Morbidity of Urologic Surgical Procedures: An Analysis of Rates, Risk Factors, and Outcomes

Abstract

Objectives To quantify national complication rates, perioperative outcomes, and predictors for a broad range of urological procedures to demonstrate background rates and discuss benchmarking. Methods Urologic procedures from NSQIP (2006–2011) were analyzed to identify 30-day rates of 21 complications, outcomes (length of stay (LOS), reoperation, death), and predictors including resident involvement for 18 specific procedures. Multivariable logistic regression models assessed predictors for any complication and for Clavien IV or V complication. Results A total of 39,700 procedures were included with abdominopelvic operations more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days LOS, 3.2% mortality) with 56% experiencing any complication followed by nephrectomy (21%), RPLND (20%), and RRP (19%). TURBT (11%) and TURP (10%) had highest rates for endoscopic procedures. Older age, ASA class, dependent functional status, AKI [OR2.70(1.89–3.87)], and ≥5 units preoperative transfusion [OR4.44(3.40–5.80)] were strongest predictors of any complication. Higher ORs of similar predictors along with COPD [OR1.52(1.21–1.92)] and steroid use [OR1.51(1.07–2.14)] were associated with Clavien IV or V complication. Resident involvement increased odds of any complication [OR1.18(1.09–1.29)], mostly for abdominopelvic and urogynecologic procedures, but not Clavien IV or V complication (p=0.55). Conclusions Complication rates of urological procedures based on the retrospective experience of few surgeons does not allow for appropriate benchmarking. Baseline rates and benchmarks derived from NSQIP may help hospitals better track deficient areas and improvements in quality of care. Many predictors were similar across procedures, although magnitudes differed, and resident trainees did not impact rates of serious complications (Clavien-Dindo grade IV or V).

Age-stratified perioperative mortality after urological surgeries

“…Therefore, it is difficult to generalize their findings and find data that are broadly applicable and readily accessible in a clinical setting. A study by Patel et al 7 used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to examine the relationship between age and morbidity in several urological procedures; however, they did not completely characterize the association between age and mortality for each procedure. 7 Crude mortality rates are a common starting point for risk discussions with individual patients.…”

“…A study by Patel et al 7 used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to examine the relationship between age and morbidity in several urological procedures; however, they did not completely characterize the association between age and mortality for each procedure. 7 Crude mortality rates are a common starting point for risk discussions with individual patients. Therefore, describing and understanding the association between age and mortality risk for specific urological procedures will help urologists counsel patients about their risk of death from surgery.…”

Are renal tumour scoring systems better than clinical judgement at predicting partial nephrectomy complexity?

“…Total complications included surgical complications, as well as medical complications, including cardiovascular (new-onset hypertension, angina, myocardial infarction, new-onset arrhythmia, congestive heart failure), pulmonary (symptomatic atelectasis, pneumonia, respiratory failure), thromboembolic (deep vein thrombosis, pulmonary embolism, cerebrovascular accident), gastrointestinal (ileus, clostridium difficile infection, pancreatitis), and metabolic (hyperkalemia, rhabdomylosis). The expected rates of complications following partial nephrectomy have been previously described by Patel et al 15 …”

Application of Self Care Orem’s theory Guideline on elderly Suffering from Urinary Diversion

“…Regarding to their income for treatment 100% of the study group and 84% of the control group had insufficient income for treatment. Concerning clinical data of the study and control groups, table (2) shows that 16% of patients in the study and 20% of patients in the control groups had family member with cancer, meanwhile, the results reflect that there were no family member have had similar problem in both study and control group. Also, the table shows that 48% of the study group and 28% of the control group had previous operation.…”