Laura E Grimmer, MD, Mary C Nally, Jonathan Myers, Daniel Deziel, Minh B Luu, MD. Rush University Medical Center
Background: Technology has the potential to increase efficiency, improve patient safety, and enhance technical capability in surgery. While some surgical innovations do not utilize technology (such as creating new post-operative pathways), other innovations are dependent on such technology (such as robotic laparoscopy). We investigated the extent to which the innovations presented in surgical literature utilize technology.
Hypothesis: A systematic literature review reveals the amount and type of technology utilized in recently proposed surgical innovations.
Methods: The most recent issues from the top ten high impact surgical journals were analyzed by two independent reviewers. After excluding editorials and letters, the remaining research articles were categorized by whether their primary innovation utilized technology. Technology utilization was determined by comparing the current solution to the proposed solution and evaluating whether a specific technology was inherent to the innovation. The type of technology utilized was then classified into one the following: laboratory studies, imaging, laparoscopic capabilities, endoscopic capabilities, instrumentation, data/computing, robotics, medication, simulation and other. Additional characteristics of the innovations were classified including type of innovation, primary aim and hypothetical benefit of innovation implementation. Technology utilization and innovation characteristics were analyzed using chi-squared tests.
Results: In 200 studied articles, 149 articles proposed an identifiable innovation. Of these innovations, 60 (40.3%) utilized technology. The most commonly utilized technology was imaging (23%), followed by laparoscopic capabilities (19.7%) and instrumentation (18%). Few innovations utilized technology in data/computing, robotics, medications or simulation (<5% for each category). Technology utilization did not differ based on publishing journal, publishing department, country of study, grant funding, conflict of interest, body system studied or type of intervention accomplished. Product innovations utilized technology significantly more than procedural or systems-based innovations (66.7% v. 45%, 25%, p= 0.006). Technology utilization was significantly associated with innovations that reduced incision size and decreased invasiveness (p=0.001). Technology utilization was also significantly greater in innovations whose adoption would likely require higher levels of training (p=0.001), greater difficulty (p=0.043), higher cost (p<0.000) and more resources (p<0.001).
Conclusion: Currently less than half of the innovations in the surgical literature utilize technology. The goal of harnessing new technology to improve surgical safety, decrease cost and increase access to care will require a wider application of technology to all aspects of surgical care and emphasis on cost-effective technology.