An analysis of deaths related to urological surgery, reviewed by the State Coroner: a case for cardiac vigilance before transurethral prostatectomy.
OBJECTIVE
To ascertain the frequency of in-hospital deaths after urological surgery in a compulsory reporting setting, and to identify the contributing and potentially reversible factors involved in patients who had had transurethral resection of the prostate (TURP).


METHODS
We reviewed all hospital deaths reported to the State Coroner from Coronial Services Victoria (CSV), Australia, in 2000-2002 to identify those instances associated with urological surgery. These cases were then analysed using methods developed by CSV. Resources available included medical records, police reports, government data on operative procedures and autopsy results.


RESULTS
There were 20 in-hospital deaths after urological surgery identified for the 3-year period; most related to pre-existing comorbidities, predominantly ischaemic heart disease. Two episodes of hospital-acquired infection, two instances of technical complication of surgery contributing to death, and one pulmonary embolus were identified. Numerically the largest group of deaths after surgery was patients having TURP, and these deaths represented 0.05% (nine of 17 044) of all TURPs in this period. Most in this group (eight) had an acute myocardial infarction.


CONCLUSIONS
Death after urological surgery appears to be uncommon; assessing patients for coronary artery disease before urological surgery, particularly TURP, closer cardiovascular monitoring after surgery, and rapid transfer to a coronary care unit if required, may further reduce mortality.
Surgery and Urology, University of Melbourne, Austin Hospital, Heidelberg, Australia.
Dennis
D
Gyomber
Nathan
N
Lawrentschuk
David L
DL
Ranson
Damien M
DM
Bolton
D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000592:standards; D011469:Prostatic Diseases / Q000401:mortality / Q000601:surgery; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000401:mortality; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000401:mortality*