Transition to Outpatient Urological Surgeries Increases Mortality

As common urological procedures transition from inpatient procedures to outpatient ones, there has been a rise in preventable deaths, research published in the British Journal of Urology International claimed.

Extracting data from the Nationwide Inpatient Sample, the largest all-payer inpatient healthcare database in the US, Jesse D. Sammon, DO, and his colleagues identified 7.7 million urological outpatient surgeries conducted between 1998 and 2010. With this data, the researchers assessed overall and failure-to-rescue (FTR) mortalities. The investigators also utilized the data to create logistic regression models and generalized estimating equations to determine relevant mortality predictors.

Additionally, the researchers noted each patient’s age, race, and insurance status. To assess the severity of a patient’s illness at the time of surgery, they looked for comorbidity or the presence of other chronic diseases.

Sammon and colleagues discovered a 0.63% (P = 0.008) annual decrease in admissions for urological surgeries (odds ratio [OR] 0.990, 95% confidence interval [CI] 0.988—0.993). Although, the likelihood of overall mortality slightly dropped, the researchers reported mortalities associated with FTR increased by 5% annually (OR 1.050, 95% CI 1.038–1.062).

FTR was explained as clinician failure to notice complications resulting in death. FTR rates determine safety and quality of care better than overall mortality rates, Sammon said.

The writers also noted a disproportionate increase in preventable deaths amongst patients who were minorities, sicker, older, and enrolled under public insurances.

Sammon found these results alarming as the likelihood of FTR-related deaths has rose for common urological procedures, such as ureteral stenting, treatment of enlarged prostate, bladder biopsies, and removal of a diseased kidney.

In light of their findings, the investigators recommended improvement in care especially for candidates they pinpointed as high 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,” Sammon said in a statement.