Mr Sandeep Chauhan is the lead knee surgeon at University Sussex Hospitals and a senior orthopaedic consultant specialising in knee surgery at The Montefiore Hospital in Hove. He is also the co-founder of Definition Health which has recently been chosen to be one of just 12 high impact innovators to join the NHS Innovation Accelerator (NIA) in 2021. He is a pioneer of computer-assisted and robotic knee surgery.
OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?
SC: When I was at medical school (St Thomas’ Hospital, London) I really enjoyed watching surgeries being performed and seeing how surgery can make a dramatic difference to a person’s quality of life. My mentor was the acclaimed orthopaedic surgeon Professor Fred Heatley and he inspired me to follow that route. He taught us the first three key principles of being an orthopaedic surgeon were: be kind, be strong – both mentally and physically – and be clever. I got the first two right!
OPN: It is clear that the healthcare industry has been greatly impacted by the Covid-19 pandemic, what has been the greatest impact within the orthopaedic industry?
SC: I appreciate that, quite rightly, the big focus for the NHS during the pandemic has been to treat the people with COVID. However, that has had a significant impact on patients on waiting lists for hip and knee surgery. During this time, their quality of life will have significantly deteriorated. I have seen figures quoting 4.8 million people on waiting lists for procedures and, of that, around 1.4 million patients are waiting for elective orthopaedic surgery – that is three times the pre-COVID19 average.
I also haven’t seen the same number of people coming into my clinics as they did before the pandemic, which means people are not even getting their first appointments. What myself and my colleagues are really worried about is how we deal with those vast numbers of patients who are currently suffering.
OPN: As a surgeon, how do you embrace new technologies to ensure the best patient experience, management strategies and surgical outcomes?
SC: I am passionate about the use of technology in health care and have been ever since I first used computers in the theatre in 2002. These allowed us to monitor the surgery in real time, giving greater accuracy and precision and making the procedure very specific to the patient as an individual.
The more recent robotic technologies produce 3D models of a patient’s knee or hip, which allows for pre-surgical planning specific to the patient. This 3D model is then used to determine how much bone to remove, and where to place the implant, thus minimising trauma and preserving the maximum of healthy tissue. This means we are seeing really good outcomes with our patients who are recovering quicker.
The primary role of introducing new technology is always to improve patient and surgical outcomes. It has been an interesting journey so far, but I believe decisions to introduce new technology into surgery should be evidence-based. It is very easy to embrace new ideas because they seem fashionable but they need to be applied properly.
Change is often uncomfortable in the health care sector, but by blending clinical experience with digital transformation, we can improve the patient pathway and outcomes. You only need to look at the National Joint Registry to see evidence that digital technology is improving patient outcomes.
OPN: Tell us more about the creation of your web-based apps and how they support outpatient consultations and the pre-operative assessment of patients.
SC: Our very first web-based app, launched in 2018, was born out of a deep frustration with the surgical journey for patients. They were often faced with unnecessary appointments pre-surgery or had their operations cancelled at the last minute. This left the patient on the periphery of their care and was a costly process for the NHS.
We identified a need to have patients ‘surgery-ready’ on the day of their operation, having undergone a higher level of pre-operative assessment to reduce risk. We also wanted to increase patient confidence and understanding, and for them to feel fully informed about the procedure they were about to have. Our aim was to put the patient at the centre of their care.
We worked with a team of 10 NHS consultants supported by agile software developers to create the LifeBox digital Patient Pre-Operative Assessment app (LifeBox POA) The product was in development for two years and patient feedback was at the heart of that process.
The LifeBox ePOA has three key components – an interactive digital health questionnaire which patients can complete in the comfort and safety of their home, audio-visual tools for enhanced patient education, and specific outcome tools to measure success of procedures. LifeBox has proved an invaluable tool during the COVID crisis, supporting the safe triage of NHS patients needing clinically urgent surgery while getting other patients ‘surgery-ready’ for when their elective procedures can finally take place.
We have since launched Secure Virtual Clinic (SVC) – software which provides secure patient-practitioner consultation via video or audio call while allowing secure two-way file uploading, information sharing and complete follow-up to ensure medical continuity. It means the patient now has a complete end-to-end digital surgical journey which improves their experience and their outcomes as well as saving time and costs for hospitals. Our apps are now deployed in 10 UK hospitals with 50,000 patients registered to use them.
OPN: What does it mean to be appointed an innovator with the NHS Innovation Accelerator?
SC: This is a huge accolade for us. There were 450 applicants and we were the only surgical company among the final 12 to be chosen. The vetting process was vigorous – the selection panel included Professor Stephen Powis, National Medical Director for NHS England and NHS Improvement and Amanda Pritchard NHS England’s chief Operating Officer. They specifically chose companies which can help the NHS recover from COVID – that is a huge honour as well as a responsibility, but we are looking forward to the challenge.
OPN: What’s the best part of your job?
SC: It has always been looking after patients, making them better and seeing that I have made a difference.
OPN: … and the worst?
SC: There are times when things don’t go so well, and you are not able to help people who are clearly experiencing pain. That for me is the worst part of my job.
OPN: What has been the highlight of your career so far?
SC: There have been many highlights, but I would say doing my first surgery is definitely top of the list. It was in 1995 and it was a hip replacement on a female hip fracture patient, and I was a junior doctor at the time. And the most recent highlight has to be doing my first robot-assisted knee replacement.
OPN: Are you currently involved in any scientific research within your work?
SC: I am currently working with academics and fellow surgeons at Brighton and Sussex University Hospitals to develop new techniques in computer-assisted surgery and in minimally invasive surgical procedures.
OPN: If you weren’t an orthopaedic surgeon what would you be?
SC: I have always been fascinated by technology and how it can improve all aspects of our lives so I think, if I hadn’t become as surgeon, I would have become a digital entrepreneur.
OPN: What would you tell your 21-year-old self?
SC: Live life to the full and don’t have any regrets.
OPN: If you were Health Minister for the day what changes would you implement?
SC: Firstly, protect and pay NHS staff properly. Secondly, to utilise every available operating theatre and hospital bed – NHS or Private – to effectively reduce our national waiting list. We need to create regional high volume centres quickly and, although it may not be popular, using a dedicated private hospital per region to do this as a green COVID-free high volume centre would decompress the NHS sites and give them time to recover.
OPN: Away from the clinic and operating theatre – what do you do to relax?
SC: I like cycling with my children and to get outdoors as much as possible and have lots of fresh air. I am lucky as I live near the beautiful Sussex coast. I also enjoy relaxing to music after work. Music is played during operations, but my theatre team get to choose the playlist, so it tends to be hip hop and rap rather than my preferred soulful melodies.
OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for 2021 and the next decade?
SC: I feel hugely excited especially as I believe, over the next decade, we are going to continue to see huge changes in how we do surgical training and prepare the surgeons of the future. The virtual surgical training I have witnessed recently is amazing.
I also believe 3D imaging and digital technology is here to stay and will enable us to continue to achieve better outcomes and treat people more quickly. These tools will help us greatly in 2021 as we recover from COVID and focus on reducing those waiting lists and ending the long-term pain for our orthopaedic patients.
- Bone Jt Open 2021;2(2):103–110
For more information on Definition Health, visit: www.definitionhealth.co.uk