title: Patient safety and the diffusion of surgical innovations: a national analysis of laparoscopic partial nephrectomy.
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.
authors.affiliation: Division of Urology, UC San Diego Medical Center, San Diego, CA, USA. k0parsons@ucsd.edu
authors.forename: J Kellogg
authors.initials: JK
authors.lastname: Parsons
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi
authors.forename: David
authors.initials: D
authors.lastname: Chang
authors.forename: Sean P
authors.initials: SP
authors.lastname: Stroup
mesh_terms: D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004059:Diffusion of Innovation; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007431:Intraoperative Complications / Q000453:epidemiology*; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010351:Patient Discharge / Q000706:statistics & numerical data; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012371:Robotics; D014481:United States