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Safety of Transurethral Resection of Bladder Tumor in Octogenarians: A NSQIP Analysis
Jonathan J. Song, BA1, Maya T. Zhou, BS
1, James McAndrew Jones, III, MD
2, Samuel Z. Lee, BA
1, Mark H. Katz, MD
2, David S. Wang, MD
2.
1Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA,
2Boston Medical Center, Boston, MA, USA.
BACKGROUND:Even for procedures conventionally considered low risk in the general population, caution should be exercised in older adults due to potentially increased morbidity. Little research currently exists investigating the comparative safety of transurethral resection of bladder tumors (
TURBT) in patients over 80 despite the high prevalence of this subgroup. We aimed to compare rates of post-operative complications after TURBT in octogenarians versus in younger patients.
METHODS:We conducted a review of the American College of Surgeons (
ACS) National Surgical Quality Improvement Program (
NSQIP) database from 2012-2022. All reports of TURBT as the principal procedure were included. We conducted multivariate logistic regression to evaluate the association of age (≥80 vs <80 year-old) with complications, adjusting for confounders. We report adjusted odds ratios (aOR) and 95% confidence intervals (
CI).
RESULTS:We identified 78,665 reports of TURBT, of which 21,627 (27.5%) were performed on patients aged ≥80. In multivariate analysis, age ≥80 was significantly associated with septic shock (aOR 2.29; 95% CI 1.44-3.66), receipt of blood transfusion ≤72 hours (aOR 1.42; 95% CI 1.20-1.67), prolonged post-operative stay ≥1 day (aOR 1.50; 95% CI 1.43-1.57), unplanned related readmission (aOR 1.26; 95% CI 1.15-1.38), and death (aOR 2.74; 95% CI 2.15-3.52). Age ≥80 was not associated with post-operative UTI, sepsis, DVT, PE, or unplanned related reoperation. By contrast, age ≥80 was protective against prolonged operation time (aOR 0.87; 95% CI 0.79-0.96). Octogenarians had greater rates of readmission and reoperation for hematuria (198 [0.9%] vs 364 [0.6%]) in univariate analysis.
CONCLUSIONS:Octogenarians who underwent TURBT experienced higher rates of several 30-day complications, including the risk of septic shock, blood transfusion, prolonged post-operative stay, unplanned related readmission, and death. While TURBT in octogenarians has a low incidence of complications overall, clinicians should remain mindful of increased risk of complications while counseling pre-operatively and preparing for discharge.
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