Advertisement

The Perioperative Morbidity of Transurethral Resection of Bladder Tumor: Implications for Quality Improvement

Published:October 23, 2018DOI:https://doi.org/10.1016/j.urology.2018.10.027

      Abstract

      Objectives

      To characterize the perioperative morbidity of transurethral resection of bladder tumor (TURBT) in order to identify important determinants of both quality and cost in the delivery bladder cancer care.

      Methods

      We identified 24,100 patients aged 18-89 years who underwent TURBT from 2010 to 2015 in the National Surgical Quality Improvement Program database. Multivariable logistic regression was performed to evaluate the associations of patient features and tumor size (<2 cm, 2-5 cm, or >5 cm) with 30-day perioperative outcomes.

      Results

      Thirty-day postoperative complications occurred in 5.1% of patients, perioperative blood transfusion in 1.5% of patients, hospital readmission in 3.7% of patients, reoperation in 1.5% of patients, and mortality in 0.8% of patients. The most common reasons for readmission were bleeding (29%) and infectious (21%) complications. Although several patient features were associated with increased perioperative morbidity on multivariable analysis, including congestive heart failure, renal failure, higher American Society of Anesthesiology class, and dependent functional status, only larger tumor size was independently associated with increased risks of all perioperative endpoints.

      Conclusion

      Perioperative morbidity following TURBT is substantial and represents an important target for quality improvement. Extent of resection, patient functional status, and specific comorbidities are independently associated with increased risks of perioperative morbidity and mortality. These results have implications for patient counseling, perioperative management, and quality improvement programs.

      Abbreviations

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2017.
        CA Cancer J Clin. 2017; 67: 7
        • Mariotto A.B.
        • Yabroff K.R.
        • Shao Y.
        • et al.
        Projections of the cost of cancer care in the United States: 2010-2020.
        J Natl Cancer Inst. 2011; 103: 117
        • Howlader N
        • Noone AM
        • Krapcho M
        • Miller D
        • Bishop K
        • Kosary CL
        • Yu M
        • Ruhl J
        • Tatalovich Z
        • Mariotto A
        • Lewis DR
        • Chen HS
        • Feuer EJ
        • Cronin KA
        SEER Cancer Statistics Review, 1975-2014. 2018. National Cancer Institute, Bethesda, MD2017
        • Woldu S.L.
        • Bagrodia A.
        • Lotan Y.
        Guideline of guidelines: non-muscle-invasive bladder cancer.
        BJU Int. 2017; 119: 371
        • Tan W.S.
        • Rodney S.
        • Lamb B.
        • et al.
        Management of non-muscle invasive bladder cancer: a comprehensive analysis of guidelines from the United States, Europe and Asia.
        Cancer Treat Rev. 2016; 47: 22
        • Avritscher E.B.
        • Cooksley C.D.
        • Grossman H.B.
        • et al.
        Clinical model of lifetime cost of treating bladder cancer and associated complications.
        Urology. 2006; 68: 549
        • Chang S.S.
        • Boorjian S.A.
        • Chou R.
        • et al.
        Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline.
        J Urol. 2016; 196: 1021
        • Picozzi S.
        • Marenghi C.
        • Ricci C.
        • et al.
        Risks and complications of transurethral resection of bladder tumor among patients taking antiplatelet agents for cardiovascular disease.
        Surg Endosc. 2014; 28: 116
        • De Nunzio C.
        • Franco G.
        • Cindolo L.
        • et al.
        Transuretral resection of the bladder (TURB): analysis of complications using a modified Clavien system in an Italian real life cohort.
        Eur J Surg Oncol. 2014; 40: 90
        • Nieder A.M.
        • Meinbach D.S.
        • Kim S.S.
        • et al.
        Transurethral bladder tumor resection: intraoperative and postoperative complications in a residency setting.
        J Urol. 2005; 174: 2307
        • Konishi T.
        • Washino S.
        • Nakamura Y.
        • et al.
        Risks and complications of transurethral resection of bladder tumors in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study.
        BMC Urol. 2017; 17: 118
        • Gregg J.R.
        • McCormick B.
        • Wang L.
        • et al.
        Short term complications from transurethral resection of bladder tumor.
        Can J Urol. 2016; 23: 8198
        • Balbay M.D.
        • Cimentepe E.
        • Unsal A.
        • et al.
        The actual incidence of bladder perforation following transurethral bladder surgery.
        J Urol. 2005; 174: 2260
        • Avallone M.A.
        • Sack B.S.
        • El-Arabi A.
        • et al.
        Ten-year review of perioperative complications after transurethral resection of bladder tumors: analysis of monopolar and plasmakinetic bipolar cases.
        J Endourol. 2017; 31: 767
        • Ghali F.
        • Moses R.A.
        • Raffin E.
        • et al.
        What factors are associated with unplanned return following transurethral resection of bladder tumor? An analysis of a large single institution's experience.
        Scand J Urol. 2016; 50: 370
        • Allard C.B.
        • Meyer C.P.
        • Gandaglia G.
        • et al.
        The effect of resident involvement on perioperative outcomes in transurethral urologic surgeries.
        J Surg Educ. 2015; 72: 1018
        • Hollenbeck B.K.
        • Miller D.C.
        • Taub D.
        • et al.
        Risk factors for adverse outcomes after transurethral resection of bladder tumors.
        Cancer. 2006; 106: 1527
        • Matulewicz R.S.
        • Sharma V.
        • McGuire B.B.
        • et al.
        The effect of surgical duration of transurethral resection of bladder tumors on postoperative complications: an analysis of ACS NSQIP data.
        Urol Oncol. 2015; 33 (338 e19)
        • Patel H.D.
        • Ball M.W.
        • Cohen J.E.
        • et al.
        Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes.
        Urology. 2015; 85: 552
        • Rambachan A.
        • Matulewicz R.S.
        • Pilecki M.
        • et al.
        Predictors of readmission following outpatient urological surgery.
        J Urol. 2014; 192: 183
      1. Readmissions Reduction Program (HRRP). CMS.gov: Centers for Medicare & Medicaid Servies, vol. 2018, 2017.

      2. ACS NSQIP Participant Use Data File. https://www.facs.org/quality-programs/acs-nsqip/program-specifics/participant-use: American College of Surgeons.

        • Pereira J.
        • Renzulli J.
        • Pareek G.
        • et al.
        Perioperative morbidity of open vs minimally invasive partial nephrectomy: a contemporary analysis of the National Surgical Quality Improvement Program.
        J Endourol. 2017; 32: 116-123
        • Pereira J.F.
        • Golijanin D.
        • Pareek G.
        • et al.
        The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy.
        Urol Oncol. 2017; 36: 157.e7-157.e13
        • Wolf J.S.
        • Bennett C.J.
        • Dmochowski R.R.
        • et al.
        Best practice policy statement on urologic surgery antimicrobial prophylaxis.
        J Urol. 2008; 179: 1379
        • Wagenlehner F.M.
        • Wagenlehner C.
        • Schinzel S.
        • et al.
        Prospective, randomized, multicentric, open, comparative study on the efficacy of a prophylactic single dose of 500 mg levofloxacin versus 1920 mg trimethoprim/sulfamethoxazole versus a control group in patients undergoing TUR of the prostate.
        Eur Urol. 2005; 47: 549
        • MacDermott J.P.
        • Ewing R.E.
        • Somerville J.F.
        • et al.
        Cephradine prophylaxis in transurethral procedures for carcinoma of the bladder.
        Br J Urol. 1988; 62: 136
        • Womble P.R.
        • Dixon M.W.
        • Linsell S.M.
        • et al.
        Infection related hospitalizations after prostate biopsy in a statewide quality improvement collaborative.
        J Urol. 2014; 191: 1787