Adoption of new surgical technology

doi:10.1136/bmj.332.7533.112

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Charles B Wilson, professor emeritus (cwilson@charleswilson.org)1

¹ Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA

Surgeons and patients seeking improved treatment often forget that a new technique is not necessarily a better one

New surgical technology that offers the promise of improved patient care is attractive. Intrigued, and with an intuitive certainty, surgeons—cheered on by their patients—may adopt new technologies, despite little evidence of either their efficacy or their superiority over existing procedures. The argument that randomised clinical trials of surgical procedures are unethical because the new treatment is better than alternative treatment or no treatment is based on presumption more than fact, and arguments to the contrary are compelling. 1 Surgical procedures that are later found to be ineffective waste resources and endanger lives. Understanding why such procedures come to be offered as treatment can inform us—whether we are well intended perpetrators or unsuspecting patients.

Impetus for change

New medical technology may come in the form of a drug, a device, a procedure, a technique, or a process of care. In surgery, innovation is generally either a new procedure that uses existing devices or drugs, such as chymopapain for lumbar disc disorders, or an existing procedure that uses new devices, such as those for spinal fusion.

Factors that determine the adoption and diffusion of a new technology fall into two categories: characteristics of the technology itself (box 1) and contextual factors that promote it (box 2). Surgeons are attracted to the new technology if it can be passively observed, easily and quickly learnt, and added to their existing practice with minimal disruption. If the potential contribution to their practice is sufficiently great, surgeons are more likely to invest time and effort and tolerate disruption of their routine to gain the competitive advantage that a new technology offers.

Social theory

Social observers have advanced pivotal theories regarding the adoption and diffusion of technologies. Everett Rogers described an S—curve portraying the …