Oncology - Bladder, Renal, Test
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective :
Cystoscopy with transurethral resection of bladder tumor (TURBT) is fundamental to the diagnosis and staging of bladder cancer. Variability among patients, tumors, and surgeons has made it difficult to standardize care. Management of small, medium, and large tumors is largely intuitive with the belief that larger tumors warrant longer duration of an indwelling catheter and length of hospital stay. We sought to compare outcomes following TURBT of small, medium, and large tumors to determine if larger tumors truly resulted in a greater degree of complications.
The National Surgical Quality Improvement Project (NSQIP) Participant Use File (PUF) was queried to extract all TURBT cases performed from 2011-2015. CPT codes 52234 (small), 52235 (medium), and 52240 (large) were queried to stratify the data into three cohorts. Outcomes of interest included the presence of any post-surgical complications, hospital length of stay (LOS), reoperation, 30-day readmission, and mortality. ANOVA was used to detect statistical significance between continuous variables across the three cohorts and chi2 tests were used for binary variables. Linear and logistic regressions were utilized to control for potential confounders.
17,839 patients who underwent TURBT were included. 44% had small tumors (n=7,805), 35% had medium tumors (n=6,240), and 21% had large tumors (n=3,794). Univariate analysis revealed statistically significant differences in complication number, length of stay, reoperation rate, readmission at 30-days, and mortality between the three cohorts (p<0.0001). (Table 1)
In the multivariable regression models, medium and large tumors were associated with significantly greater odds of a post-operative complication (OR= 1.37 and 1.64; p<0.0001), reoperation (OR=1.33 and 1.52; p=0.019 and p=0.002), readmission at 30 days (OR=1.27 and 1.56; p=0.001 and p<0.0001), and death (OR=1.65 and 2.59; p=0.015 and p<0.0001). Large tumors were associated with a significantly longer LOS compared to small tumors, although this difference was likely clinically insignificant (0.40 days longer; p<0.0001).
Larger tumor size (>5 cm) is associated with greater length of stay, reoperation, readmission, and death following TURBT. These patients should be counseled appropriately and may warrant a longer period of observation prior to discharge.