In cardiovascular and spine surgery, multi-billion dollar markets were created from entirely new procedures between 1980 and 2000, with subsequent segmentation in later years particularly as new minimally invasive procedures were developed towards the end of the 20th century. In the cardiovascular arena, the development of new procedures for angioplasty and bypasses in the late 1980s led to these procedures being performed in increasing numbers. This increase was driven by lowered risk associated with the new procedures, new product availability, and surgeon capability coupled with substantial changes in demographics caused by aging, lifestyle and economics. For example, it is estimated that approximately 20% of the over 80-year-old population suffers from some form of coronary heart disease in the United States, and the development of angioplasty procedures created a new preferable (to open heart surgery) treatment for this population.
Whereas in the United States there were 50,000 open heart surgery treatments in 1980, towards the end of the twentieth century there were 150,000 open heart bypass operations per year. There are approximately 375,000 cardiac vascular reconstruction procedures per year. In cost terms, each angioplasty in the United States costs approximately $8,000 and bypass operations cost approximately $25,000. Surgical closure and securement products are routinely used in these procedures, and new techniques like this cardiovascular example, with associated new technologies, are likely to arise in the next decade to create new market opportunities.
During this same time frame, spine surgery has also seen tremendous growth, spurred by the combined catalyst of new technology development and an increasingly active and growing senior population. Until the 1980s spinal surgery focused on multi-level segmental fusion procedures to fuse together several vertebrae to decrease the chance of failure at the bone metal interface. Fixation methods using Harrington hook and rod systems, Luque rods, and wires were used to achieve fusion. These procedures are notable by their invasive nature; they are associated with significant trauma and require substantial rehabilitation care for successful outcome. They were therefore initially used only in extreme cases of congenital deformity and cases of extreme trauma and pain. In the mid- to late 1980s, a number of manufacturers developed bone screws for use in combination with these hooks and rods, which improved the achievement of stability without requiring multi-level fusion, and the emergence of threaded fusion cages in the mid-1990s added to the surgeon’s treatment options, with resultant increase in fusion success rates. The market for these products grew from tens of millions in 1980 to a $2.4 billion world-wide market in 2000. Use of adjunctive products for surgical closure and securement have already gained foothold in these procedures, which continue to grow.
Less invasive approaches to spine surgery and concomitant technology development have expanded the patient population for spine fusion procedures. Simultaneously, a persistent demand has existed among a high caseload of patients with spine trauma and disease seeking solutions that diminish or eliminate pain, and yield lasting high quality outcomes including spine flexibility, strength and the opportunity for a more active lifestyle. These include systems for dynamic stabilization, interspinous process spacers, artificial discs and other products. The performance of procedures involving these products, while improving broadening the applicable caseload and improving the clinical outcomes of patients, will no less demand the use of advanced surgical closure and securement products to facilitate procedures, reduce complications and optimize results. Fibrin sealants and glues, high strength glues and hemostasis products have established their current and future places in these fields.
Cardiovascular and spine surgery are two among many surgical fields continuing to grow, driven by patient demand and facilitated by technologies that improve outcomes. Bariatrics, gynecologics, orthopedics, gastrointestinal and other surgeries are witnessing similar increases in procedure volume.
See the MedMarket Diligence report #S175, "Worldwide Surgical Sealants, Glues and Wound Closure, 2009-2013."