Same-Day Urology Surgeries Associated With Higher Death Rate

Urology surgeries shifted from in hospital to outpatient procedures but risk of death increased

(RxWiki News) Many surgeries for the male and female urinary tract and male reproductive organs no longer require a hospital stay. A trend toward more same-day procedures, however, may lead to deadly complications.

Common urology operations include inserting a tube to help urine flow from the kidney, treatment of an enlarged prostate, bladder biopsies (taking a tissue sample) and removal of a diseased kidney. Increasingly, patients who receive these procedures return home on the same day the surgery is performed, according to a new study.

The study suggests, however, that preventable deaths may have increased because of this growing practice of outpatient urology surgery.

"Discuss the pros and cons of outpatient surgery with a surgeon."

Jesse D. Sammon, DO, a researcher at the Vattikuti Urology Institute in Detroit, MI, led the study.

He and his colleagues analyzed data on more than 7.7 million urology surgeries. Patients were discharged between 1998 and 2010.

During that time period, admissions for urological surgery dropped by 0.63 percent each year, and the overall death rate for these patients decreased slightly.

Some scientists have thought that the drop in the death rate could be due to a decline in "failure to rescue" (FTR) rates. An FTR can be a death from a complication that was potentially preventable or recognizable.

When Dr. Sammon and his team looked at deaths attributable to FTR, they found unexpected results. These deaths increased 5 percent every year during the research period.

The authors noted the rise in FTR deaths coincided with a growing trend of same-day urological surgeries (outpatient surgeries). Previously, many of these urological procedures required hospital stays (inpatient surgeries).

Also, investigators observed that older, sicker and minority patients faced a greater likelihood of dying after a postsurgery complication that was potentially recognizable or preventable. Those with public insurance had a similar higher death risk.

"Urologic surgeons and support staff need a heightened awareness of the early signs of complications to prevent such deaths, particularly as our patient population becomes older and has more chronic medical conditions," Dr. Sammon said in a press release.

He added that "these findings also raise the possibility that the care of urologic surgical patients is suffering from inadequate or poorly applied patient safety measures."

The study was published online Aug. 19 by BJUI, the official journal of the British Association of Urological Surgeons. One of the authors consulted on advisory boards for Sanofi-Aventis, Dendreon and Myriad.

Review Date: 
August 21, 2014