[speaker001:] invitation from me, and also the Urological Society. Thank you.... And now I introduce erm Mr to present his paper on the northern regions of.
[speaker002:] Thank you erm Mr Chairman. Er Mr Chairman, ladies and gentlemen I'd like to present the early result of an audit of of the prostate which has been performed over the northern region.... Er the audit period spanned eight months starting
[speaker001:] [cough]
[speaker002:] April nineteen ninety one and ended on the thirty first of November. Twelve out of sixteen separate hospital sites within the northern region were included. One of these sites was a teaching hospital and the remaining eleven sites were a mixture of large and small district general hospitals.... Erm the northern region audit preceded er the national audit er and has been presented by er Mr and its erm data collection differed from it in that erm all notes were reviewed at three months er by using a standard pro forma independently by two clinical coordinators and so would not be
[speaker001:] [cough]
[speaker002:] upon self by medical staff at each site. And all medical staff at each site knew what data was being collected before the audit started....
[speaker001:] [cough]
[speaker002:] W we have obviously collected a lot of data er from the audit and today I'm presenting the initial er early result. Our main aims initially have been to assess mortality and major morbidity arising from T U R P within the northern region and assessing also the inter-site variation for this. In our er assessment of major morbidity we have included a return to theatre, er a postoperative blood transfusion of, of more than two units of blood and the development of postoperative sepsis. We have also assessed written evidence in the notes of counselling for retrograde ejaculation.... Er in our first assessments of mortality and major morbidity we would classify our consultants into three types, general surgeons with an interest in urology, district general hospital urologists and teaching hospital urologists. We have also looked at the effect of volume on er mortality and major morbidity by comparing sites where fewer than one hundred cases were performed during the audit period, sites where more than one hundred cases were performed and we have also examined the effects upon mor mortality of both admission types and histology.... During the audit period one thousand four hundred and thirty one operations are performed and of them one thousand three hundred and ninety six were T U R P. The mean patient age was seventy one years and the mean weight resected was twenty seven grammes. The percent of patients er who were put into the audit erm varied from four to thirty five percent erm site for site....
[speaker001:] [cough]
[speaker002:] This shows the early postoperative mortality and we have defined early mortality as appearing at less than thirty days. The mean overall early mortality was point nine percent and the inter-site variation for this ranged from zero to three point eight percent.... The late postoperative mortality, and we have defined this as death occurring between thirty and ninety days, was a mean of three point seven percent for the region as a whole and the inter-site variations for this ranged from one point seven percent to six point eight percent.
[speaker001:] [cough]
[speaker002:] would say that there were no differences in mortality rates when looking at the various classifi classifications and control. The early mortality for elected admissions was point four percent and this was found to be significantly lower than the early mortality rate for emergency admissions which was two point four percent, some six times higher. The late mortality rate for elected admission was two point nine percent and this again was significantly less than the er er late mortality rate for emergency admissions which was six point one percent.... Examining the effects of histology, histological type, the early mortality patient with benign was point three percent and this was significantly less than the early mortality for those patients who had prostate cancer, which was two point nine percent, almost ten times greater. The late mortality rate for disease was one point seven percent and again this was significantly less than the late mortality for patients with prostate cancer, which was some four times higher at eight point four percent.... A mean of two percent of patients were returned to theatre across the northern region after T U R P and this ranged from zero to seven point five percent.... A mean of two point four percent of patients received a blood transfusion of greater than two units across the region and again this ranged from zero to six point six percent across the region.... A mean of eight percent of patients developed postoperative sepsis and we have classified patients as having de developed postoperative sepsis if they have developed two out of three of the following, a temperature of greater than thirty eight degrees celsius, or a positive blood culture.... The rate for this was zero to sixteen point nine percent across the region. You may have noticed over the last three slides that several of sites have had a zero er percentage registered and we certainly feel that in a couple of these sites this was probably due to poor note-keeping rather than a percentage.
[speaker001:] [LAUGHTER] [cough] [cough]
[speaker002:] This slide shows the cumulative percent of early mortality and major morbidity. The dark areas on the slide are er, the dark areas on each bar at the bottom represent the early mortality rate. The hatched areas represent returning to theatre, the white areas represent blood transfusion of greater than two units and a hatched area represent patients developing postoperative sepsis. If it's expressed as a percentage of patients... the bar on the left side represents those sites who performed more than one hundred cases during the audit period. There were five of these sites and in the tot in total nine hundred and twenty eight operations were performed over the five sites. This bar on the right hand side represents those sites where less than one hundred cases were performed during the eight month audit period, there were seven of these sites and they performed a total of four hundred and sixty eight operations. When we looked at the cu cumulative percentage mortality and major morbidity it was found to be significantly less in those sites performing more than one hundred operations, compared to those sites performing less than one hundred operations, during the audit period.... In a mean of thirty percent of patients across the region there was evidence o well there was written evidence of counselling for retrograde ejaculation and this varied from zero to just under seventy one percent. We found that patients who were significantly younger er sorry we found that patients who were counselled for retrograde ejaculation were significantly younger er but we also found that marital status did not seem to have an effect on whether they were counselled for retrograde ejaculation or not.... In summary, Mr Chairman, the overall mortality rate for disease, for T U R P, over the northern region was point three percent and this compares very well with the large published theories from America but we did find large inter-site variations for both mortality and major morbidity rates. We also er demonstrated that mortality and major morbidity rates were significantly higher in sites treating fewer than one hundred patients compared with sites treating more than one hundred patients. So we feel that there may be a volume effect. This difference could not be explained by the distribution of either histological types or admission types between the erm sites that had less than one hundred cases and those that had more than one hundred cases. We did find however that histological type and admission type overall had a significant adverse effect on mortality and overall we feel that written ev evidence of counselling for retrograde ejaculation was poor and was not acceptable. Thank you.
[speaker001:] [clapping] Thank you Mr. We have time for several questions, I wonder if you'd be kind enough