In the World of Bladder Tumors: Size Does Matter

BACKGROUND: Transurethral resection of bladder tumor (TURBT) is fundamental to the diagnosis and management of bladder cancer. The impact of tumor size on perioperative outcomes is seemingly intuitive albeit incompletely defined. OBJECTIVE: To compare outcomes following TURBT of small, medium, and large tumors to determine if larger tumors truly resulted in a greater degree of complications. METHODS: The National Surgical Quality Improvement Project (NSQIP) Participant Use File (PUF) was queried to extract all TURBT cases performed from 2011-2015. CPT codes 52234 (small), 52235 (medium), and 52240 (large) were used to stratify the data into three cohorts. Outcomes of interest included any complications, hospital length of stay (LOS), reoperation within 30-days, 30-day readmission, and mortality. RESULTS: 17,839 patients who underwent TURBT were included. 44% had small (n = 7,805), 35% had medium (n = 6,240), and 21% had large tumors (n = 3,794). Univariate analysis revealed significant differences in complications, length of stay, reoperation rate, readmission at 30-days, and mortality when stratifying TURBT by tumor size (p < 0.0001). In the multivariable regression model, medium and large tumors were associated with significantly greater odds of a postoperative complication (OR = 1.37 and 1.64; p < 0.0001), reoperation (OR = 1.33 and 1.52; p = 0.019 and p = 0.002), readmission at 30-days (OR = 1.27 and 1.56; p = 0.001 and p < 0.0001), and death (OR = 1.65 and 2.59; p = 0.015 and p < 0.0001) compared to smaller tumors. CONCLUSIONS: Larger tumor size (>5 cm) is associated with greater length of stay, reoperation, readmission, and death following TURBT. Patients should be counseled appropriately and likely warrant vigilant observation prior to and following hospital discharge.