Evaluation of Cost, Payments, Healthcare Utilization, and Perioperative and Post-Operative Outcomes of Patients Treated with Posterior Lumbar Spinal Surgery Using Open versus Minimally Invasive Surgical Approaches.

PURPOSE: Minimally invasive surgery (MIS) of the spine has been associated with favorable outcomes compared to open surgery. This study evaluated matched cohorts treated with MIS versus open posterior lumbar fusion for costs, payments, healthcare utilization and outcomes. PATIENTS AND METHODS: This study used the Premier Healthcare and IBM® MarketScan® Commercial and Medicare Databases. Patients with posterior lumbar fusion from 2015 to 2018 were identified and categorized as "Open" or "MIS". Cohorts were matched on patient and provider characteristics. Perioperative complications, hospital costs, healthcare utilization and post-operative outcomes and payments to providers were analyzed. Statistical significance was evaluated using T-tests and chi-square tests. RESULTS: After matching, 2,388 Open and 796 MIS from PHD, and 415 Open and 83 MIS from MarketScan were included. Statistically significant differences between MIS versus Open were found for index hospital costs, $29,181 (SD: $14,363) versus $27,616 (SD: $13,822), p=0.01; length of stay, 2.94 (SD: 2.10) versus 3.15 (SD: 2.03) days, p=0.01; perioperative urinary tract infection, 1.01% and 2.09% (p=0.05); and 30-day risk of hematoma/hemorrhage, 19.28% versus 8.43%, p=0.02. There were observed, but statistically non-significant differences in additional perioperative or post-operative complications, home discharge, 90-day all-cause and spine-related readmission, and 90-day post-operative payments. CONCLUSION: Compared to Open, patients that underwent MIS had statistically significant lower length of stay, lower perioperative UTI, greater hospital costs, and higher 30-day risk of hematoma/hemorrhage. The differences observed in post-operative complications and payments and readmissions warrant further investigation in larger matched cohorts.

Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center: A comparative before-and-after study.

Optimizing surgical instrumentation may contribute to value-based care, particularly in commonly performed procedures. We report our experience in implementing a perioperative efficiency program in 2 types of orthopedic surgery (primary total-knee arthroplasty, TKA, and total-hip arthroplasty, THA).A comparative before-and-after study with 2 participating surgeons, each performing both THA and TKA, was conducted. Our objective was to evaluate the effect of surgical tray optimization on operating and processing time, cost, and waste associated with preparation, delivery, and staging of sterile surgical instruments. The study was designed as a prospective quality improvement initiative with pre- and postimplementation operational measures and a provider satisfaction survey.A total of 96 procedures (38 preimplementation and 58 postimplementation) were assessed using time-stamped performance endpoints. The number and weight of trays and instruments processed were reduced substantially after the optimization intervention, particularly for TKA. Setup time was reduced by 23% (6 minutes, P = .01) for TKA procedures but did not differ for THA. The number of survey respondents was small, but satisfaction was high overall among personnel involved in implementation.Optimizing instrumentation trays for orthopedic procedures yielded reduction in processing time and cost. Future research should evaluate patient outcomes and incremental/additive impact on institutional quality measures.

The role of the physician in transforming the culture of healthcare.

Purpose The healthcare system in the USA is undergoing unprecedented change and its share of unintended consequences. This paper explores the leadership role of the physician in transforming the present culture of healthcare to restore, refine and preserve its traditional care components. Design/methodology/approach The literature on change, organizational culture and leadership is leveraged to describe the structural interdependencies and dynamic complexity of the present healthcare system and to suggest how physicians can strengthen the care components of the healthcare culture. Findings When an organization's culture does not support internal integration and external adaptation, it is the responsibility of leadership to transform it. Leaders can influence culture to strengthen the care components of the healthcare system. The centrality of professionalism in the delivery of patient services places a moral, societal and ethical responsibility on physicians to lead a revitalization of the care culture. Practical implications This paper focuses on cultural issues in healthcare and provides options and guidance for physicians as they attempt to lead and manage the context in which services are delivered. Originality/value The Competing Values Framework, the major interdependent domains and five principal mechanisms for leaders to embed and fine tune culture serve as the main tenets for describing the ongoing changes in healthcare and defining the role of the physician as leaders and advocates for the Patient Care Culture.

Managing in the context of healthcare's escalating technology and evolving culture.

PURPOSE: As healthcare has become more scientifically based and far more sophisticated in terms of technology, it has become more fragmented in terms of care-giving, and less personal. The purpose of this paper is to discuss the challenging task of leading and managing in the gap between the existing and emerging cultures of healthcare. DESIGN/METHODOLOGY/APPROACH: This paper considers the literature on culture, how it exists at many levels and in multiple forms, and the impacts it has on the US healthcare system. Further, the paper explores foundations of the current healthcare culture and attempts to forecast features of the emerging culture, incorporating examples of advances in scientific knowledge and technology. FINDINGS: System change will continue to be problematic until leaders and change agents find ways to operate effectively in the gap between the existing cultural tenets and those emerging as the result of scientific and technological advancements. ORIGINALITY/VALUE: Punctuated equilibrium theory serves as a main tenet for describing how changes will continue to push the USA towards a cultural tipping point. This paper contends that leaders and managers can succeed only by understanding and respecting both cultures and calls for improved theory development and research to help find creative ways to advance the new culture without trampling the old.