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Underutilization of Immediate Adjuvant Intravesical Chemotherapy Following TURBT: Results from the National Surgical Quality Improvement Program (NSQIP)
Casey Kowalik, MD, Jason Gee, MD, Andrea Sorcini, MD, Alireza Moinzadeh, MD, David Canes, MD.
Lahey Hospital & Medical Center, Burlington, MA, USA.
Background: A single peri-operative dose of intravesical chemotherapy (IVC) following transurethral resection of bladder tumors (TURBT) for non-muscle invasive bladder cancer has demonstrated a reduction in recurrence. A previous study of nationwide claims data from 1997-2004 identified only 0.33% of patients received same day IVC following bladder biopsy or TURBT. In this study, we investigate whether IVC following TURBT continues to be underutilized.
Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) user files, a national prospective outcomes-based database designed to measure surgical quality of care, we identified patients with bladder cancer using ICD-9 codes 188 to 188.9. From this group, patients undergoing TURBT for small, medium, and large bladder tumors by Current Procedural Terminology (CPT) codes 52234, 52235, and 52240, respectively, were identified. We then cross-referenced this group for the CPT code 51720 to identify patients receiving concurrent intravesical therapy. Operative time, length of hospital stay, and perioperative complications were evaluated.
Results: From January 1 to December 31, 2010, 1,273 patients underwent TURBT. The median age was 73 years and 74% (n=1326) were male. Based on CPT code, there were 417 (33%) small, 486 (38%) medium, and 370 (29%) large tumors treated. Of all 1,273 patients, only 33 (2.6%) received concurrent IVC. There was no difference in average operative times (37 v. 33.mins, p=0.56) or average length of hospital stay (1.3 v 0.1 days, p=0.54) in patients receiving perioperative IVC. In the group not receiving IVC, there were 42 (3.4%) urinary tract infections, 25 (2%) incidences of bleeding requiring transfusion, and 6 (0.5%) patients with sepsis or septic shock. There was one urinary tract infection in the IVC cohort.
Conclusion: Only 2.6% of patients received concurrent IVC with TURBT. No added morbidity was observed for patients receiving IVC, although patient selection could account for low perioperative complications in this group. We also acknowledge other limitations of this data set since timing of IVC following TURBT and details regarding specific tumor characteristics and any prior TURBT procedures are not available. In addition, IVC may have been administered and not billed. Despite current guidelines, peri-operative intravesical chemotherapy following TURBT remains underutilized.
Disclosure: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
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