A Qualitative Web-Based Expert Opinion Analysis on the Adoption of Intraoperative CT and Navigation Systems in Spine Surgery

Abstract

Introduction Intraoperative computed tomography (CT) and navigation systems have several potential uses in instrumented spine surgery and may decrease patient morbidity and complications leading to very significant cost-effectiveness implications. Despite these proposed advantages, its adaptation in centers across Canada, New Zealand, and Australia is not ubiquitous. The goal of this study is to identify facilitators and barriers to the adoption of intraoperative CT and navigation systems technology by spine surgeons. Materials and Methods A web-based survey was designed to explore spine surgeons' perceived advantages and disadvantages of the use of intraoperative CT and navigation systems, the learning curve of the technology, its teaching utility, and surgeon comfort level with the technology. Questions were based on the unified theory of acceptance and use of technology (UTAUT) model, which explores four main constructs that directly determine user acceptance and usage behavior: performance expectancy, effort expectancy, social influence, and facilitating conditions. The survey was distributed to surgeon members of the Canadian, New Zealand, and Australian Spine Societies. Participants were stratified into 2 groups: users and non-users of intra-operative CT and navigation, with a slight variability in questions answered by both groups based on applicability. Results A total of 53 surgeons completed the survey (34 Canadians, 16 New Zealanders, and 4 Australians). Overall, 24 of them are users of an intraoperative CT and navigation systems, and 29 are nonusers. The top three advantages identified by both users and nonusers in order of importance were more accurate screw placement, safer screw placement, and reassurance and confirmation of optimal screw placement. The top two disadvantages identified by both users and nonusers were the expense to purchase and maintain the equipment and the exposure of patient to radiation. The third main concern for nonusers is the time consumption associated with the use of this technology, whereas for surgeons who do use it, a disadvantage was that the use of intraoperative CT and navigation is technician dependent. Another concern revealed by the survey is after intra-operative CT and navigation use is implemented at an institution, surgeons think that the use of this technology may present an increased risk of infection (58.3% of surgeons who use it are concerned about this). Surgeons who have adopted this technology have done so primarily due to its clinical efficacy with screw placement, whereas surgeons who have not adopted intra-operative CT and navigation identify the cost of this technology as a limiting factor. Conclusion Spine surgeons recognize the benefit of using intraoperative CT and navigation systems to improve screw placement accuracy and safety. The cost associated with this new technology is the biggest deterrent to its widespread adoption in spine surgery centers in Canada, New Zealand, and Australia. Cost-benefit analysis evaluating the use of this technology would be useful in helping surgeons and health care centers make informed decisions about whether or not this investment is warranted.