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Urinary tract stone deaths: data from the Australian and New Zealand Audits of Surgical Mortality
Elena Galiabovitch1, Dylan Hansen2, Claudia Retegan2
1Department of Urology, Monash Health, Melbourne, Vic., Australia.
Insights
Deaths from urinary tract stone surgery are rare but associated with more clinical management issues. Improving diagnosis and treatment speed can enhance patient outcomes in urological surgery.
Area of Science:
- Urology
- Surgical Mortality Analysis
- Nephrolithiasis Management
Background:
- Urinary tract calculi surgery carries risks, and understanding mortality patterns is crucial for improving patient safety.
- The Australian and New Zealand Audit of Surgical Mortality (ANZASM) provides valuable data on surgical outcomes.
Purpose of the Study:
- To analyze mortalities from urinary tract stone surgery in Australia (2009-2018).
- To identify common causes of death, clinical management issues (CMIs), and areas for improvement in surgical care for urinary calculi.
Main Methods:
- Analysis of urological deaths reported to the ANZASM (2009-2017).
- Interrogation of the Bi-National Audit of Surgical Mortality (BAS) database for stone-related deaths.
- Review and comparison of documented CMIs with national urology and general surgery data.
Main Results:
- 100 (9.7%) of 1034 urological deaths were stone-related.
- Urinary sepsis (49.5%) and cardiac events (20%) were primary causes of death.
- 39% of stone-related deaths involved CMIs, notably delays in diagnosis/treatment and inadequate preoperative evaluation. Ureterorenoscopy had the highest CMI rate (54%).
Conclusions:
- Stone surgery contributes a small fraction of urological deaths but has a higher CMI rate.
- Enhanced patient outcomes are possible through expedited diagnosis and treatment.
- Recommendations include careful case selection and ensuring access to all available treatment modalities.
Objectives:
To analyse all mortalities related to surgery for urinary tract calculi in Australia from 1 January 2009 to 31 December 2018, and identify common causes, clinical management issues (CMIs), and areas for improvement.
Patients And Methods:
All urological-related deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) from 2009 to 2017 were analysed. The Bi-National Audit of Surgical Mortality (BAS) database was interrogated for any involvement with renal, ureteric or bladder stones and all relevant associated data analysed. Any CMIs documented by the peer reviewers were recorded and compared to those in urology and all of surgery ANZASM data.
Results:
Of 1034 total urological deaths, 100 (9.7%) were related to stones. The mean (range) age of patients was 74.4 (21-97) years; 95% of the patients underwent at least one procedure, with 45 (47.4%) of these being elective. Urinary sepsis was responsible for 49.5% of the deaths, with 20% dying of cardiac events. In all, 39% (37/95) of deaths were associated with CMIs, the most common considerations being delays in diagnosis or treatment, perioperative management and inadequate preoperative evaluation. This is a considerably higher percentage than the 26% recorded for the general urology and all surgery national data. Ureterorenoscopy at 54% (12/22) had the highest rate of CMIs.
Conclusion:
Death related to stone surgery represents only a small proportion of all urological surgical deaths, but generates more CMIs amongst ANZASM peer assessors. Results could be improved with more rapid diagnosis and treatment. Careful case selection and access to all treatment options are recommended.
Related Concept Videos
01:28Urinary Tract Calculi I: Introduction
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:30Urinary Tract Calculi III: Medical Management
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:28Urinary Tract Calculi V: Nursing Management
01:25Urinary Tract Calculi VI: Surgical Management