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Death after endoscopic prostate surgery in Australia and New Zealand: a review of clinical management issues.

ANZ Journal of Surgery 2023 November 9
BACKGROUND: Endoscopic prostate surgery is an established treatment for male lower urinary tract symptoms (LUTS) and is recognized to have low mortality rates. We aimed to describe factors that may have contributed to death following endoscopic prostate surgery using data from the Australia and New Zealand Audits of Surgical Mortality (ANZASM).

METHODS: All urological related deaths reported to ANZASM from January 1 2012 to December 31 2019 were reviewed. Deaths related to endoscopic prostate resection (transurethral resection of prostate - TURP, laser procedures) were included. Peer reviewers identified up to three clinical management issues (CMIs), and these were analysed. CMIs were classified in order of least to most concerning: area of consideration, area of concern and adverse events.

RESULTS: Of 1127 total urological deaths, 77 deaths were related to endoscopic prostate surgery (7.0%). Most procedures were monopolar TURP. The mean age of patients was 80.9 years (range 57.0-96.2). Leading causes of death were cardiovascular events 23/77 (29.9%) and respiratory failure 14/77 (18.2%). Assessors identified 39 CMIs in 26/77 (33.8%) patients. Twenty-three were areas of consideration, nine were areas of concern and seven identified adverse events. The most common CMIs were regarding post-operative care (14/39) and the decision to operate (13/39).

CONCLUSION: Most deaths did not elicit concerns from the ANZASM peer assessors. However, the main concerns identified were surrounding decision making and rationale for operating. This highlights the importance of clear counselling and documentation during the treatment decision process.

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