Inpatient Urological Surgery Linked to Preventable Deaths: Study

Preventable deaths during common inpatient urological surgery are on the rise, as healthy and more affluent patients increasingly rely on outpatient services, according to the findings of new research.

In a study published by the medical journal BJU International on August 19, researchers from VUI Center for Outcomes Research Analytics and Evaluation at Henry Ford Health System in Detroit found that an increasing rate of patients undergoing urological procedures as an inpatient are dying from preventable causes.

Researchers largely attribute the problem to an increase in “failure to rescue” deaths, which occurs when a patient dies after a complication during surgery that was potentially recognizable or preventable.

The study involved a review of data on hospital discharges involving patients undergoing low-risk surgeries between 1998 to 2000. Researchers looked at data for nearly 8 million patients who underwent urological procedures, such as transurethral resection of the prostate or a bladder biopsy.

The odds of patients experiencing death attributable to failure to rescue increased five percent every year, even as admissions for urological procedures decreased about half a percent per year.

Urological surgeries are increasingly performed as outpatient procedures. Yet, the study found many of these procedures that are still being performed as inpatient surgeries, resulted in preventable deaths.

Recognizable or preventable complications found during the study included sepsis, pneumonia, blood clots, shock, cardiac arrest and upper gastrointestinal bleeding during admission. Researchers say the procedures are not becoming more dangerous, but a sicker, poorer population of patients is more likely to need to stay in the hospital or experience complications during surgery.

Healthier patients are being treated outpatient, which may account for the rise in inpatient deaths from complications to patients who are unwell already.

Hospital admissions for all surgeries continue to decrease annually and the overall risk of dying in the hospital is less than one percent. Yet, the risk concerning urology surgeries appears to be increasing.

“Older, sicker, minority group patients and those with public insurance were more likely to die after a potentially recognizable or preventable complication,” said Dr. Jesse Sammon, lead author of the study. “While improvements in mortality and failure to rescue mortality are being made in the overall surgical population that is not the case for urology patients.”