BACKGROUND: Risk factors for adverse outcomes after transurethral resection of bladder tumors (TURBT) have not been identified to date. Such information would facilitate preoperative risk stratification and case-mix-adjusted outcome comparison, and lead to the development of processes of care directed at improving outcomes and ultimately the quality of care for bladder carcinoma patients. METHODS: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. Since 1991, a total of 21,515 TURBTs have been prospectively registered by the NSQIP; these cases compose the current study population. Using multivariable logistic regression, the authors determined the independent association between preoperative patient risk factors and perioperative elements of structure/process and morbidity, mortality, and prolonged length of stay (LOS) outcomes. RESULTS: The postoperative complication, 30-day, and 90-day mortality rates were 4.3%, 1.3%, and 3.3%, respectively. The median, 75th percentile, and 90th percentile for LOS among patients undergoing TURBT was 2 days, 3 days, and 8 days, respectively. Robust preoperative patient risk factors that were found to be uniformly associated with all adverse outcomes included the presence of disseminated disease (odds ratio [OR], 1.9-5.2) weight loss (OR, 1.8-3.8), low serum albumin (OR, 2.3-7.1), elevated serum creatinine (OR, 1.3-2.9), a dependent functional status (OR, 1.5-2.7), and emergent case status (OR, 1.8-3.1). Compared with models using preoperative patient factors alone, models including perioperative structure and process measures explained further variation in surgical outcomes (each likelihood ratio test, P < .0001). CONCLUSIONS: The findings of the current study highlight the fact that there are a wide array of patient risk factors that are associated with adverse outcomes after TURBT. Validation of those processes implemented to modify such elements can provide a basis for quality metrics in the context of TURBT. Copyright 2006 American Cancer Society.
BACKGROUND: Risk factors for adverse outcomes after transurethral resection of bladder tumors (TURBT) have not been identified to date. Such information would facilitate preoperative risk stratification and case-mix-adjusted outcome comparison, and lead to the development of processes of care directed at improving outcomes and ultimately the quality of care for bladder carcinomapatients. METHODS: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. Since 1991, a total of 21,515 TURBTs have been prospectively registered by the NSQIP; these cases compose the current study population. Using multivariable logistic regression, the authors determined the independent association between preoperative patient risk factors and perioperative elements of structure/process and morbidity, mortality, and prolonged length of stay (LOS) outcomes. RESULTS: The postoperative complication, 30-day, and 90-day mortality rates were 4.3%, 1.3%, and 3.3%, respectively. The median, 75th percentile, and 90th percentile for LOS among patients undergoing TURBT was 2 days, 3 days, and 8 days, respectively. Robust preoperative patient risk factors that were found to be uniformly associated with all adverse outcomes included the presence of disseminated disease (odds ratio [OR], 1.9-5.2) weight loss (OR, 1.8-3.8), low serum albumin (OR, 2.3-7.1), elevated serum creatinine (OR, 1.3-2.9), a dependent functional status (OR, 1.5-2.7), and emergent case status (OR, 1.8-3.1). Compared with models using preoperative patient factors alone, models including perioperative structure and process measures explained further variation in surgical outcomes (each likelihood ratio test, P < .0001). CONCLUSIONS: The findings of the current study highlight the fact that there are a wide array of patient risk factors that are associated with adverse outcomes after TURBT. Validation of those processes implemented to modify such elements can provide a basis for quality metrics in the context of TURBT. Copyright 2006 American Cancer Society.
Authors: Jorge Panach-Navarrete; Lorena Valls-González; Eduardo Sánchez-Cano; María Medina-González; Ana Castelló-Porcar; José María Martínez-Jabaloyas Journal: Can Urol Assoc J Date: 2018-06-08 Impact factor: 1.862
Authors: Raj Satkunasivam; Christopher J D Wallis; James Byrne; Azik Hoffman; Douglas C Cheung; Girish S Kulkarni; Avery B Nathens; Robert K Nam Journal: Can Urol Assoc J Date: 2016 Nov-Dec Impact factor: 1.862
Authors: Florian R Schroeck; Kristine E Lynch; Zhongze Li; Todd A MacKenzie; David S Han; John D Seigne; Douglas J Robertson; Brenda Sirovich; Philip P Goodney Journal: Cancer Date: 2019-05-23 Impact factor: 6.860
Authors: Yue Zhang; Fei Li; Fan Yang; Wen-Li Zeng; Hao Lin; Qi-Liang Zhai; Ming-Qiang Su; Zi-Hao Chen; Wan-Long Tan Journal: Nan Fang Yi Ke Da Xue Xue Bao Date: 2018-02-20
Authors: Hiten D Patel; Mark W Ball; Jason E Cohen; Max Kates; Phillip M Pierorazio; Mohamad E Allaf Journal: Urology Date: 2015-03 Impact factor: 2.649
Authors: Michael A Avallone; Bryan S Sack; Ahmad El-Arabi; David K Charles; William R Herre; Andrew C Radtke; Carley M Davis; William A See Journal: J Endourol Date: 2017-06-29 Impact factor: 2.942