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Marcus HJ, Ramirez PT, Khan DZ, Layard Horsfall H, Hanrahan JG, Williams SC, Beard DJ, Bhat R, Catchpole K, Cook A, Hutchison K, Martin J, Melvin T, Stoyanov D, Rovers M, Raison N, Dasgupta P, Noonan D, Stocken D, Sturt G, Vanhoestenberghe A, Vasey B, McCulloch P. The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring. Nat Med 2024; 30:61-75. [PMID: 38242979 DOI: 10.1038/s41591-023-02732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/20/2023] [Indexed: 01/21/2024]
Abstract
The next generation of surgical robotics is poised to disrupt healthcare systems worldwide, requiring new frameworks for evaluation. However, evaluation during a surgical robot's development is challenging due to their complex evolving nature, potential for wider system disruption and integration with complementary technologies like artificial intelligence. Comparative clinical studies require attention to intervention context, learning curves and standardized outcomes. Long-term monitoring needs to transition toward collaborative, transparent and inclusive consortiums for real-world data collection. Here, the Idea, Development, Exploration, Assessment and Long-term monitoring (IDEAL) Robotics Colloquium proposes recommendations for evaluation during development, comparative study and clinical monitoring of surgical robots-providing practical recommendations for developers, clinicians, patients and healthcare systems. Multiple perspectives are considered, including economics, surgical training, human factors, ethics, patient perspectives and sustainability. Further work is needed on standardized metrics, health economic assessment models and global applicability of recommendations.
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Affiliation(s)
- Hani J Marcus
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK.
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK.
| | - Pedro T Ramirez
- Department of Obstetrics and Gynaecology, Houston Methodist Hospital Neal Cancer Center, Houston, TX, USA
| | - Danyal Z Khan
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - John G Hanrahan
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Simon C Williams
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - David J Beard
- RCS Surgical Interventional Trials Unit (SITU) & Robotic and Digital Surgery Initiative (RADAR), Nuffield Dept Orthopaedics, Rheumatology and Musculo-skeletal Sciences, University of Oxford, Oxford, UK
| | - Rani Bhat
- Department of Gynaecological Oncology, Apollo Hospital, Bengaluru, India
| | - Ken Catchpole
- Department of Anaesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Cook
- NIHR Coordinating Centre and Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, Ontario, Canada
| | - Tom Melvin
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Republic of Ireland
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Maroeska Rovers
- Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands
| | - Nicholas Raison
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Prokar Dasgupta
- King's Health Partners Academic Surgery, King's College London, London, UK
| | | | - Deborah Stocken
- RCSEng Surgical Trials Centre, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Anne Vanhoestenberghe
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Baptiste Vasey
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Information and Guidance on the Adoption of Surgical Innovation and Technology in Urogynecology. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:318-326. [PMID: 36808927 DOI: 10.1097/spv.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
ABSTRACT The development of new technology and techniques (NTT) is an integral component of contemporary medicine. In surgery, rapidly advancing technology offers opportunities to innovate and study new approaches to help improve the quality and effectiveness of therapies. The American Urogynecologic Society is committed to the responsible implementation and use of NTT prior to the broad application of clinical care for patients, which includes not just new devices but application of new procedures. The aim of this document is to present a framework by which AUGS and its members can address future NTT development. Core areas of patient advocacy, industry partnerships, postmarket surveillance, and credentialing were identified to provide both a perspective and pathway for responsible use of NTT.
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Baines R, Hoogendoorn P, Stevens S, Chatterjee A, Ashall-Payne L, Andrews T, Leigh S. Navigating Medical Device Certification: A Qualitative Exploration of Barriers and Enablers Amongst Innovators, Notified Bodies and Other Stakeholders. Ther Innov Regul Sci 2023; 57:238-250. [PMID: 36194368 PMCID: PMC9531632 DOI: 10.1007/s43441-022-00463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical device certification has undergone significant changes in recent years. However, exploration of stakeholder experiences remains relatively limited, particularly in the context of software as a medical device. This study sought to explore stakeholder experiences of medical device certification across both the UK and EU. METHODS Semi-structured interviews (n = 22) analysed using inductive-thematic analysis, synthesised using activity theory. RESULTS Innovators, consultants and notified bodies share more similarities than differences when discussing barriers and enablers to achieving medical device certification. Systemic tensions between existing rules, tools, community understanding and division of labour currently undermine the intended aim of certification processes. Existing rules are considered complex, with small and medium-sized enterprises considered disproportionality affected, resulting in several unintended outcomes including the perceived 'killing' of innovation. Existing certification processes are described as unfit for purpose, unethical and unsustainable. CONCLUSION Stakeholder experiences suggest that the intention of establishing a robust and sustainable regulatory framework capable of ensuring a high level of safety whilst also supporting innovation is not yet being realised. Failure to enact desired changes may further jeopardise future innovations, outcomes and care quality.
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Affiliation(s)
- Rebecca Baines
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB UK ,University of Plymouth, Plymouth, PL4 8AA UK
| | - Petra Hoogendoorn
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Sebastian Stevens
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB UK ,University of Plymouth, Plymouth, PL4 8AA UK
| | | | - Liz Ashall-Payne
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB UK ,Warwick Medical School, University of Warwick, Coventry, UK
| | - Tim Andrews
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB UK ,Warwick Medical School, University of Warwick, Coventry, UK
| | - Simon Leigh
- The Organisation for the Review of Care and Health Applications (ORCHA), Daresbury, WA4 4AB, UK. .,Warwick Medical School, University of Warwick, Coventry, UK.
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Kramer DB, Parasidis E. Informed consent and compulsory medical device registries: ethics and opportunities. JOURNAL OF MEDICAL ETHICS 2022; 48:79-82. [PMID: 33608445 DOI: 10.1136/medethics-2020-107031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
Many high-risk medical devices earn US marketing approval based on limited premarket clinical evaluation that leaves important questions unanswered. Rigorous postmarket surveillance includes registries that actively collect and maintain information defined by individual patient exposures to particular devices. Several prominent registries for cardiovascular devices require enrolment as a condition of reimbursement for the implant procedure, without informed consent. In this article, we focus on whether these registries, separate from their legal requirements, have an ethical obligation to obtain informed consent from enrolees, what is lost in not doing so, and the ways in which seeking and obtaining consent might strengthen postmarket surveillance in the USA.
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Affiliation(s)
- Daniel B Kramer
- Harvard Medical School, Boston, Massachusetts, USA
- Richard A. and Susan F. Smith Center in Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Lalani C, Kunwar EM, Kinard M, Dhruva SS, Redberg RF. Reporting of Death in US Food and Drug Administration Medical Device Adverse Event Reports in Categories Other Than Death. JAMA Intern Med 2021; 181:1217-1223. [PMID: 34309624 PMCID: PMC8314174 DOI: 10.1001/jamainternmed.2021.3942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE In the US, most postmarket medical device safety data are obtained through adverse event reports that are submitted to the US Food and Drug Administration (FDA)'s Manufacturer and User Facility Device Experience (MAUDE) database. Adverse event reports are classified by the reporter as injury, malfunction, death, or other. If the device may have caused or contributed to a death, or if the cause of death is unknown, the FDA requires that the adverse event be reported as a death. OBJECTIVE To determine the percentage of medical device adverse event reports submitted to the MAUDE database that were not classified as death even though the patient died. DESIGN, SETTING, AND PARTICIPANTS In this study, a natural language processing algorithm was applied to the MAUDE database, followed by manual text review, to identify reports in the injury, malfunction, other or missing categories that included at least 1 term that suggested a patient death, such as patient died or patient expired, from December 31, 1991, to April 30, 2020, for any medical device. EXPOSURES Manual review of a random sample of 1000 adverse event reports not classified as death and of selected reports for 62 terms that are associated with deaths but were not classified as death. MAIN OUTCOMES AND MEASURES Percentage of adverse event reports in which the patient was said to have died in the narrative section of the report but the reporter classified the report in a category other than death. RESULTS The terms in the natural language processing algorithm identified 290 141 reports in which a serious injury or death was reported. Of these, 151 145 (52.1%) were classified by the reporter as death and 47.9% were classified as malfunction, injury, other, or missing. For the overall sample, the percentage of reports with deaths that were not classified as deaths was 23% (95% CI, 20%-25%), suggesting that approximately 31 552 reports in our sample had deaths that were classified in other categories. The overall percentage of missed deaths, defined as the percentage of deaths that were classified in other categories, was 17% (95% CI, 16%-19%). CONCLUSIONS AND RELEVANCE Many of the findings of this study suggest that many medical device adverse event reports in the FDA's MAUDE database that involved a patient death are classified in categories other than death. As the FDA only routinely reviews all adverse events that are reported as patient deaths, improving the accuracy of adverse event reporting may enhance patient safety.
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Affiliation(s)
| | - Elysha M Kunwar
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Sanket S Dhruva
- Division of Cardiology, Department of Medicine, University of California, San Francisco.,San Francisco Veterans Affairs Health Care System, San Francisco, California.,Institute for Health Policy Studies, University of California, San Francisco.,Teachable Moments Editor, JAMA Internal Medicine
| | - Rita F Redberg
- Division of Cardiology, Department of Medicine, University of California, San Francisco.,Institute for Health Policy Studies, University of California, San Francisco.,Editor, JAMA Internal Medicine
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Muacevic A, Adler JR, Novakovic E, Huynh H, Jones K, Gendreau JL, Mammis A, Abraham ME. Characterizing Complications of Deep Brain Stimulation Devices for the Treatment of Parkinsonian Symptoms Without Tremor: A Federal MAUDE Database Analysis. Cureus 2021; 13:e15539. [PMID: 34277165 PMCID: PMC8269991 DOI: 10.7759/cureus.15539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) is a modality of treatment for medication refractory Parkinson's disease (PD) in patients with debilitating motor symptoms. While potentially life-changing for individuals with Parkinson's disease, characterization of adverse events for these DBS devices have not yet been systematically organized. Therefore, the goal of this study was to characterize reported complications of DBS devices reported to the Food & Drug Administration over the last 10 years. Methods The Manufacturer and User Facility Device Experience (MAUDE) database was utilized to retrieve entries reported under "Stimulator, Electrical, Implanted, For Parkinsonian Symptoms" between July 31, 2010 and August 1, 2020. After removing duplicate entries, each unique adverse event reported was sorted into complication categories based on the entries' provided narrative description. A final tabulation of complications was generated. Results The search query revealed 221 unique adverse events. The most common DBS devices were the Vercise Gevia, Vercise Cartesia and Vercise PC produced by Boston Scientific (Brian Walker, Boston Scientific, Marlborough, MA, USA). The most commonly reported complications were infection (16.2%) follow by lead migrations (8.6%). Other common causes of complications were circuit-related impedance (6.5%), cerebral bleeds (6.3%), device failure (6.3%) and device-related trauma (4.5%). Over a third (40%) of all devices reported with adverse events required returning to the operating room for explant or revision. Conclusion The most common complications of DBS systems are infections followed by lead migrations. Further research is needed to minimize infection rates associated with DBS systems and to reduce intrinsic device malfunctions for patients in the future.
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Affiliation(s)
| | | | - Ena Novakovic
- Neurological Surgery, Mercer University School of Medicine, Savannah, USA
| | - Huey Huynh
- Neurological Surgery, Mercer University School of Medicine, Macon, USA
| | - Keri Jones
- Graduate Medical Education, Eisenhower Army Medical Center, Augusta, USA
| | | | - Antonios Mammis
- Neurological Surgery, New York University School of Medicine, New York, USA
| | - Mickey E Abraham
- Neurological Surgery, University of California San Diego, San Diego, USA
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Smith S, Taylor CR, Kanevsky E, Povoski SP, Hawley JR. Long-term safety and efficacy of breast biopsy markers in clinical practice. Expert Rev Med Devices 2020; 18:121-128. [PMID: 33233969 DOI: 10.1080/17434440.2020.1852928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: Percutaneous breast and axillary core biopsy followed by marker placement are integral parts of a breast imager's practice benefiting both patients and clinicians. Marker placement is the standard to facilitate future care. The purpose of this study is to characterize the safety and performance of MammoMARK, CorMARK, and HydroMARK biopsy markers by evaluating device-related adverse events, device deficiencies, and long-term safety.Methods: A retrospective review of three radiology practices identified patients who underwent image-guided breast or axillary biopsies followed by marker placement between 1 January 2012 and 1 January 2017. Medical records were reviewed with adverse events related to marker placement and use recorded.Results: 768 markers were placed with three (0.4%) events recorded. Two device deficiencies and one non-serious adverse event occurred in three patients. Device deficiency events involved user errors deploying the markers, one to inability to locate the marker on post-biopsy imaging, and the second to misplacement relative to biopsy target. One non-serious adverse event involved inability to locate/retain the marker in a surgically resected specimen. No serious adverse events were reported.Conclusion: Placement of breast biopsy markers is safe with minimal associated risks. Issues related to device malfunction, durability, reliability, safety, or performance were not reported.
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Affiliation(s)
- Sharon Smith
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Clayton R Taylor
- Department of Radiology, Division of Women's and Breast Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeffrey R Hawley
- Department of Radiology, Division of Women's and Breast Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Giles TX, Bennett J, Stone CE, Gendreau JL, Abraham M, Mammis A. Characterizing Complications of Intracranial Responsive Neurostimulation Devices for Epilepsy Through a Retrospective Analysis of the Federal MAUDE Database. Neuromodulation 2020; 25:263-270. [PMID: 32881224 DOI: 10.1111/ner.13259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Responsive neurostimulation is an innovative modality in the treatment of medication-refractory epilepsy for patients who are not suitable candidates for surgical intervention. While being a potentially life-changing treatment option for many individuals with epilepsy, little is known about the system's complications aside from its performance in initial clinical trials. Therefore, the goal of this study was to characterize all reported complications of the RNS system made to the Food & Drug Administration since its approval. MATERIALS AND METHODS The Manufacturer and User Facility Device Experience (MAUDE) database was queried for entries reported under "implanted brain stimulator for epilepsy" through the dates of November 1, 2013 to March 1, 2020. After correction of duplicate entries, each was sorted into complication types based on the entries' narrative descriptions. RESULTS The searched yielded 241 unique complication events. The most common complications were attributed to infections (40%) and lead breaks (12%). Other reported complications included poor wound healing (10%) and intrinsic device failure (7%). Focal neurological deficits were found in 2%. Over half (67%) of the reported complications required return to the operating room for revision or explant. The remainder of the adverse events were self-resolved or treated with either medication or software adjustment. CONCLUSIONS Future research endeavors should attempt to optimize the implantable device for preventing infections. The data of complications provided by this review will also aid physicians in providing the most accurate informed consent for patients when deciding to undergo implantation with the responsive neurostimulation system.
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Affiliation(s)
- Tyler Xavier Giles
- School of Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Josiah Bennett
- School of Medicine, Mercer University School of Medicine, Macon, GA, USA
| | | | | | - Mickey Abraham
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Antonios Mammis
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Abstract
The medical device industry has long been subject to criticism for lack of price transparency and minimal regulations surrounding device approval, which have functioned as barriers to providing quality and cost-effective care. Recent health care reforms aimed at overcoming these barriers, including improving market approval regulations, increasing postmarket surveillance, and using comparative effectiveness research, have drastically changed industry practices. These reforms have also prompted increasingly cost-aware health care practices, which have encouraged new trends in medical device innovation such as frugal innovation and deinstitutionalization. This article explores the challenges faced by industry, physicians, and patients in light of these reforms.
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Affiliation(s)
- Preethi Kesavan
- Office of Medical Student Research, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8077, St. Louis, MO 63110, USA
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA.
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Prentice HA, Chan PH, Namba RS, Inacio MC, Sedrakyan A, Paxton EW. Association of Type and Frequency of Postsurgery Care with Revision Surgery after Total Joint Replacement. Perm J 2020; 23:18.314. [PMID: 31926574 DOI: 10.7812/tpp/18.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Postmarket surveillance is limited in the ability to detect medical device problems. Electronic health records can provide real-time information that might help with device surveillance. Specifically, the frequency of postsurgery care might indicate early problems and determine high-risk patients requiring more active surveillance. OBJECTIVE To evaluate whether intensity of postsurgery care is associated with revision risk after total joint arthroplasty (TJA). DESIGN Using an integrated health care system's TJA registry, we identified primary TJA performed between April 2001 and July 2013 (22,953 knees and 9904 hips). Survival analyses evaluated the frequency of specific types of outpatient and inpatient utilization 0 to 90 and 91 to 180 days postoperatively and revision risk. MAIN OUTCOME MEASURES Revision surgery occurring at least 6 months after primary TJA. RESULTS Knee arthroplasty recipients with 3 or more outpatient orthopedic allied health/nurse visits within 90 days had a 2.2 times (95% confidence interval [CI] = 1.6-2.9) higher risk of revision within the first 2 years postoperatively and 10.1 times higher risk (95% CI = 7.6-13.3) after 2 years. Compared with hip arthroplasty recipients who had 0 to 3 visits, patients with 6 or more outpatient orthopedic office visits within 90 days had a 15.7 times (95% CI = 5.7-42.9) higher risk of revision. Similar results were observed for 91-day to 180-day visits. CONCLUSION Future studies are needed to determine if more specific data on reasons for the higher frequency of outpatient visits can refine these findings and elicit more specific recommendations for TJA devices.
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Affiliation(s)
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | | | - Maria Cs Inacio
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Medical College of Cornell University, New York-Presbyterian Hospital, NY
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11
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Affiliation(s)
- Daniel B Kramer
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron S Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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12
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Rajan PV, Holtzman JN, Kesselheim AS, Yeh RW, Kramer DB. Landscape of Cardiovascular Device Registries in the United States. J Am Heart Assoc 2019; 8:e012756. [PMID: 31433706 PMCID: PMC6585371 DOI: 10.1161/jaha.119.012756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/24/2019] [Indexed: 12/03/2022]
Abstract
Background Regulators increasingly rely on registries for decision making related to high-risk medical devices in the United States. However, the limited uniform standards for registries may create substantial variability in registry implementation and utility to regulators. We surveyed the current landscape of US cardiovascular device registries and chart the extent of inconsistency in goals, administration, enrollment procedures, and approach to data access. Methods and Results A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines identified studies (1995-2017) referencing cardiovascular device registries with a US-based institution. Registries were then evaluated by reviewing associated articles and websites. Extracted data included device type, primary scientific aim(s), funding, stewardship (eg, administration of registry procedures), enrollment procedures, informed consent process, and mechanisms to access data for research. The 138 cardiovascular device registries in the cohort covered devices addressing interventional cardiology (65.9%), arrhythmias (15.2%), heart failure (10.1%), and valvular disease (10.1%). While the majority (55.8%) were industry-funded, stewardship was predominantly overseen by academic centers (74.0%). Most registry participation was voluntary (77.5%), but a substantial minority (19.7%) were required as a condition of device implantation. Informed consent requirements varied widely, with written consent required in only 55.1% of registries. Registry data were primarily accessible only to stewards (84.1%), with 13.8% providing pathways for external applications. Conclusions The majority of cardiovascular device registries were funded privately under the auspices of academic institutions, which set the rules for data access. The substantial variation between cardiovascular device registries suggests a role for regulators to further strengthen guidelines to improve quality, consistency, and ethical standards.
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Affiliation(s)
- Prashant V. Rajan
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Jessica N. Holtzman
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Aaron S. Kesselheim
- Harvard Medical SchoolBostonMA
- Program on Regulation, Therapeutics, and Law (PORTAL)Department of Pharmacoepidemiology and PharmacoeconomicsBrigham and Women's HospitalBostonMA
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
| | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMA
- Harvard Medical SchoolBostonMA
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13
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Janetos TM, Xu RS, Walter JR, Xu S. Reducing FDA regulations for medical devices: cutting red tape or putting patients' lives at risk? Expert Rev Med Devices 2018; 15:859-861. [PMID: 30345824 DOI: 10.1080/17434440.2018.1539666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Timothy M Janetos
- a Department of Ophthalmology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Rebecca S Xu
- b Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - Jessica R Walter
- c Department of Obstetrics and Gynecology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Shuai Xu
- d Department of Dermatology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.,e Center for Bio-Integrated Electronics , Northwestern University , Chicago , IL , USA
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Abstract
Medical devices are essential in the diagnosis and treatment of otolaryngologic disease. The US Food and Drug Administration (FDA) is tasked with assuring the safety and effectiveness of these devices. Otolaryngologists, in turn, are often responsible for helping patients understand risks, benefits, and alternatives when deciding whether to rely on devices in their care. To best counsel patients, otolaryngologists should be aware of the strengths and limitations of device regulation by the FDA. This article reviews the FDA regulatory framework for medical devices, premarket evidentiary standards for marketing devices, and postmarket methods of safety surveillance.
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Affiliation(s)
- Vinay K Rathi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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15
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Jazayeri MA, Vuddanda V, Turagam MK, Parikh V, Lavu M, Atkins D, Earnest M, Di Biase L, Natale A, Wilber D, Reddy YM, Lakkireddy DR. Safety profiles of percutaneous left atrial appendage closure devices: An analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database from 2009 to 2016. J Cardiovasc Electrophysiol 2017; 29:5-13. [DOI: 10.1111/jce.13362] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Mohammad-Ali Jazayeri
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Venkat Vuddanda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Mohit K. Turagam
- Division of Cardiovascular Disease; University of Missouri Hospital & Clinics; Columbia MO USA
| | - Valay Parikh
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Madhav Lavu
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Matthew Earnest
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
- Mid-America Cardiology, Bloch Heart Rhythm Center; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Luigi Di Biase
- Electrophysiology Section; Albert Einstein College of Medicine at Montefiore Medical Center; Bronx NY USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin TX USA
| | - David Wilber
- Division of Cardiovascular Medicine; Loyola University Medical Center; Chicago IL
| | - Yeruva Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
- Mid-America Cardiology, Bloch Heart Rhythm Center; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Dhanunjaya R. Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
- Mid-America Cardiology, Bloch Heart Rhythm Center; University of Kansas Hospital & Medical Center; Kansas City KS USA
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16
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Lohman ME, Ghobadi CW, Xu S. Device Safety Implications of the Clinical Data Leading to US Food and Drug Administration Approval of Soft-Tissue Fillers. JAMA FACIAL PLAST SU 2017; 19:421-429. [DOI: 10.1001/jamafacial.2017.0082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mary E. Lohman
- Department of Medicine, McGaw Medical Center, Northwestern University, Chicago, Illinois
| | - Comeron W. Ghobadi
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Shuai Xu
- Department of Dermatology, McGaw Medical Center, Northwestern University, Chicago, Illinois
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17
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Rathi VK, Gadkaree SK, Ross JS, Kozin ED, Sethi RK, Naunheim MR, Puram SV, Gray ST. US Food and Drug Administration Clearance of Moderate-Risk Otolaryngologic Devices via the 510(k) Process, 1997-2016. Otolaryngol Head Neck Surg 2017; 157:608-617. [PMID: 28786317 DOI: 10.1177/0194599817721689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The US Food and Drug Administration (FDA) clears moderate-risk devices via the 510(k) process based on substantial equivalence to previously cleared devices; evidence of safety and effectiveness is not required. We characterized the premarket evidence supporting FDA clearance of otolaryngologic devices. Study Design Retrospective cross-sectional analysis. Setting Publicly available FDA documents. Subjects and Methods Recently cleared (1997-2016) moderate-risk otolaryngologic devices were categorized by type (diagnostic/therapeutic), subspecialty, implantable designation (yes/no), and recall history (yes/no). Supporting evidence was categorized by type (clinical/nonclinical/none; nonclinical and clinical mutually inclusive) and public availability of nonclinical and clinical performance data (available/not provided/not applicable). Results Between 1997 and 2016, the FDA cleared 377 moderate-risk otolaryngologic devices. The majority were therapeutic (n = 240/377 [63.7%]) and otologic (n = 311/377 [82.5%]); roughly one-third (n = 121/377 [32.1%]) were implantable. Few (n = 10/377 [2.7%]) devices were subject to recall. FDA documents summarizing premarket evidence were accessible for two-thirds (n = 247/377 [65.5%]) of devices. Among these devices, one-quarter (n = 66/247 [26.7%]) were supported by clinical evidence. The majority (n = 177/247 [71.7%]) were supported by nonclinical evidence, although nearly one-quarter (n = 58/247 [23.5%]) were cleared without supporting evidence. Therapeutic devices were more often cleared without supporting evidence (therapeutic: n = 53/170 [31.2%]; diagnostic: n = 5/77 [6.5%]; P < .0001). Nonclinical and clinical performance data were rarely available (nonclinical: n = 49/247 [19.8%]; clinical: n = 32/247 [13.0%]) within public summaries. Conclusion The FDA cleared most moderate-risk otolaryngologic devices for marketing via the 510(k) process without clinical evidence of safety and effectiveness. Otolaryngologists should be aware of limitations in premarket evidence when considering the adoption of new devices into clinical practice.
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Affiliation(s)
- Vinay K Rathi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shekhar K Gadkaree
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph S Ross
- 3 Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut.,4 Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut.,5 Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Elliott D Kozin
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosh K Sethi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew R Naunheim
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Sidharth V Puram
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T Gray
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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18
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Zippel C, Bohnet-Joschko S. Post market surveillance in the german medical device sector – current state and future perspectives. Health Policy 2017; 121:880-886. [DOI: 10.1016/j.healthpol.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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19
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Abstract
With the increasing accuracy of continuous glucose monitors (CGM) have come calls for the Food and Drug Administration (FDA) to label these devices as safe for nonadjunctive dosing of insulin. However, there is evidence that these devices are subject to sporadic, unpredictable, large errors. A text analysis of reports to the FDA MAUDE database since 2015 reveals over 25 000 complaints of CGM sensor inaccuracy, with instances directly leading to serious outcomes. These new data were not considered at a recent FDA Advisory Panel meeting that voted to approve Dexcom G5 relabeling for nonadjunctive use. Social media is another source of surveillance data providing evidence of large CGM inaccuracies in real-world use. We need to improve safety procedures, not remove them. CGMs offer unique information and alerts for managing diabetes, but the issue is not whether they are better than other approaches to monitoring glucose, but how they can be best used in conjunction with devices that offer the confirmatory readings needed for patient safety.
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Affiliation(s)
- Alan R. Shapiro
- Department of Medicine, NYU School of Medicine, New York, NY, USA
- Alan R. Shapiro, MD, MSPH, 5 Pheasant Run Rd, Pleasantville, NY 10570, USA.
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20
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Janetos TM, Ghobadi CW, Xu S, Walter JR. Overview of high-risk medical device recalls in obstetrics and gynecology from 2002 through 2016: implications for device safety. Am J Obstet Gynecol 2017; 217:42-46.e1. [PMID: 28500861 DOI: 10.1016/j.ajog.2017.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/04/2017] [Accepted: 03/23/2017] [Indexed: 11/19/2022]
Abstract
The field of women's health has endured numerous recent controversies involving medical devices such as pelvic meshes, laparoscopic morcellators, and a hysteroscopic sterilization device. With the recent passage of the 21st Century Cures Act, new legislation will change how the Food and Drug Administration regulates medical devices. Given these controversies and new changes, we investigated high-risk, class I recalls in women's health from 2002 through 2016. Class I recalls for medical devices are defined by the Food and Drug Administration as the most serious recall events and are designated for situations when there is a reasonable probability of serious adverse health consequences or death. We defined a recall event as a group of unique Food and Drug Administration recalls that share a similar reason for recall and occurred within a 1-month time frame. In total, 7 class I recall events were identified encompassing 83 unique recalls affecting >88,000 medical devices in distribution. Recalls involved a broad range of devices used in women's health including diagnostic assays for chlamydia and gonorrhea, a laparoscopic tissue morcellator, and obstetrical/gynecological surgical kits. Four of 7 (57%) recall events were due to postmarketing problems such as improper packaging and labeling while the remaining 3 (43%) recalls were due to premarketing problems (eg, software issues). Additionally, 3 of 7 (43%) recall events were cleared via the 510(k) pathway, while the remaining were essentially exempt from any form of premarket approval. Two recall events involved sterility concerns of 71 surgical kits used in obstetrics and gynecological surgeries representing the majority of affected devices (78,423) in distribution. Class I medical device recalls are rare but serious events. Most recalled devices in women's health had minimal preapproval regulation and were recalled due to both premarketing and postmarketing reasons. Future regulatory efforts to improve postmarketing surveillance may mitigate the potential impact and frequency of class I recalls, but do not replace the need for a higher burden of proof for both safety and efficacy prior to medical device approval.
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Affiliation(s)
- Timothy M Janetos
- Northwestern University's Feinberg School of Medicine, Chicago, and Kellogg School of Management, Evanston, IL
| | - Comeron W Ghobadi
- Department of Radiology, University of Chicago Medical Center, Chicago, IL
| | - Shuai Xu
- Department of Dermatology, McGaw Medical Center of Northwestern University, Chicago, IL
| | - Jessica R Walter
- Department of Obstetrics and Gynecology, McGaw Medical Center of Northwestern University, Chicago, IL.
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21
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Medical Device Approvals Through the Premarket Approval Pathway in Obstetrics and Gynecology From 2000 to 2015: Process and Problems. Obstet Gynecol 2017; 127:1110-1117. [PMID: 27159747 DOI: 10.1097/aog.0000000000001430] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent controversies surrounding obstetrics and gynecology devices, including a permanent sterilization device, pelvic meshes, and laparoscopic morcellators, highlight the need for deeper understanding of obstetrics and gynecology medical device regulation. The U.S. Food and Drug Administration premarket approval database was queried for approvals assigned to the obstetrics and gynecology advisory committee from January 2000 to December 2015. Eighteen device approvals occurred in the time period studied. The most common clinical indications included endometrial ablation (33%), contraception (28%), and fetal monitoring (17%). The median approval time was 290 days (range 178-1,399 days). Regarding the pivotal trials leading to approval, there were 11 randomized controlled trials, one randomized crossover study, five nonrandomized prospective studies, and two human factor studies. Fourteen devices (78%) met their primary clinical efficacy endpoint. Only 12 of 18 devices were required to conduct postmarket surveillance. A significant proportion of devices (42%) were approved on the basis of nonrandomized controlled trials. Three devices have been withdrawn after approval, all of which were either not referred or not recommended for approval by the obstetrics and gynecology advisory committee. Of the three devices withdrawn from the market, two failed to demonstrate clinical benefit in their pivotal trials. One device was not required to undergo postmarketing surveillance and was subsequently withdrawn as a result of patient safety concerns. Our results reveal significant weaknesses in the preapproval and postapproval regulation of high-risk obstetrics and gynecology devices. Greater specialty group involvement is necessary to ensure the development of safe and clinically effective devices.
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23
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Radiological Medical Device Innovation: Approvals via the Premarket Approval Pathway From 2000 to 2015. J Am Coll Radiol 2017; 14:24-33. [DOI: 10.1016/j.jacr.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/07/2016] [Accepted: 08/16/2016] [Indexed: 11/20/2022]
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24
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Efficacy and Safety of Combined Ultrasonic and Bipolar Energy Source in Laparoscopic Surgery. J Gastrointest Surg 2016; 20:1760-8. [PMID: 27456017 DOI: 10.1007/s11605-016-3217-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/13/2016] [Indexed: 01/31/2023]
Abstract
AIM Energy devices represent an alternative to clips and staplers for vessel sealing. Outcome data of patients undergoing laparoscopic surgery with use of a novel combined ultrasonic and bipolar energy device (TB, Thunderbeat™) was gathered. METHODS Consecutive patients undergoing laparoscopic surgery using TB were prospectively included between November 2011 and January 2016. Large vessels were dissected using the energy device without additional clips or staplers. The type of procedure, operative time, length of stay, complications, blood transfusions, number and type of vessels being dissected, and need for additional clips were noted. RESULTS Six hundred eighty-three patients underwent 758 procedures with dissection of 1310 large vessels. No additional hemoclips or vascular staplers were used. There were 0.7 % (5/758) intraoperative and 2.6 % (20/758) postoperative bleeding complications. Eleven bleeding occurred at the stapler line of anastomosis, leaving 1.8 % (14/758) bleeding that were potentially related to inadequate hemostasis. Failure of large vessel dissection occurred in two cases (0.15 %, 2/1310) and device-related complications in 1.1 % (8/758). Two of 42 conversions (5.5 %) were bleeding-related. CONCLUSION TB provides a reliable and effective hemostasis. However, ligation failure may occur. As with any kind of electrosurgery, the hot tip of the instruments bears the risk of potentially fatal thermal injuries.
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25
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Frigerio M. Getting approval for new therapeutic medical devices versus drugs: are the differences justified? Eur Respir Rev 2016; 25:223-6. [PMID: 27581821 PMCID: PMC9487206 DOI: 10.1183/16000617.0037-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/24/2016] [Indexed: 01/14/2023] Open
Abstract
In the so-called evidence-based medicine (EBM) era, pre-market clinical trials showing equivalent or superior benefit from new drugs versus existing therapies are required by regulatory bodies, while the process for approval of medical devices is less stringent [1]. The expansion of device-based therapies for cardiovascular conditions makes cardiology the ideal setting for analysing the peculiarities of this process [2]. Lessons learned from cardiology: the process for approval of medical therapeutic devices must be redesigned http://ow.ly/bJPm3017ySH
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Affiliation(s)
- Maria Frigerio
- "A. DeGasperis" CardioCenter, Niguarda Great Metropolitan Hospital, Milan, Italy
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26
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Zeitler EP, Al-Khatib SM, Drozda JP, Kessler LG, Kirtane AJ, Kong DF, Laschinger J, Marinac-Dabic D, Morice MC, Reed T, Sedrakyan A, Stein KM, Tcheng J, Krucoff MW. Predictable and SuStainable Implementation of National Cardiovascular Registries (PASSION) infrastructure: A think tank report from Medical Device Epidemiological Network Initiative (MDEpiNet). Am Heart J 2016; 171:64-72.e1-2. [PMID: 26699602 PMCID: PMC4692177 DOI: 10.1016/j.ahj.2015.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022]
Abstract
The MDEpiNet is a public-private partnership between the US Food and Drug Administration's Center for Devices and Radiological Health and participating partners. The PASSION program is an MDEpiNet-sponsored program that aims to demonstrate the goals of MDEpiNet by using cardiovascular medical device registries to bridge evidence gaps across the medical device total product life cycle. To this end, a PASSION Think Tank meeting took place in October 2014 in Silver Spring, MD, to facilitate discussion between stakeholders about the successes, challenges, and future novel applications of medical device registries, with particular emphasis on identifying pilot projects. Participants spanned a broad range of groups including patients, device manufacturers, regulators, physicians/academicians, professional societies, providers, and payers. The meeting focus included 4 areas of cardiovascular medicine intended to cultivate interest in 4 MDEpiNet disease-specific/device-specific working groups: coronary intervention, electrophysiology, valvular disease, and peripheral vascular disease. In addition, more general issues applying to registry-based infrastructure and analytical methodologies for assessing device benefit/risk were considered to provide context for the working groups as PASSION programs going forward. This article summarizes the discussions at the meeting and the future directions of the PASSION program.
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Affiliation(s)
| | | | | | | | - Ajay J Kirtane
- Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY
| | | | | | | | | | - Terrie Reed
- US Food Drug Administration, Silver Spring, MD
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27
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Rathi VK, Ross JS, Samuel AM, Mehra S. Postmarket Modifications of High-Risk Therapeutic Devices in Otolaryngology Cleared by the US Food and Drug Administration. Otolaryngol Head Neck Surg 2015; 153:400-8. [DOI: 10.1177/0194599815587508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
Objective: The US Food and Drug Administration (FDA) grants initial marketing clearance for novel high-risk medical devices via the premarket approval (PMA) pathway, which requires clinical data demonstrating safety and effectiveness. Manufacturers may subsequently file supplemental PMA applications (supplements) to implement incremental device changes, usually without additional clinical data. Given the potentially significant clinical implications of using new device models, this study characterized the frequency and nature of changes to high-risk therapeutic otolaryngic devices cleared via the PMA pathway. Study Design: Retrospective cohort study. Setting: FDA PMA database. Methods: Original high-risk therapeutic otolaryngic devices and supplements were identified. Supplements were characterized by clearance date, change type, and review track, including real-time (design-minor) and 180-day (design-major) tracks. Median device lineage life span (postmarket period over which changes occurred) and median number of changes per original device were calculated. Results: Through 2014, the FDA cleared 14 original high-risk therapeutic otolaryngic devices via the PMA pathway and 528 incremental changes via supplements. Devices were modified over a median 10.5-year life span (interquartile range, 4.4-15.8; range, 0.7-24.1), and they underwent a median 22 changes (interquartile range, 10-70; range, 2-108). Over half (272 of 528; 52%) altered device design, most of which were reviewed via the 180-day track (199 of 272; 73%) intended for major design changes. Few real-time design changes (11 of 73; 15%) were designated by the FDA as “minor.” Conclusion: A substantial number of incremental changes have been made to high-risk therapeutic otolaryngic devices over time, including many major design changes without supporting clinical data.
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Affiliation(s)
- Vinay K. Rathi
- Yale University School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Joseph S. Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Saral Mehra
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, New Haven, Connecticut
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