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
Article

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

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Kidney cancerLaparoscopic partial nephrectomyOpen partial nephrectomyPartial nephrectomyPatient safetyPatient safety indicator

Abbreviations

AHRQ

Agency for healthcare research and quality

LPN

Laparoscopic partial nephrectomy

NIS

Nationwide inpatient sample

OPN

Open partial nephrectomy

PSI

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