The effect of surgical duration of transurethral resection of bladder tumors on postoperative complications: An analysis of ACS NSQIP data

Introduction: Transurethral resection of bladder tumor (TURBT) is a common procedure used in the diagnosis and treatment of bladder cancer. Despite how often it is performed, not much is known about the risk factors for complications. Traditional surgery has an increase in morbidity and mortality with increasing operative duration. We assess the effect of operative duration on TURBT complications. Methods: The years 2006 to 2012 of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were queried for patients undergoing TURBT. We separated patients into 4 groups based on operative time: 0 to 30 minutes, 30.1 to 60 minutes, 60.1 to 90 minutes, and greater than 90 minutes. Standard statistical analysis including multivariate regression was performed to determine predictors of complications. Results: A total of 10,599 TURBTs were included in our analysis. The overall complication rate for TURBT was 5.8% and there was an increase in the rate of complications seen as operative duration increased, which remained after controlling for age, comorbidities, tumor size, and American Society of Anesthesiology classification. Increased operative duration was associated with a greater risk of postoperative urinary tract infection, sepsis or septic shock, pulmonary embolism/deep venous thrombosis, reintubation or failure to wean, myocardial infarction, and death. Larger tumors were related to an increased odds of requiring blood transfusions. Conclusions: Using a contemporary multicenter cohort of TURBTs from the ACS NSQIP database, we demonstrate that increased operative duration is associated with serious postoperative complications. This association was found to persist even after adjusting for patient age, comorbidities, tumor size, and functional status.