title: Risk factors for adverse outcomes after transurethral resection of bladder tumors.
abstract: BACKGROUND
  Risk factors for adverse outcomes after transurethral resection of bladder tumors (TURBT) have not been identified to date. Such information would facilitate preoperative risk stratification and case-mix-adjusted outcome comparison, and lead to the development of processes of care directed at improving outcomes and ultimately the quality of care for bladder carcinoma patients.
  
  
  METHODS
  The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. Since 1991, a total of 21,515 TURBTs have been prospectively registered by the NSQIP; these cases compose the current study population. Using multivariable logistic regression, the authors determined the independent association between preoperative patient risk factors and perioperative elements of structure/process and morbidity, mortality, and prolonged length of stay (LOS) outcomes.
  
  
  RESULTS
  The postoperative complication, 30-day, and 90-day mortality rates were 4.3%, 1.3%, and 3.3%, respectively. The median, 75th percentile, and 90th percentile for LOS among patients undergoing TURBT was 2 days, 3 days, and 8 days, respectively. Robust preoperative patient risk factors that were found to be uniformly associated with all adverse outcomes included the presence of disseminated disease (odds ratio [OR], 1.9-5.2) weight loss (OR, 1.8-3.8), low serum albumin (OR, 2.3-7.1), elevated serum creatinine (OR, 1.3-2.9), a dependent functional status (OR, 1.5-2.7), and emergent case status (OR, 1.8-3.1). Compared with models using preoperative patient factors alone, models including perioperative structure and process measures explained further variation in surgical outcomes (each likelihood ratio test, P < .0001).
  
  
  CONCLUSIONS
  The findings of the current study highlight the fact that there are a wide array of patient risk factors that are associated with adverse outcomes after TURBT. Validation of those processes implemented to modify such elements can provide a basis for quality metrics in the context of TURBT.
authors.affiliation: Department of Urology, The University of Michigan, Ann Arbor, 48109, USA. bhollen@umich.edu
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: David
authors.initials: D
authors.lastname: Taub
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Shukri F
authors.initials: SF
authors.lastname: Khuri
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.forename: Willie
authors.initials: W
authors.lastname: Underwood
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects* / Q000401:mortality; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009017:Morbidity; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D014521:Urethra / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*