Diffusion of Surgical Innovations, Patient Safety, and Minimally Invasive Radical Prostatectomy
Diffusion of Surgical Innovations, Patient Safety, and Minimally Invasive Radical Prostatectomy
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DOI：
10.1001/jamasurg.2014.31
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发表时间：
2014-08-01
期刊：
影响因子：
16.9
通讯作者：
Chang, David
中科院分区：
文献类型：
--
作者：
Parsons, J. Kellogg;Messer, Karen;Chang, David
重要性外科创新传播的协调系统，以确保他们的安全整合到临床实践的情况下，潜在地暴露患者的风险增加医疗error.Objective调查协会的患者安全与扩散的微创根治性直肠癌切除术（MIRP）的发展所导致的da芬奇robot。和参与者一项队列研究，纳入了2003年1月1日至2009年12月31日期间在MIRP扩散期间接受根治性直肠癌切除术的401325例全国住院患者样本。主要结果和指标我们使用医疗保健研究机构和质量患者安全指标（PSI），其测量护理过程和手术提供者的表现。我们估计了所有直肠癌切除术中MIRP的患病率，并比较了研究期间每年MIRP和开放性直肠癌根治术之间PSI的发病率。我们还收集了估计MIRP的发病率归因于制造商的达芬奇robot.RESULTS接受MIRP的患者更可能是白色（P = 0.004），有较少的合并症（P = 0.02），并在高收入地区接受手术（P = 0.005）。MIRP的发生率远低于达芬奇制造商的估计。2006年发生了快速扩散，当时MIRP占美国所有根治性前列腺切除术的10.4%（95%CI，10.2-10.7）。在2005年，MIRP与任何PSI的调整后风险增加相关（调整后比值比，2.0; 95%CI，1.1-3.7; P = 0.02）。按医院地位分层显示了类似的模式：2006年教学医院中出现了快速扩散（11.7%; 95% CI，11.3-12.0），2005年MIRP的PSI风险增加（调整后的优势比，2.7; 95%CI，1.4-5.3; P = 0.004），非教学医院的发病发生在2008年（27.1%; 95% CI，26.6-27.7），2007年PSI风险增加，但无显著性（校正比值比，2.0; 95% CI，0.8-5.2;结论和相关性在其最初的全国性传播中，MIRP与围手术期患者安全性降低有关。为了促进安全和保护患者，手术创新传播到临床实践的过程需要改进。
IMPORTANCE Surgical innovations disseminate in the absence of coordinated systems to ensure their safe integration into clinical practice, potentially exposing patients to increased risk for medical error.OBJECTIVE To investigate associations of patient safety with the diffusion of minimally invasive radical prostatectomy (MIRP) resulting from the development of the da Vinci robot.DESIGN, SETTING, AND PARTICIPANTS A cohort study of 401 325 patients in the Nationwide Inpatient Sample who underwent radical prostatectomy during MIRP diffusion between January 1, 2003, and December 31, 2009.MAIN OUTCOMES AND MEASURES We used Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs), which measure processes of care and surgical provider performance. We estimated the prevalence of MIRP among all prostatectomies and compared PSI incidence between MIRP and open radical prostatectomy in each year during the study. We also collected estimates of MIRP incidence attributed to the manufacturer of the da Vinci robot.RESULTS Patients who underwent MIRP were more likely to be white (P = .004), have fewer comorbidities (P = .02), and have undergone surgery in higher-income areas (P = .005). The incidence of MIRP was substantially lower than da Vinci manufacturer estimates. Rapid diffusion onset occurred in 2006, when MIRP accounted for 10.4% (95% CI, 10.2-10.7) of all radical prostatectomies in the United States. In 2005, MIRP was associated with an increased adjusted risk for any PSI (adjusted odds ratio, 2.0; 95% CI, 1.1-3.7; P = .02) vs open radical prostatectomy. Stratification by hospital status demonstrated similar patterns: rapid diffusion onset among teaching hospitals occurred in 2006 (11.7%; 95% CI, 11.3-12.0), with an increased risk for PSI for MIRP in 2005 (adjusted odds ratio, 2.7; 95% CI, 1.4-5.3; P = .004), and onset among nonteaching hospitals occurred in 2008 (27.1%; 95% CI, 26.6-27.7), with an increased but nonsignificant risk for PSI in 2007 (adjusted odds ratio, 2.0; 95% CI, 0.8-5.2; P = .14).CONCLUSIONS AND RELEVANCE During its initial national diffusion, MIRP was associated with diminished perioperative patient safety. To promote safety and protect patients, the processes by which surgical innovations disseminate into clinical practice require refinement.