Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours
Monday, 9 April 2012- Laparoscopic radical nephrectomy for renal cancer provides equivalent long-term cancer control with shorter hospital stays, less postoperative pain, and faster resumption of normal activities, but it has diffused slowly into clinical practice, perhaps as a result of perceptions about safety.
Patient safety outcomes for laparoscopic and open radical nephrectomy using validated measures remain incompletely characterized.
S. Stroup and colleagues conducted the first study to investigate peri-operative outcomes of radical nephrectomy using validated patient safety measures. They published their findings in an online edition of the BJU International.
“We found a 32% decreased probability of adverse patient safety events occurring in laparoscopic compared with open radical nephrectomy. The safety benefits of laparoscopy were attained only after 10% of cases were completed laparoscopically – a proportion some have proposed as the ‘tipping point’ for the adoption of surgical innovations. This observation could have implications for patient safety in the setting of diffusion of new surgical techniques,” Stroup wrote in their report.
The researchers aimed to compare peri-operative adverse patient safety events occurring in laparoscopic radical nephrectomy (LRN) with those occurring in open radical nephrectomy (ORN).
They used the US Nationwide Inpatient Sample to identify patients undergoing kidney surgery for renal tumours from 1998 to 2008. The investigators also used patient safety indicators (PSIs), which are validated measures of preventable adverse outcomes, and multivariate regression to analyse associations of surgery type with patient safety.
The results showed that open radical nephrectomy accounted for 235 098 (89%) cases while 28 609 (11%) cases were LRN. Compared with ORN, LRN patients were more likely to be male (P= 0.048), have lower Charlson comorbidity scores (P < 0.001), and to undergo surgery at urban (P < 0.001) and teaching (P < 0.001) hospitals.
PSIs occurred in 18 714 (8%) of ORN and 1434 (5%) of LRN cases (P < 0.001). On multivariate analysis, LRN was associated with a 32% decreased probability of any PSI (adjusted odds ratio 0.68, 95% confidence interval: 0.6 to 0.77, P < 0.001). Stratification by year showed that this difference was initially manifested in 2003, when the proportion of LRN cases first exceeded 10%.
“We found that LRN was associated with substantially superior peri-operative patient safety outcomes compared with ORN, but only after the national prevalence of LRN exceeded 10%. Further study is needed to explain these patterns and promote the safe diffusion of novel surgical therapies into broad practice,” the researchers wrote.
Source: S. Stroup, et al., “Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours,” BJU International; DOI: 10.1111/j.1464-410X.2012.11071.x