Urinary tract stone deaths: data from the Australian and New Zealand Audits of Surgical Mortality

Abstract

, and identify common causes, clinical management issues (CMIs), and areas for improvement. Patients and Methods All urological-related deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) from 2009 to 2017 were analysed. The Bi-National Audit of Surgical Mortality (BAS) database was interrogated for any involvement with renal, ureteric or bladder stones and all relevant associated data analysed. Any CMIs documented by the peer reviewers were recorded and compared to those in urology and all of surgery ANZASM data. Results Of 1034 total urological deaths, 100 (9.7%) were related to stones. The mean (range) age of patients was 74.4 (21-97) years; 95% of the patients underwent at least one procedure, with 45 (47.4%) of these being elective. Urinary sepsis was responsible for 49.5% of the deaths, with 20% dying of cardiac events. In all, 39% (37/95) of deaths were associated with CMIs, the most common considerations being delays in diagnosis or treatment, perioperative management and inadequate preoperative evaluation. This is a considerably higher percentage than the 26% recorded for the general urology and all surgery national data. Ureterorenoscopy at 54% (12/22) had the highest rate of CMIs. Conclusion Death related to stone surgery represents only a small proportion of all urological surgical deaths, but generates more CMIs amongst ANZASM peer assessors. Results could be improved with more rapid diagnosis and treatment. Careful case selection and access to all treatment options are recommended.

The effect of COVID-19 outbreak on urological procedures for urinary stones: data from three high-volumes centers in China

“…The impact of the inappropriate management of urinary stones can have a dramatic impact on patients’ safety. As reported by Galiabovitch et al [ 12 ], approximately 10% of all surgical deaths are secondary to stones. Also, urinary sepsis are demonstrated to be responsible for 49.5% of all deaths.…”

Ureterorenoscopic stone procedures have low success rates and poor post‐operative follow‐up: results from an Australian tertiary health service

“…From these results it can be seen that URS consumes many hospital resources, has a 10% complication rate and a stone‐free rate of less than 40%, when reviewed. With urinary tract stones accounting for almost 10% of all urological related deaths in Australia, a number of which can be attributed to clinical management issues during URS, 16 we would suggest that all patients with renal tract stones should be discussed at a regular stone meeting to ensure consistency in treatment and adherence to guidelines. Furthermore, follow‐up appointments with stone analysis and imaging should be made mandatory practice and incorporated into local guidelines to ensure that all patients have adequate follow‐up to ensure complete resolution of disease.…”

Unexpected deaths after endocrine surgery: learning from rare events using a national audit of surgical mortality

“…To date, there has been no comprehensive review of factors associated with death after thyroid, parathyroid, and adrenal surgery. The Australian and New Zealand Audit of Surgical Mortality (ANZASM) has been used to examine trends in mortality across various surgical specialties, including neurosurgery 2 , cardiothoracic surgery 3 , urology 4 , 5 , and general surgery 6 , 7 . These studies have demonstrated that, by examining the small subset of operations resulting in patient death, potential gaps and pitfalls in clinical management may be identified to direct future improvement strategies in the quality and safety of surgical care.…”