Complications rates of non-oncologic urologic procedures in population-based data: a comparison to published series

Abstract

Purpose: Published single institutional case series are often performed by one or more surgeons with considerable expertise in specific procedures. The reported incidence of complications in these series may not accurately reflect community-based practice. We sought to compare complication and mortality rates following urologic procedures derived from populationbased data to those of published single-institutional case series. Materials and Methods:In-hospital mortality and complications of common urologic procedures (percutaneous nephrostomy, ureteropelvic junction obstruction repair, ureteroneocystostomy, urethral repair, artificial urethral sphincter implantation, urethral suspension, transurethral resection of the prostate, and penile prosthesis implantation) reported in the U.S.'s National Inpatient Sample of the Healthcare Cost and Utilization Project were identified. Rates were then compared to those of published single-institution series using statistical analysis. Results: For 7 of the 8 procedures examined, there was no significant difference in rates of complication or mortality between published studies and our population-based data. However, for percutaneous nephrostomy, two published single-center series had significantly lower mortality rates (p < 0.001). The overall rate of complications in the population-based data was higher than published single or select multi-institutional data for percutaneous nephrostomy performed for urinary obstruction (p < 0.001). Conclusions: If one assumes that administrative data does not suffer from under reporting of complications then for some common urological procedures, complication rates between population-based data and published case series seem comparable. Endorsement of mandatory collection of clinical outcomes is likely the best way to appropriately counsel patients about the risks of these common urologic procedures.

Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification

“…Whereas some authors described a significantly higher rate of complications for gynaecological-laparoscopic operations for patient collectives with malignant underlying diseases, other working groups could not detect such a correlation [34,35]. Last but not least, some authors view a retrospective non-standardised registration of the surgical morbidity in the evaluation of surgical treatment procedures as a methodologically intrinsic reason for a systematic underestimation of the actually occurring complication rates [36]. An association of, on the one hand, the degree of technical difficulty of a laparoscopic intervention and, on the other hand, surgical complications was also observed in our studies: interventions with the degrees of difficulty of III and IV according to Barakat exhibit a significantly higher number of severe complications and, in turn, a significantly higher rate of overall morbidity for this intervention group.…”