Anesthesia for urological surgery in a European region with 6.7 million inhabitants (Catalonia, Spain)

doi:10.1016/j.jclinane.2008.06.017

Journal of Clinical Anesthesia

Volume 21, Issue 1, February 2009, Pages 30-37

https://doi.org/10.1016/j.jclinane.2008.06.017 Get rights and content

Abstract

Study Objective

To describe the characteristics of anesthetic and postoperative care applied in urologic surgery.

Design

Prospective, cross-sectional survey.

Setting

131 authorized public and private hospitals in Catalonia, Spain.

Measurements

Data were collected from a representative sample of 23,136 patients and all questionnaires related to urologic surgery were analyzed.

Main Results

Data included patient characteristics, anesthetic techniques, and type of procedure. Eighty-five hospitals performed urologic surgery and 75.4% of activity took place in public hospitals. The median age of patients was 61 years and 87.3% were men. Preoperative physical status was poorer than in the rest of the surgical population. Surgery was elective in 93.2% of the cases, and the most frequent procedure was transurethral resection of bladder tissue (25.6%). The median duration of anesthesia was 60 minutes, and 9.7% of patients required postoperative admission to an intensive care unit. Regional anesthesia, especially subarachnoid block, was the most frequently used anesthetic technique.

Conclusions

The older age and poor physical status of urology patients make high demands on anesthetic resources and must be considered in the organization of services and training programs.

Introduction

Surgical specialties advance with improvements in available resources and the applications that accompany new developments in technology and pharmacology, as well as in response to social and economic changes. The quality of urologic surgery is particularly influenced by the practice of anesthesia and resources available in that specialty.

Knowledge of the epidemiology of the urologic diseases that can be treated surgically in a geographical area is essential for analyzing the demand for anesthetic care. Although overall surgical anesthetic activity has been analyzed for some European countries such as France [1] and Italy [2], such studies do not give specific data for urologic surgery, which accounts for a large portion of anesthetic practice: 7.6% in France and 9.7 % in Italy.

In Europe, as in the United States [3], [4], demographic characteristics of the population will change in the coming decades, and the proportion of patients older than 65 years is projected to increase more than that of individuals younger than 65. The aging population will lead to new challenges for the health care system because older patients are the largest consumers of medical care. The procedure-based work in urology is expected to increase by 35% in the US as the population over 65 years of age increases by 53.4%, according to forecasts [3]. In Catalonia, the population over 65 years old is expected to have grown by 9.5% in 2010 and by 25.4% in 2020 [5].

Given such forecasts for urology, and the considerable increase in demand on the specialty of anesthesiology to assist with a rising procedure-based workload for an aging population [3], it would be useful to know the state of the present situation when planning future performance and training objectives. The aim of this study was to describe the characteristics of anesthesia and postoperative care related to urologic surgery in Catalonia, a European region of nearly 7 million inhabitants.

Section snippets

Study design

A prospective cross-sectional survey known as ANESCAT 2003 [6] was performed over 14 randomized days in 2003 by the local society of anesthesiology (Societat Catalana d'Anestesiologia i Teràpia del Dolor; SCARTD). The design was approved by the ethics committee of the local official college of physicians (Collegi Oficial de Metges of Barcelona), upon assurance of total confidentiality of patient data. The project was co-financed by the Catalan Health Service and SCARTD.

The survey was undertaken

Results

A total of 131 hospitals participated in the survey, 100% of those officially allowed by the Catalan health care authorities to give anesthesia in 2003. Seventy-three (55.7%) were private and 58 (44.3%) belonged to the public health service. The collected number of questionnaires was 23,136. Less than 5% of the information per item was missing. We estimated that 603,189 anesthetic procedures were performed in Catalonia in 2003 (95% CI: 578,470 – 627,908). It represented an annual rate of 90

Discussion

The ANESCAT survey is the first study in Spain describing the whole activity of one medical specialty, in terms of both patient demographic characteristics and organizational aspects. The structure of the specialty of anesthesiology in Catalonia, an autonomous region of Spain with 6.7 million inhabitants, and the cohesion and established links among Catalan anesthesiologists made it possible to obtain extensive and reliable information about the specialty in a single year in all public and

Acknowledgments

We thank all anesthetists who completed the questionnaire. M.E. Kerans provided assistance with English usage in a version of the manuscript.

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Urological procedures range from minor day case procedures, to major surgery in which extensive resources are needed both intra- and postoperatively (high-dependency unit (HDU)/intensive care unit (ICU)). Consequently anaesthesia may encompass local, monitored anaesthesia care (MAC), regional or general techniques.1 A thorough assessment of the patient history, including any anaesthetic records, is important in detecting any underlying co-morbidities and to assess the degree of major organ function.
Anaesthesia is commonly used to facilitate urological procedures and many patients are elderly with multiple co-morbidities. Urological procedures range from minor day case to major surgery in which extensive resources are needed both intra- and postoperatively. For simple day case procedures like cystoscopy or ureteroscopy, general anaesthesia is most commonly used because it allows for early ambulation. Transurethral resection of the prostate (TURP) needs special attention. TURP syndrome due to excessive absorption of the irrigation fluid can be catastrophic if not managed early. Avoiding contributing factors and choosing regional anaesthesia which allows for early detection are key. Careful perioperative planning and risk stratification is important in major urological cancer surgery. Most of these procedures will require general anaesthesia (due to longer operative time and more extensive surgical trauma). Postoperative pain management in the form of epidural or patient-controlled multimodal analgesia are essential. Postoperative high-dependency care is beneficial.
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Urological procedures range from minor day case procedures, to major surgery in which extensive resources are needed both intra- and postoperatively (high-dependency unit (HDU)/intensive care unit (ICU)). Consequently anaesthesia may encompass local, monitored anaesthesia care (MAC), regional or general techniques.1 A thorough assessment of the patient history, including any anaesthetic records, is important in detecting any underlying co-morbidities and to assess the degree of major organ function.
Anaesthesia is commonly used to facilitate urological procedures and many patients are elderly with multiple co-morbidities. Urological procedures range from minor day case to major surgery in which extensive resources are needed both intra- and postoperatively. For simple day case procedures like cystoscopy or ureteroscopy, general anaesthesia is most commonly used because it allows for early ambulation. Transurethral resection of the prostate (TURP) needs special attention. TURP syndrome due to excessive absorption of the irrigation fluid can be catastrophic if not managed early. Avoiding contributing factors and choosing regional anaesthesia which allows for early detection are key. Careful perioperative planning and risk stratification is important in major urological cancer surgery. Most of these procedures will require general anaesthesia (due to longer operative time and more extensive surgical trauma). Postoperative pain management in the form of epidural or patient controlled multimodal analgesia are essential. Postoperative high-dependency care is beneficial.
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^☆: Funded in part by the Catalan Public Health Service and the Societat Catalana d’Anestesiologia i Terapèutica del Dolor (SCARTD), Barcelona, Spain. The funding sources had no involvement in the production of this manuscript for publication.

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Original contributionAnesthesia for urological surgery in a European region with 6.7 million inhabitants (Catalonia, Spain)☆

Abstract

Study Objective

Design

Setting

Measurements

Main Results

Conclusions

Introduction

Section snippets

Study design

Results

Discussion

Acknowledgments

Med Clin (Barc)

Ann Fr Anesth Réanim

Best Practice Res Clin Anaesthesiol

Eur Urol

Med Clin (Barc)

French survey of anesthesia in 1996

Anesthesiology

A multicenter survey on anaesthesia practice in Italy

Minerva Anestesiol

The aging population and its impact on the surgery workforce

Ann Surg

The increasing workload of general surgery

Arch Surg

Original contribution
Anesthesia for urological surgery in a European region with 6.7 million inhabitants (Catalonia, Spain)☆