Surgical Endoscopy

, Volume 27, Issue 5, pp 1674–1680

Patient safety and the diffusion of surgical innovations: a national analysis of laparoscopic partial nephrectomy

  • J. Kellogg Parsons
  • Kerrin Palazzi
  • David Chang
  • Sean P. Stroup

DOI: 10.1007/s00464-012-2655-z

Cite this article as:
Parsons, J.K., Palazzi, K., Chang, D. et al. Surg Endosc (2013) 27: 1674. doi:10.1007/s00464-012-2655-z



There are scant data on patient safety and the national diffusion of surgical innovations. Laparoscopic partial nephrectomy (LPN) provides an apt model for population-based analyses of patient safety and the propagation of complex surgical innovations.


In the nationwide inpatient sample, we identified patients undergoing partial nephrectomy for renal tumors from 1998 to 2009 and utilized patient safety indicators (PSI) to measure preventable adverse outcomes.


Of the cases, 68,713 (87 %) were OPN and 9,842 (13 %) were LPN. The prevalence of LPN increased more than threefold from 2006 to 2009. Compared to open partial nephrectomy (OPN), LPN patients were more likely to be younger (p = 0.022), have lower Charlson comorbidity scores (p = 0.002), and undergo surgery at urban (p < 0.001) and teaching (p = 0.02) hospitals. On multivariate analysis, LPN was associated with a 28 % decreased probability of any PSI (adjusted odds ratio [ORadj] 0.72, 95 % confidence interval [CI] 0.55–0.96, p = 0.025), although this benefit did not attain significance when comparing robot-assisted LPN to OPN (ORadj 0.72, 95 % CI 0.44–1.16, p = 0.173). Overall mortality decreased from 0.9 % in 1998 to 0.1 % in 2009 (p < 0.001). There were no differences in adjusted mortality between LPN and OPN (p = 0.75).


During its initial national diffusion, LPN resulted in enhanced perioperative patient safety compared to OPN. Mortality for both LPN and OPN decreased over time. Further study is needed to elucidate and promote factors contributing to the safe diffusion of complex surgical innovations.


Kidney cancerLaparoscopic partial nephrectomyOpen partial nephrectomyPartial nephrectomyPatient safetyPatient safety indicator



Agency for healthcare research and quality


Laparoscopic partial nephrectomy


Nationwide inpatient sample


Open partial nephrectomy


Patient safety indicator

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • J. Kellogg Parsons
    • 1
    • 2
    • 3
  • Kerrin Palazzi
    • 1
  • David Chang
    • 1
  • Sean P. Stroup
    • 1
    • 4
  1. 1.Division of UrologyUC San Diego Medical CenterSan DiegoUSA
  2. 2.VA San Diego Medical CenterSan DiegoUSA
  3. 3.Division of Urologic OncologyMoores UCSD Cancer CenterLa JollaUSA
  4. 4.Department of UrologyNaval Medical Center San DiegoSan DiegoUSA