100 stone related deaths.

Abstract

Introduction & Objectives: Mortality from treatment of renal tract calculi is rarely reported with operative management considered relatively low risk. We report on the largest ever series of stone related deaths using the Australia and New Zealand Audits of Surgical Mortality (ANZASM) data. Material(s) and Method(s): All urological related deaths reported to ANZASM from 2009 - 2018 were analysed. The Bi-National Audits of Surgical Mortality (BAS) were interrogated for any involvement with renal, ureteric or bladder calculi and all relevant associated data analysed. Areas of concern documented by the peer reviewers were recorded and compared to trends of national urology and all surgery death data. Result(s): Of 1034 total urological deaths 100 (9.7%) were related to stones. Mean age of patients was 74.4 years (range 21-97). 95% of the patients underwent at least one procedure as documented in Table 1. Urinary sepsis was responsible for 43% of the deaths with 22% dying of cardiac events. 37/95 (39%) of deaths of patients who had surgery were associated with clinical management issues. This is a considerably higher percentage than the 26% recorded for the general urology and all surgery national data. The most common considerations were: delays in diagnosis or surgery, perioperative problems and inadequate pre-operative work-up. [Table presented] Conclusion(s): Death related to stone surgery represents a small proportion of all urological deaths but generates more concern amongst ANZASM peer assessors. The most common cause of death is overwhelming sepsis often in an emergency setting. Results can be improved in these cases with more rapid diagnosis and treatment. Over 50% of deaths related to elective surgery for renal stones are associated with assessor concerns, with the majority of these cases involving the rapidly increased use of pyeloscopy. Careful case selection, with thorough pre-operative assessment and access to all treatment options are recommended.Copyright © 2020 Elsevier B.V.