What 1 spine surgeon sees for the future of surgical outcomes

Ariana Portalatin -  

Standards of care for spine surgery will become increasingly aligned as surgeons become more reliant on patient outcome data to drive treatment, one spine surgeon predicts.

Oren Gottfried, MD, is a neurosurgeon and spine surgeon at Durham, N.C.-based Duke Health. He is also a professor in the division of neurosurgery at Duke University.

He spoke with Becker's about how outcomes for spine surgery have evolved and what he predicts for standards of care in the field. 

Editor's note: Responses were lightly edited for clarity and length. 

Question: What are the biggest challenges facing the industry? How do these challenges compare to five to 10 years ago?

Dr. Oren Gottfried: I feel there is a great emphasis on quality and value, but surgeons are monitoring and adjusting things in isolation. Also, surgeons are not held to any particular level or standard and there is significant variability by location or region. It would be nice to have the entire spine community working on these efforts as a team and sharing best practices. It would be nice for every surgeon to have their own data and benchmarks. I feel we are getting better at seeing and understanding quality and cost data. I think with value-based care and employer contracts, the time will come that there are strict cutoffs and expectations everyone has to achieve.

Q: What technologies/innovations are coming into the industry that will improve efficiency and quality of care?

OG: I think personalized surgeon and hospital-level data and scorecards for quality and cost are key technology and innovation. Registries like the [American Joint Replacement Registry], [Quality Outcomes Database], [International Spine Study Group], [American Spine Registry], [National Surgical Quality Improvement Program] and others will help distribute this data and make things actionable. We will be held accountable to function at a high level of efficiency and will no longer be able to do high cost, low value surgeries. I provide spine surgeons at Duke University with monthly, very detailed personal quality data, and I think it's a start and hope this trend of providing surgeons the opportunity to improve their own outcomes and data becomes more prevalent. 

I do feel surgeons need help interpreting all their own [preoperative, intraop, and post-op] surgery and care data and making actionable plans to provide best possible treatment and outcomes for patients. I strongly feel surgeons will be assisted by predictive analytics when making clinical decisions during the continuum of care. Our brains can only see several iterations of possible responses, but these tools can provide patients and doctors support to match patients [with the] right treatment or intervention, hospital or facility [and] best possible surgeon for this specific issue. These tools will also help with preop optimization and risk stratification. I see the spine community growing to find unison with data and predictive analytics tools to provide best care and best outcomes for our patients.There will be a learning curve, and there will always be the need for surgeons' skills and wisdom, but predictive analytics will be immensely helpful in preop decision making as well as with intraop decisions and tools. 

Q: How do you see your practice/the industry evolving in the next three to five years?

OG: Currently, indications for surgery are surgeon based. In the future, we will all follow standard indications for each surgery. Optimizing non-operative care is generally a checklist item for payers to pre-authorize surgery, but there will be far more stringent requirements to not only prove that a patient did adequate trials of [physical therapy], [Non-steroidal anti-inflammatory drugs], other meds and injections, but that they did it well. Also, we will have to prove our surgeries demonstrate efficacy with low costs and durable outcomes. In the current model, all you have to do is complete a checklist to pass go, but in the future you will have to show success on the back end with your outcomes and data to get the patients to operate on in the first place. 

Q: If you could change one thing about the industry, what would it be?

OG: I would have every surgeon looking at their own quality data, objective patient satisfaction, patient reported outcomes, and costs daily compared to benchmarks and peers. I would have all surgeons follow evidence-based guidelines and practice guideline-concordant care. 

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