Hello and welcome back!
This morning as we were looking around the internet for interesting articles when we came upon a interesting review on changes in mortality rates associated with common urological procedures. It’s a mix of good and not so good news. Overall mortality is stable or declining, especially among common procedures. Despite that good news, the study, published in BJU International, found that deaths attributable to “failure to rescue” (FTR) had an absolute increase of 18% during the 12 year study period. This increase coincided with a shift to more procedures being conducted in community based surgical centers without many of the same resources as hospitals. Failure to rescue is defined as death after a complication that was potentially recognisable/preventable.
The researchers also found that older, sicker patients had higher FTR rates, as did minorities, publicly insured patients, and patients who received care at urban hospitals. Complications that lead to mortality included sepsis, pneumonia, deep vein thrombosis or pulmonary embolism, shock or cardiac arrest, and upper gastrointestinal bleeding during admission for surgery.
But it’s not all doom and gloom. The study did uncover some good news. The mortality rate decreased for several of the most common urologic surgical procedures, including: radical prostatectomy, ureteric stenting, transurethral resection of bladder tumor (TURBT), percutaneous nephrostomy (PCN) placement, transurethral resection of the prostate (TURP), retrograde pyelogram, bladder biopsy, and percutaneous cystostomy.
Between 1998 and 2010, admission for urological surgery procedures decreased about 6% from 605,629 to 569,784. Overall inpatient mortality rate was 0.71% (54,949 deaths). However, the proportion of inpatient mortality attributable to FTR increased from 41.1% in 1998 to 59.5% in 2010. So more people survive surgery but more people are experiencing post-operative complications and aren’t being treated, that means that a patient who could have been saved, wasn’t.
So what does this all mean for the urological community? Well for starters it indicates that urologists have the opportunity to implement process improvements to increase patient safety. The study is also a reminder that process improvement requires looking at the “entire process”. This includes taking a closer look at the older patients during the pre-operative phase and what factors in the operating room are contributing to mortality.
Additionally, identifying the risk factors for FTR will also allow individual practices to take steps to optimize care for higher-risk patients. The Urological community has made great strides in improving the quality and safety of many common procedures but better vetting for high risk patients is necessary if we want to continue this trend.
That’s all we have for today. I know there was a lot of technical information in this blog. So if you have any questions, leave a comment below and we will get back to you ASAP. As always thanks for reading and have a great day!