Category: Epidemiology, Health Policy, Socioeconomics & Outcomes

MP28-16 - Predicting Factors Of Unexpected Hospital Return Following Transurethral Resection Of Bladder Tumor

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective : Transurethral resection of bladder tumor (TURBT) is the basis of diagnosis and management of bladder cancer. The aims of our study were to evaluate which factors were associated with unexpected hospital return (UHR) following TURBT and which good clinical practice measures could be implemented to avoid it.


Methods : An exploratory cross-sectional study of all programmed TURBTs at a tertiary institution between January/2015 and December/2016 was performed. Patients who died during the hospitalization were excluded from the study. Demographics, comorbidities, duration of surgery, length of hospital stay, duration of urethral catheterization (UC), use of postoperative antibiotics, tumor related factors and patient’s analytical data were recorded. UHR was recorded within 30 days of surgery. Univariate and multivariable analyses were performed to determine factors associated with UHR – SPSS®21.0.


Results : A total of 499 TURBTs were performed in 389 patients, 72.5% males. The average age was 71.4 years. Within 30 days of surgery, there was an UHR in 84 cases (16.8%), 4.2% demanding a hospital readmission. UHR occured mainly because of urinary tract infection (UTI) (38.1%), hematuria (26.2%) and acute urinary retention (14.3%). There was a significantly increased UHR in cases of primary tumour (p=0.025), larger tumor size (p=0.004), incomplete tumour resection (p=0.049) and need for additional endoscopic procedures (p=0.002). A higher surgery time (p<0.001) and a longer urethral catheterization (p=0.001) were significantly related to an increased UHR. Higher values of preoperative c-reactive protein (CRP) (p=0.03) and lower preoperative hemoglobina (p=0.03) also showed a significant association with an increased URH. In a multivariate logistic regression analysis, we found a strong association between UHR and 3 variables: length of surgery (OR=1.016; [1.002-1.030], 95% CI), duration of urethral catheterization (OR=1.059; [1.001-1.122], 95% CI) and preoperative CRP (OR=1.131; [1.027-1.246], 95% CI).


Conclusions : Early UHR after programmed TURBT occurs in almost 17% of cases, mainly because of UTI. Analysing our multivariate model we can find that for each additional minute of surgery, each additional day of UC and each additional unit (mg/dL) of preoperative CRP, there is an increased risk of UHR in 1.6%, 5.9% and 13.1% respectively. In conclusion, as CRP value isn’t a modifiable variable, it’s up to the surgeon to optimize the operative time and mainly the length of UC in order to reduce the probability of UHR.

Miguel Eliseu

Urology Resident
Coimbra Hospital and University Centre
Coimbra, Coimbra, Portugal

Vera Marques

Coimbra Hospital and University Centre
Coimbra, Coimbra, Portugal

Edgar Tavares-Da-Silva

Coimbra Hospital and University Centre
Coimbra, Coimbra, Portugal

Francisco Rolo

Coimbra, Coimbra, Portugal

Arnaldo Figueiredo

Coimbra Hospital and University Centre
Coimbra, Coimbra, Portugal