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

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 cancer Laparoscopic partial nephrectomy Open partial nephrectomy Partial nephrectomy Patient safety Patient 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

References

  1. 1.
    Institute of Medicine (2001) Crossing the quality chasm: a new health system for the twenty-first century. National Academy Press, Washington, DCGoogle Scholar
  2. 2.
    Chang DC, Handly N, Abdullah F, Efron DT, Haut ER, Haider AH, Pronovost PJ, Cornwell EE (2008) The occurrence of potential patient safety events among trauma patients: are they random? Ann Surg 247:327–334PubMedCrossRefGoogle Scholar
  3. 3.
    Kohn LT, Corrigan JM, Donaldson MS (1999) To err is human: building a safer health system. National Academy Press, Washington, DCGoogle Scholar
  4. 4.
    DeVoe WB, Kercher KW, Hope WW, Lincourt AE, Norton HJ, Teigland CM (2009) Hand-assisted laparoscopic partial nephrectomy after 60 cases: comparison with open partial nephrectomy. Surg Endosc 23:1075–1080PubMedCrossRefGoogle Scholar
  5. 5.
    Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S (2009) Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 55:1171–1178PubMedCrossRefGoogle Scholar
  6. 6.
    Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Russo P, Uzzo RG (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279PubMedCrossRefGoogle Scholar
  7. 7.
    Zorn KC, Gautam G, Shalhav AL, Clayman RV, Ahlering TE, Albala DM, Lee DI, Sundaram CP, Matin SF, Castle EP, Winfield HN, Gettman MT, Lee BR, Thomas R, Patel VR, Leveillee RJ, Wong C, Badlani GH, Rha KH, Eggener SE, Wiklund P, Mottrie A, Atug F, Kural AR, Joseph JV (2009) Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J Urol 182:1126–1132PubMedCrossRefGoogle Scholar
  8. 8.
    Anderson JE, Chang DC, Parsons JK, Talamini MA (2012) The first national examination of outcomes of and trends in robotic surgery in the United States. J Am Coll Surg 215:107–114PubMedCrossRefGoogle Scholar
  9. 9.
    Patel SG, Penson DF, Pabla B, Clark PE, Cookson MS, Chang SS, Herrell SD, Smith JA Jr, Barocas DA (2012) National trends in the use of partial nephrectomy: a rising tide that has not lifted all boats. J Urol 187:816–821PubMedCrossRefGoogle Scholar
  10. 10.
    Zhan C, Miller MR (2003) Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 290:1868–1874PubMedCrossRefGoogle Scholar
  11. 11.
    Romano PS, Geppert JJ, Davies S, Miller MR, Elixhauser A, McDonald KM (2003) A national profile of patient safety in US hospitals. Health Aff (Millwood) 22:154–166CrossRefGoogle Scholar
  12. 12.
    Coffey RM, Barrett M, Houchens B, Brady J, Moy E, Ho K, Andrews R (2008) Methods applying AHRQ quality indicators to Healthcare Cost and Utilization Project (HCUP). Data for the Sixth National Healthcare Quality ReportGoogle Scholar
  13. 13.
    Stroup SP, Palazzi KL, Chang DC, Ward NT, Parsons JK (2012) Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours. BJU Int. doi:10.1111/j.1464-410X.2012.11071.x
  14. 14.
    Parsons JK, Palazzi KL, Stroup SP, Chan D (2012) Patient safety and the diffusion of minimally invasive radical prostatectomy. J Urol 187:E24–E25CrossRefGoogle Scholar
  15. 15.
    Wilson CB (2006) Adoption of new surgical technology. BMJ 332:112–114PubMedCrossRefGoogle Scholar
  16. 16.
    Gladwell M (2000) The tipping point: how little things can make a big difference. Little, Brown, New YorkGoogle Scholar
  17. 17.
    Rogers EM (2003) Diffusion of innovations, 5th edn. Free Press, New YorkGoogle Scholar
  18. 18.
    Dev HS, Sooriakumaran P, Stolzenburg JU, Anderson CJ (2012) Is robotic technology facilitating the minimally invasive approach to partial nephrectomy? BJU Int 109:760–768PubMedCrossRefGoogle Scholar
  19. 19.
    Peterson CY, Osen HB, Tran Cao HS, Yu PT, Chang DC (2011) The battle of the sexes: women win out in gastrointestinal surgery. J Surg Res 170:e23–e28PubMedCrossRefGoogle Scholar
  20. 20.
    Nadu A, Kleinmann N, Laufer M, Dotan Z, Winkler H, Ramon J (2009) Laparoscopic partial nephrectomy for central tumors: analysis of perioperative outcomes and complications. J Urol 181:42–47PubMedCrossRefGoogle Scholar
  21. 21.
    Frank I, Colombo JR Jr, Rubinstein M, Desai M, Kaouk J, Gill IS (2006) Laparoscopic partial nephrectomy for centrally located renal tumors. J Urol 175:849–852PubMedCrossRefGoogle Scholar

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

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