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
- AKI acute kidney injury
- ASA American Society of Anesthesiology
- CHF congestive heart failure
- CI confidence interval
- COPD chronic obstructive pulmonary disease
- CPT current procedural erminology
- HTN hypertension
- IQR interquartile range
- LOS length of stay
- NMIBC non–muscle-invasive bladder cancer
- NSQIP National Surgical Quality Improvement Program
- OR odds ratio
- RF renal failure
- TURBT transurethral resection of bladder tumor
- UTI urinary tract infection
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Article info
Publication history
Published online: October 23, 2018
Accepted:
October 12,
2018
Received:
September 6,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
