L. E. Grimmer1, M. C. Nally1, J. C. Kubasiak1, M. Luu1, J. Myers1 1Rush University Medical Center,General Surgery,Chicago, IL, USA
Introduction: "Disruptive innovations" are defined as novel solutions to existing problems which are cheaper, simpler and more convenient than the current solution. Examples of disruptive innovations include coronary angioplasty rivaling CABG, or TIPS replacing spleno-renal shunts. This is in contrast to "incremental innovations" which modify and improve on the current solution through increased complexity and cost, such as single incision surgery improving upon traditional laparoscopy. Despite widespread application of this innovation framework in other professional fields, classification of surgical innovations as disruptive or incremental has not been previously studied. We hypothesized that a standardized inventory of items related to disruptive and incremental innovations can be applied to surgical literature.
Methods: Each article in the most recent issues of ten high impact surgical journals was included; editorials and guidelines reviews were excluded. Of 200 articles, 51 lacked an identifiable innovation, and 149 were scored on the following items: cost of implementation, overall healthcare cost, level of infrastructure required, level of care needed during procedure, level of training, level of difficulty, number of operative/non-operative procedures performed, extent of tissue excised or dissected, invasiveness and incision size.
Results: Compared to the current solutions, the innovations proposed in the literature had higher initial cost (55% increased v 8% decreased cost) and overall system cost (21% inc v 11% dec). Innovations also required more resources (40% inc v 5% dec), more training (38% inc v 3% dec) and were more difficult to perform (37% inc v 5% dec). Innovations tended toward more tissue excised/dissected (26% inc v 13% dec), but offered smaller incisions (18% smaller incision v 11% larger) and less invasive procedures (22% less v 19% more).
Conclusion: Surgical literature is dominated by resource-intense, interval improvements to existing solutions, characteristic of incremental innovations, with a relative dearth of disruptive innovations.