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NEW YORK (Reuters Health) – As more urological surgeries are performed outside hospitals, deaths from preventable complications among men and women getting inpatient surgery have risen, according to a new study.
It’s likely that older, sicker and poorer people make up more of the population having inpatient surgery, not that the surgeries are getting more dangerous, researchers say.
“Our present findings provide evidence of a major shift in the type of patients being admitted for urological surgery,” lead author Dr. Jesse Sammon told Reuters Health. “Historically, a much larger proportion of relatively healthy urology patients were admitted for low-risk procedures.”
Sammon, a urologist at the VUI Center for Outcomes Research, Analytics and Evaluation at Henry Ford Health System in Detroit, and his coauthors used data on all hospital discharges of patients undergoing low-risk surgeries like transurethral resection of the prostate and bladder biopsy, which included almost eight million surgeries between 1998 and 2010. About two-thirds of the patients were men.
Hospital admissions decreased annually, and overall the risk of dying in the hospital was less than one percent.
In-hospital deaths following urologic surgery stayed stable over the study period but deaths attributable to “failure to rescue” following recognizable or preventable complications, increased 1.5 percent per year on average, Sammon said.
Recognizable or preventable complications included sepsis, pneumonia, blood clots, shock or cardiac arrest. Upper gastrointestinal bleeding during admission for surgery was also included.
Older, sicker and minority patients or those with public insurance were more likely to die as a result of a potentially preventable cause, according to the results published in BJU International.
“There’s a pretty wide variety of types of procedures here, but they tilt toward men because they include prostate procedures,” said Dr. Hung-Jui Tan, a urology fellow at UCLA who was not involved in the new study.
Overall the mortality rates were quite low, even lower than some other studies have found, he told Reuters Health.
Healthier patients being treated without being inpatients could be one explanation for the rise in inpatient deaths from complications, but it could also have to do with a increasing emphasis on coding and accounting for complications that could lead to mortality over the period of the study, he said.
“Making surgery safer down the road will really involve being aware of complications that have the highest risk of downstream issues, morbidity and death,” Tan said.
Patients should not be concerned that their outpatient procedures may be unsafe, he said.
“For urology patients the rate of both in-hospital mortality and (failure to rescue) are lower than for the overall surgical population,” Sammon said. “That said, 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.”
Patients should be encouraged to seek care at institutions that perform a large number of whatever procedure they require, which may require more travel, he noted.
SOURCE: bit.ly/VCWOfJ BJUI, online August 19, 2014.