A Paradigm Shift in Surgical Intervention: The Hybrid OR market

For 2016, the estimated global market of hybrid ORs was valued at €3.9bn. At a forecasted CAGR of 16.6%, the market is expected to reach €13.3bn in 2025.

What makes this market especially interesting is that the hybrid suites require many different medtech devices and components combining a wide range of therapeutic and diagnostic functionalities. We look at the market values, drivers and inhibitors, the clinical and medical indications/uses of, and the medical devices implicated in Hybrid Operating Rooms or hybrid suites.

The medtech required for the hybrid OR

Following is a list of product segments able to serve the hybrid OR market:

  • Operating tables (radio-transparent), appropriate lights, surgical booms
  • Communication systems, ranging from video (split-screens, high accuracy) and audio displays in the OR, as well as data connectivity to pertinent medical devices
    • OR cameras and surgery-specific cameras
    • Communication functions with an exterior observation/meeting room, i.e. intercom capacity
  • Radiation shield(s)
  • Fixed (and) or mobile / ceiling or floor-mounted CT, MRI, angiography, C-arms
  • Anesthesia apparatus and equipment
  • Sterile environment and paraphernalia, air renewal system
  • Appropriate electrical supplies, e.g. for electrocautery
  • Surgical instruments and consumables

Market figures, segments, and hybrid OR costs

  • (Current) key national markets for hybrid ORs are:
    • North America – USA (holding 37.5% of the global market) and Canada
    • Europe/Eurozone – Germany (16%), United Kingdom, France, Italy and Spain
    • Asia-Pacific – China, India, Japan and Thailand
  • There are an estimated 500 hybrid ORs globally.
  • Regarding the global market for operating room equipment, this is estimated around €3.25 bn, with a CAGR of almost 7% for the next 4 years.
  • The operating room equipment market includes endoscopes, anesthesia equipment, operating room fixtures such as tables lights and surgical booms, microscopes, mobile imaging equipment and displays, as well as integration systems.
  • Regarding the installation costs of a hybrid OR, this has been estimated to vary from €0.46m to as high as €4.7m.
  • Considering the various key components required to install a hybrid OR, their average cost and share of the installation cost as a whole, are as follows:
    • Surgical material– 90,000 = 3%
    • Video and audio tools – €190,000 = 5%
    • Life support devices – €280,000 = 7%
    • OR equipment – €370,000m = 10%
    • Planning/constructing– ranging between €480,000m and 1.87m = equal to 25% of the total installation costs
    • Imaging apparatus– €1.87m = equal to 50% of the installation costs of a hybrid OR
      • It is worthwhile to note that imaging equipment tends to represent half of the cost of building a hybrid OR.
  • Key market players of hybrid OR systems are:
    • Maquet Getinge Group
    • Stryker
    • Steris Corporation
    • TRUMPF GmbH and Co. KG
  • Angiography systems are at the core of the hybrid OR, and this market is dominated by:
    • Siemens – 41.5%
    • Phillips – 32%
    • General Electric – 26.5%

Market drivers

Now that we have an impression of the immense value of the market, the active players in the field, and the market splits based on the medtech components that it requires, let us have a look at what factors are driving the growth of this market.

The foremost economic driver is easily inferred by the fact that there is a greater demand (in developed HC systems in particular) for complex procedures and surgical approaches.

Paradigm shifts in regards to operational flexibility and patient safety are other key drivers.

E.g. In traditional heart catheterization procedures, if a certain complication were to emerge, the patient would have to be moved to a different part of the hospital where the corresponding facilities and specialists are found to handle it. Often patients in such instances are not in a condition to be moved risk-free. In the hybrid setting, a patient can be treated by the appropriate specialists in the same location for the duration of the entire intervention.

In the past, cardiac surgeons and cardiologists worked separately, in different environments, with different technical support, equipment, and staffing needs. In the hybrid model, these two fields can be united in an optimized setting, where both have the facilities at hand to respond quickly and accurately.

Further drivers are:

  • Hybrid ORs allow a diagnostic evaluation whilst simultaneously performing an intervention, which has great implications on the efficiency of the operation. Such as:
  • Reducing the need for anesthetic treatments; i.e. less risk factors and increased patient safety.
  • Reducing the total exposure to X-rays (for both staff and patient).
  • Greater flexibility when performing a surgical intervention; ability to switch from MIS to open.
  • Real time imaging serves as instant quality control, enhancing safety and reducing risk and error.
  • Social, technical, and organizational drivers include:
  • Increased expenditure all across the world, in overall terms, on healthcare infrastructure and services.
  • National and regional governments (both in the EU and Asia in particular) are initiating modernization projects and building new hospitals.
  • Increased demand for patient safety.
  • The widespread medical preference to seek minimally invasive alternatives to traditionally open surgeries.
  • Technological advances in imaging capabilities and mobility facilitates the emergence of hybrid ORs.
  • Continuous drive for innovation in healthcare.
  • Demographic trends, showing ageing populations that are characteristic for having higher rates of cardiovascular conditions that can benefit from hybrid ORs
  • Competitive ability, as well as professional interest. I.e. Surgeons and healthcare players being aware that there exists a superior type of OR wish to be able to offer and partake in the same quality of services and engage with the latest state-of-the-art interventions
  • Cost savings also deliver market drivers. On one hand, the reduced trauma for patients due to performing more minimally invasive procedures paired with lesser anesthetic use, speeds up recovery time, reducing hospitalization time and related costs.

Additionally, the popularity of hybrid ORs and their benefits are spurring market growth, driving the emergence of more competitively priced mobile C-arms and other key components. Competitive pricing is attracting and enabling more hybrid OR consumers.

Trends and opportunities

Considering all the aforementioned market drivers, one trend is clear: hybrid ORs are growing in appeal and in numbers.

More regional and medical specialism-related trends are:

  • Image-guided minimally invasive surgery and interventions are the preferred approach in various medical specialisms.
  • Asia Pacific (APAC) is expected to have the steepest hybrid OR growth rate, explained by their rising medical tourism markets for general and restorative care, HC modernization programs, and their pursuit of medical business ventures across sectors and internationally (in some but not all cases). Countries expected to have the most significant growth are:
    • India
    • Thailand
    • South Korea
    • Malaysia
    • China
    • Japan
  • Latin America is also showing some promising hybrid OR participants, incited by government efforts and investments to modernize their healthcare systems:
    • Brazil
    • Argentina
  • Europe obviously offers an appealing market also, as European nations tend to follow (if not spearhead) cutting-edge technological developments closely and seek continuous improvements of healthcare infrastructures and techniques.
  • North America is expected to perform 75% of all cardiovascular procedures in hybrid ORs within 3 years.
  • Immediate growth is likely to encounter success and meet demands in the segments of robotic surgical equipment and therapeutics.

Market inhibitors and challenges

After having heard all the benefits and growth opportunities, what are the possible organizational roadblocks and growth challenges facing hybrid operating rooms?

  • The costs are high, and a thorough analysis must be made of the procedures being performed in a given facility, expected volumes of procedures eligible for hybrid ORs, etc., in order to establish whether the ROI of such a substantial investment is financially responsible, and rewarding.
  • Constructing a hybrid can take from 5-18 months, obviously depending on resources and planning.
  • On average, a hybrid OR requires 50-80% more space than a conventional OR based on US figures, and 30-40% more based on German figures.
  • Not only does a hybrid OR create a crossover of technologies, its very essence is enabling a crossover and hybridization of medical interventions. This requires a re-organization of specialty professionals and an efficient coordination between multiple surgeons and the staff.
  • The operational complexity is increased, requiring additional training for all the staff involved. It is vital that all the professionals involved with the use of the hybrid suite are aware of all its functions, applications and the full potential of the room they are operating in.
  • Considering the various inputs of interconnected audio and visual devices, as well as robotic machinery, often linked to exterior viewing rooms, it is of critical importance that OR systems and apparatuses are well integrated with one another. Compatibility with existing or new devices/infrastructure could present a hurdle for designers, suppliers and end-users.

Medical applications and indications for using hybrid ORs

Key when either considering the investment into a hybrid OR, or when marketing the devices related to the construction and furnishings of a hybrid OR, is knowing which medical applications it serves.

Below are some of its principal functions:

  • Cardiovascular and neurosurgery applications combined represent over half of the therapeutic use of the hybrid market share, followed by thoracic:
    • Cardiovascular – 37%
      • g. Endovascular interventions paired with cardio, vascular and thoracic surgeries
    • Neurosurgery – 22%
    • Thoracic – 10%
  • Other common fields are:
    • Interventional radiology
    • Orthopedics
    • Pediatric surgery
    • Emergency interventions
    • Biopsies (thoracic)
  • Diagnostic use values include:
    • Fluoroscopy
    • Digital subtraction angiography
    • 3D C-arm CT
  • For new approaches relying on angiography guided imaging, whilst performing endovascular, laparoscopic (and) or open interventions.
  • High-risk minimally invasive procedures, which may progress to the need for an open surgery.
  • To reduce the patient trauma and reduce recovery time.
  • For cases conventionally performed in a cath lab and a cardiovascular operating room.

TforG healthcare market intelligence

Tforg specializes in surgical procedure volumes in 13 medical specialisms, giving a better understanding of market sizes and market trends. The TforG myTools platform provides a detailed statistical overview of 1,000 surgical procedures (based on ICD 9), that can be filtered and investigated per medical field, country, facility type, and based on whether it is performed minimally invasively or through open surgery. Not only does the data reflect national statistics up-to-date, it also provides forecasts up to 2017.

To give you a little taster – based on all the procedure statistics listed in the myTools database pertaining to cardiology – total cardio procedure volumes in Germany will grow by 3.5% in a single year, from 2016 to 2017.

To extract a particular procedure, which is eligible for hybrid OR care in particular, you can fine-tune the search according to your market interests within your customized myToolsforGrowth dashboard.

The paradigm shift in surgery techniques and safety that the hybrid OR offers is fantastic. The market is far from saturated and full of potential, on both the development as well as on the sales side.

If you would like to read more about the minimally invasive surgery trend, check out this earlier TforG article.

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About Bart Van den Mooter

Bart is the founder of TforG and works closely together with over 50 global companies such as Abbott, Baxter, GE, J&J, Medtronic, Philips, Stryker and Covidien. In this function, he spends a lot time with Key Opinion Leaders and Health Policy makers in Europe and in Emerging Markets. He graduated at the Polytechnic University of Leuven with a Master of Engineering and has an MBA (Flanders Business School).