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

• Published in: Urology (Ridgewood, N.J.) N.J.), 2019-03, Vol.125, p.131-137
• Main Authors: Pereira, Jorge Francisco, Pareek, Gyan, Mueller-Leonhard, Catrina, Zhang, Zheng, Amin, Ali, Mega, Anthony, Tucci, Christopher, Golijanin, Dragan, Gershman, Boris
• Format: Article
• Language: English
• Subjects: acute kidney injury; AKI; American Society of Anesthesiology; ASA; CHF; chronic obstructive pulmonary disease; confidence interval; congestive heart failure; COPD; CPT; current procedural erminology; HTN; hypertension; interquartile range; IQR; length of stay; LOS; National Surgical Quality Improvement Program; NMIBC; non–muscle-invasive bladder cancer; NSQIP; odds ratio; renal failure; transurethral resection of bladder tumor; TURBT; urinary tract infection; UTI
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2018.10.027

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. 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 (5 cm) with 30-day perioperative outcomes. 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. 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.