There's no question that hybrid ORs are a huge investment for hospitals. But according to a new report issued by the nonprofit ECRI Institute, which advises facilities on health care safety and technology, this is not stopping hospitals, large and small, from looking into building these hybrid rooms.

ECRI sees the trend growing from many different angles. Not only have they witnessed the mounting clinical advancements in minimally invasive procedures, particularly endovascular surgery, as one aspect of the trend, but they have also seen significant interest from hospitals in capital purchases.

"Our capital advisory services see the imaging systems to support the hybrid OR as one of their top requests, so that's providing validation for what we're seeing as far as the emergence of these clinical procedures," Thomas Skorup, FACHE, vice president of applied solutions at ECRI Institute, told DOTmed News.

From his day-to-day perspective, Skorup and his group at ECRI Institute provide on-site technical assistance to hospitals. In the last few years he said they have worked with both academic medical centers and community hospitals to build these hybrid systems.

"There's a high level of validation that this is something on the move based on us commonly seeing a trend but also seeing a validation of that trend," he said.

The trend is driven by the rise of minimally invasive procedures that require both real-time imaging as well as OR capability in case anything goes wrong. Procedures such as TAVR, or transcatheter aortic valve replacement, one of the more well-known minimally invasive procedures, are already performed in roughly 200 hospitals nationwide. Down the road, mitral valve repairs, as well as Abdominal Aortic Aneurysms (Triple A) graft stents, while not new, will be targeted for this room.

"I do think there is an undercurrent of belief that these procedures, once they become more proven, could displace some more traditional surgical procedures over time," said Skorup. Community hospitals and large academic medical centers with heart programs are willing to invest, because if they don't, they fear they will be left out of an important service line, according to Skorup.

Cost and size considerations

According to the report, on average, hybrid ORs cost about $3 to $4 million — surely not an investment to be taken lightly.

Costs can be higher based on what is included in the room. For example, an OR integration system for managing the images can increase the price tag, according to Skorup.

Skorup said they see the most variability in construction costs. Some facilities might build the room from scratch, while others could consolidate two ORs into one big room.

Historically, ORs are big spaces, taking up roughly 800 square feet of space. But hybrid ORs require at least 1000 square feet — almost double in size. The rooms are also more complex, with up to 100 technologies required, including large mounted C-arms, and a more crowded team of clinicians.

Top vendors

The report highlights one vendor who got a jump on the market. Skorup said Siemens Healthcare's Artis zee imaging system gained traction because of the C-arm's ability to rest in the corner of the OR when it's not in use.

"The ability to move it and being able to park it out of the way has space implications," said Skorup.

The Artis zee was also marketed as having robotic capabilities related to the axis of articulation for the C-arm. However, this system runs at a higher price point in the market. Skorup said GE Healthcare and Philips Healthcare also offer comparable systems, and Toshiba has been competitive in more niche markets.

But it's not just floor space that needs to be taken into consideration. Skorup said ceiling requirements are also a serious part of the planning process.

"It becomes very busy real estate: you have surgical booms, lights, air flow considerations that can't be impeded. That can be complex to design," he said.

Safety concerns

While an enormous planning effort goes into constructing hybrid ORs, safety concerns are also paramount, according to the report. Skorup highlights radiation safety for the patient, but particularly the staff who are exposed day after day.

"We are talking about training surgical people to do dose safety," said Skorup. This might not be as ingrained as it would be for radiologists who began their training with safety in mind.

Proper training with such a large team is also a priority for patient safety and maximizing pricey OR time, according to Skorup. He recommends having a licensed professional run the imaging system so they can help pull images for surgeons when they need them.

Room for growth

While the report focused on endovascular hybrid ORs, Skorup said it's not limited to this area.

"There's an appetite for potential to do a combination downstream of both endovascular and maybe laparoscopic procedures, and of course the need to transfer from endovascular to open procedures if things are not going right," he said.

Right now, he said he feels strongly about getting decision-makers to understand what they need — whether it be a hybrid OR or a hybrid cath lab that's OR ready.

"There's some panache in saying I have a hybrid OR but understanding your clinical case mix is so important," said Skorup.

Click here to download the report from ECRI Institute's website.