Urinary tract stone deaths: ANZASM data.

Abstract

Introduction & Objectives: Mortality from treatment of renal tract calculi is rarely reported and operative management is 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. 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. Any areas of concern documented by the peer reviewers were recorded and compared to trends of national urology and all surgery data. Result(s): Of 1034 total urological deaths, 100 were related to stones (9.7%). The 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 were associated with areas of concern, the most common considerations being delays in diagnosis or surgery, perioperative problems and inadequate pre-operative workup. This is a considerably higher percentage than the 26% recorded for the general urology and all surgery national data. Conclusion(s): Death related to stone surgery represents only a small proportion of all urological deaths but generates more concern amongst ANZASM peer assessors. The most common cause of death is due to 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 and access to all treatment options are recommended.