisfaction, utilizing these apps to communicate becomes paramount. I envision these apps being utilized for every patient.”

Cybersecurity Threats

What you need to know: Ransomware attacks on healthcare facilities have intensified, with over 60% of these attacks resulting in data encryption, which can greatly impact patient care and safety. There are several methods bad guys use to get into your networks, including theft of data, third party attacks, phishing and ransomware. It is important to regularly remind your staff that they are your first line of defense, because they are the ones getting the suspicious emails and phone calls. Experts recommend that if your facility is a victim of a cyberattack that it is essential to demonstrate how you are attempting to recover the stolen data and protect your systems from future attacks.

Rise of the Robotic Hysterectomy

What you need to know: A trend inside the larger trend of ASC robotics growth, pioneering surgeons are increasingly performing robot-assisted hysterectomies using Intuitive Surgical’s da Vinci surgical system. With that system’s patents starting to expire, increased competition will likely drive down the cost of the tech enough for budget-conscious facilities to access it, with about a half-dozen new robotic platforms on the market or in the pipeline, including systems from Medtronic and Johnson & Johnson.

Observers say that increased competition and lower costs over the next five to 10 years could even lead to vendors including part or all of the cost of the robot into a larger contract with a facility, which would purchase surgical supplies like gowns, masks, drapes and sutures from the robot manufacturer in exchange. Younger surgeons who are training on the platforms will likely also help drive more widespread adoption of robotic-assisted hysterectomies. 

Physicians who use the platforms can enjoy 3D views of the surgical field that allow them to zoom in on target anatomy in greater detail; increased maneuverability with instrumentation; and the ability to perform more complex cases in ASCs. Proponents also point to quicker and less painful recoveries for patients, and less physical strain on surgeons.

While outpatient hysterectomy is still a developing trend, it’s likely the number of robotic-assisted cases will only increase in the coming years. Once the financial numbers work, it could present a huge potential opportunity for forward-thinking surgical facilities.

Interventional Radiology 

What you need to know: A small but growing number of ASCs are adding a wide variety of what some call “pinhole surgeries” to their mix. These interventional radiology (IR) procedures — performed by specialized physicians called interventional radiologists — leverage catheters, wires, needles and sheaths and are guided by fluoroscopy, ultrasound, CT or MRI images. Essentially, these are therapeutic procedures that traditionally have been open or laparoscopic in nature, further reducing surgical impacts on patients’ bodies. Proponents say IR procedures, often performed using sedation rather than general anesthesia, are less risky and less painful and involve shorter recoveries than traditional surgeries. Cardiovascular procedures are a sweet spot for the discipline, including treatment of peripheral vascular disease using balloon angioplasty or stents to stretch narrowed arteries or infusing clot-busting drugs into the artery via catheter; preventing pulmonary embolisms by placing inferior vena cava filters to capture blood clots or using catheter tubes to break them up; and treatment of varicose and blocked veins. IR physicians can also treat diseases in the liver, kidney and uterus, as well as remove kidney stones and gallstones.

ASCs interested in this emerging discipline need to explore fully whether adding an IR line would be both legal and profitable, but those who have done it are excited about the present and future of these super minimally invasive surgeries. OSM