| RE:
ADVERSE EVENTS AND READMISSIONS AFTER DAY-CASE UROLOGICAL SURGERY
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ALVARO PAEZ, ENRIQUE
REDONDO, ANA LINARES, EMILIO RIOS, JORGE VALLEJO, MARGARITA SANCHEZ-CASTILLA
Department
of Urology and Department of Anesthesia, Hospital De Fuenlabrada, Madrid,
Spain
Int
Braz J Urol, 33: 330-338, 2007
To the Editor:
This
valuable retrospective study looks at the complication rate and frequency
of re-admission following day case (ambulatory urological surgery), under
both local and general anaesthesia. The authors have reviewed all day
case surgery over a 16 month period at a single institution accumulating
data on 1189 patients from a possible 1420.
The importance of this paper is two fold.
Firstly, it highlights the ever increasing trend toward day case surgery
throughout the world with an inevitable parallel rise in the degree of
surgical complexity that can be accomplished in such a setting. Not too
long ago, day case ureteroscopy with stent placement was unheard of, now
it is common place with excellent results and acceptable rates of complication
and re-admission.
The second important issue is that of re-admission
and complications following day case surgery and the distribution of these
issues amongst the various procedures with identification of risk factors
where possible. It is no surprise that more complex procedures are inextricably
linked to a higher rate of both complication and re-admission. One would
accept this as the first cousin of change and progress and it is this
facet that offers the greatest opportunity for improvement and further
progress.
The re-admission figures are very impressive
in this series – overall 0.5 %. This compares very favourably with
figures from other studies1 and is well below the recommended
re-admission rate of 3% (1).
There are minor omissions from this paper, the re admission rate following
GA day case procedures, whilst having a risk ration in excess of 7 in
comparison to the rate following local anaesthesia is not calculated.
It would also have been of use to include the actual re-admission rates
for each procedure classification. In our own multi-centre study (2),
ureteroscopy yielded a re-admission rate of over 13% which may be loosely
compared to the 18% complication rate following ureteroscopy in this series
despite an unknown rate of re-admission.
There is no doubt that there is a huge drive,
both from a patient acceptability view and from a health economic stand,
for day case surgery to continually evolve. As it does so, there is a
vital need for perpetual audit and analysis of results to ensure that
patient interests are not overlooked or indeed sacrificed in the name
of such progress.
References
1. RCS Commission on the provision of surgical services. Guidelines for
day surgery. A report of the working party of the Royal College of Surgeons
of England, March 1992.
2. Sinclair AM, Gunendren T, Pearce I: Day case urological surgery : Are
we improving? BJU Int. 2007; 99: 491-3.
Dr.
Ian Pearce
Consultant Urological Surgeon
Manchester Royal Infirmary
Manchester, United Kingdom
E-mail: pearcey@totalise.co.uk
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