Safety of transurethral resection of bladder tumor in octogenarians: a NSQIP analysis

To compare rates of 30-day post-operative complications after transurethral resection of bladder tumors (TURBT) in octogenarians versus younger patients.

We conducted a review of the NSQIP database from 2012 to 2022. We included patients undergoing TURBT as the principal procedure, and excluded patients with disseminated cancer, pre-operative sepsis, or who were ventilator-dependent. We conducted multivariate logistic regression modeling to evaluate the association of age (≥ 80 vs. < 80 years) with 30-day post-operative complications, adjusting for confounders. We report adjusted odds ratios (aOR) and 95% confidence intervals (CI).

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 h (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). Octogenarians had greater rates of readmission for hematuria (0.7% vs. 0.5%) but not reoperation for hematuria (0.7% vs. 0.8%). Octogenarians were also more frequently readmitted for severe complications (31.8% vs. 26.3% CD grades 3-5).

Octogenarians who underwent TURBT experienced higher rates of several serious 30-day complications. While TURBT in octogenarians has a low rate of complications overall, clinicians should remain mindful of increased risk of complications for pre-operative counseling and discharge preparation.