Division of Urology, UC San Diego Medical Center, San Diego, CA, USA.
Surg Endosc. 2013 May;27(5):1674-80. doi: 10.1007/s00464-012-2655-z. Epub 2012 Dec 13.
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.
关于患者安全和外科创新在全国范围内的推广，相关数据很少。腹腔镜部分肾切除术（LPN）为基于人群的患者安全分析和复杂外科创新的传播提供了一个很好的模型。
在全国住院患者样本中，我们从 1998 年到 2009 年确定了接受肾肿瘤部分肾切除术的患者，并利用患者安全指标（PSI）来衡量可预防的不良结果。
在这些病例中，68713 例（87%）为开放式部分肾切除术（OPN），9842 例（13%）为腹腔镜部分肾切除术（LPN）。LPN 的患病率从 2006 年到 2009 年增加了两倍多。与开放式部分肾切除术（OPN）相比，LPN 患者更年轻（p = 0.022），Charlson 合并症评分较低（p = 0.002），并且在城市（p < 0.001）和教学医院（p = 0.02）接受手术。多变量分析显示，LPN 与任何 PSI 的概率降低 28%（调整后的优势比 [ORadj] 0.72，95%置信区间 [CI] 0.55-0.96，p = 0.025）相关，尽管在比较机器人辅助 LPN 与 OPN 时，这种益处并未达到显著水平（ORadj 0.72，95%CI 0.44-1.16，p = 0.173）。总死亡率从 1998 年的 0.9%降至 2009 年的 0.1%（p < 0.001）。LPN 和 OPN 之间的调整死亡率没有差异（p = 0.75）。
在其最初的全国推广过程中，与 OPN 相比，LPN 导致围手术期患者安全性提高。LPN 和 OPN 的死亡率随时间推移而降低。需要进一步研究阐明和促进促进复杂外科创新安全传播的因素。
