Pereira Jorge Francisco, Pareek Gyan, Mueller-Leonhard Catrina, Zhang Zheng, Amin Ali, Mega Anthony, Tucci Christopher, Golijanin Dragan, Gershman Boris
Columbia University Division of Urology, Mount Sinai Medical Center, Miami Beach, FL.
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.
Urology. 2019 Mar;125:131-137. doi: 10.1016/j.urology.2018.10.027. Epub 2018 Oct 23.
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 (<2 cm, 2-5 cm, or >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.
描述经尿道膀胱肿瘤切除术（TURBT）的围手术期发病率，以确定膀胱癌护理质量和成本的重要决定因素。
我们在国家外科质量改进计划数据库中识别出2010年至2015年间接受TURBT的24100例年龄在18 - 89岁的患者。进行多变量逻辑回归分析，以评估患者特征和肿瘤大小（<2 cm、2 - 5 cm或>5 cm）与30天围手术期结局的关联。
5.1%的患者发生30天术后并发症，1.5%的患者接受围手术期输血，3.7%的患者再次入院，1.5%的患者再次手术，0.8%的患者死亡。再次入院的最常见原因是出血（29%）和感染（21%）并发症。尽管在多变量分析中，包括充血性心力衰竭、肾衰竭、较高的美国麻醉医师协会分级和依赖性功能状态等几个患者特征与围手术期发病率增加相关，但只有较大的肿瘤大小与所有围手术期终点风险增加独立相关。
TURBT后的围手术期发病率较高，是质量改进的重要目标。切除范围、患者功能状态和特定合并症与围手术期发病率和死亡率风险增加独立相关。这些结果对患者咨询、围手术期管理和质量改进计划具有启示意义。
