From the March 2013 issue of HealthCare Business News magazine
“The cost is really dependent on the use of an existing room versus a buildout, location of the OR and the rest of the procedural focus,” Robert Popilock, senior market development manager with Steris, tells DOTmed News. “Most commonly in the OR, we’re seeing dedicated C-arms (monoplanes or biplanes) but some of these more sophisticated ORs are using MRI or CT or even have robotics, which will also change the cost equation.”
Hybrid ORs, at least compared to cath labs, have another pricey element: lighting. Typically they need two to three sets of lights above the table because of the different entry points on the body that need to be illuminated. This means lighting up an OR is an order of magnitude more expensive than outfitting a cath lab. Standard cath lab lighting could run you $10,000 to $25,000, while OR lighting could be as much as $100,000, Philips’ Schapiro says.
Cost is important to get a handle on, as hospitals have to plan for what sort of volume they’ll see. Schapiro says many hospitals could only expect 75-150 TAVR cases a year, which isn’t enough to sustain the room. That’s one of the reasons, he says, Philips has partnered with Maquet to offer a configurable OR table for surgeries, called the Magnus, which can be swapped with their Philips-made radiolucent table for image-guided procedures. The OR table is for customers that, say, aren’t big academic medical centers, and who might need to do orthopaedic or other procedures in the hybrid OR to get the most out of the space. Toshiba has had a similar deal with Maquet since 2008, and Siemens inked one last spring.
“If you’re only doing a few TAVI procedures a week, what else do you use the room for? The vascular surgeon can pick up some time. But if they doesn’t have the volume, the Maquet table comes in,” Berthe says. “You don’t want the OR sitting idle.”
For its part, Maquet tells DOTmed News in an e-mail that it has outfitted more than 175 hybrid rooms with either its Magnus table or its complete hybrid solution, including lights, booms OR integration and cardiac disposables.
Up or down?
When designing a hybrid OR, a key issue is space. These rooms get crowded, and access to patients can be a challenge. For TAVR procedures, as many as 15 people could be jostling around monitoring equipment, working on the patient or simply on standby. “At a moment’s notice they could need access to the patient and the C-arms have to move quickly out of the way,” says Toshiba’s Berthe.
That’s why one of the most important decisions centers on the C-arm. In short, where do you put it, on the floor or the ceiling? There’s no industry consensus, and there are tradeoffs to each. On the one hand, the ceiling is crowded with booms and, for the sake of hygiene, laminar airflow in an operating room has to be protected. On the other hand, the floor is occupied by moving bodies, and tables and carts could present a collision risk to expensive imaging equipment.
