Jorge Francisco Pereira1, Gyan Pareek2, Catrina Mueller-Leonhard3, Zheng Zhang4, Ali Amin5, Anthony Mega6, Christopher Tucci7, Dragan Golijanin2, Boris Gershman8. 1. Columbia University Division of Urology, Mount Sinai Medical Center, Miami Beach, FL. 2. Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI. 3. Lifespan Oncology Clinical Research, The Miriam Hospital, Providence, RI. 4. Department of Biostatistics, Brown University, Providence, RI. 5. Department of Pathology and Laboratory Medicine, The Miriam Hospital, Providence, RI. 6. Department of Hematology/Oncology, The Miriam Hospital, Providence, RI. 7. Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI. 8. Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI. Electronic address: Boris.Gershman@lifespan.org.
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.
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.
Authors: K Kent Chevli; Neal D Shore; Andrew Trainer; Angela B Smith; Daniel Saltzstein; Yaron Ehrlich; Jay D Raman; Boris Friedman; Richard D'Anna; David Morris; Brian Hu; Mark Tyson; Alexander Sankin; Max Kates; Jennifer Linehan; Douglas Scherr; Steven Kester; Michael Verni; Karim Chamie; Lawrence Karsh; Arnold Cinman; Andrew Meads; Soumi Lahiri; Madlen Malinowski; Nimrod Gabai; Sunil Raju; Mark Schoenberg; Elyse Seltzer; William C Huang Journal: J Urol Date: 2021-08-26 Impact factor: 7.450
Authors: Beth Russell; Christel Häggström; Lars Holmberg; Fredrik Liedberg; Truls Gårdmark; Richard T Bryan; Pardeep Kumar; Mieke Van Hemelrijck Journal: BJUI Compass Date: 2021-01-07