In recent years, a shift from inpatient to outpatient surgery in the U.S. for commonly performed urologic procedures has coincided with increasing deaths following complications that were potentially recognizable or preventable. The finding, which comes from a recent study published in BJU International, indicates the importance of monitoring urologic surgery patients for potential complications.
Over the last two decades, measures to improve healthcare safety and quality have expanded significantly. In the context of surgical procedures, this has lead in a decrease in deaths despite an increase in the number of inpatient admissions after surgery. Jesse Sammon, DO, of the Henry Ford Health System's Vattikuti Urology Institute in Detroit, and his colleagues found that this has not been true for patients undergoing urologic surgery, however. "Unfortunately, we saw an opposite trend in urology, wherein in-hospital surgery rates fell, mortality overall stayed stable, and failure to rescue rates—which refer to deaths following complications that were potentially recognizable or preventable—went up," said Dr. Sammon.
For their study, the researchers analyzed the discharge records of patients undergoing urologic surgery in the United States between 1998 and 2010. The team found that an estimated 7,725,736 urologic surgeries requiring hospitalization were performed during that time. Admissions for urologic surgery decreased 0.63 percent per year. Odds of dying after urologic surgery decreased ever so slightly overall, yet the odds of dying following complications that were potentially recognizable or preventable increased 1.5 percent every year. Older, sicker, and minority patients, as well as those with public insurance, were more likely to die as a result of a potentially preventable death.
The researchers also discovered evidence of a major shift in the type of patients being admitted for urologic surgeries. Historically, a much larger proportion of relatively healthy urology patients were admitted for low-risk procedures. As surgeons began doing such procedures as outpatient surgeries, the in-patient population became generally sicker. "Consequently, urological surgeons and ancillary staff members need to recognize that the contemporary cohort of urology inpatients is generally at higher risk of complications and consequently failure to rescue mortality," said Dr. Sammon. Therefore, a heightened awareness of early signs of complications may help reduce mortality rates after urologic surgery.
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