Clinical and tumor-related determinants of early morbidity and prolonged hospital stay after TUR-BT

Abstract

Introduction and objectives

Transurethral resection of bladder tumor (TUR-BT) morbidity rates vary widely in the literature (4.3%–43.5%), and differences across studies reflect differences in patient populations and definitions of adverse events. We aimed to identify independent risk factors for postoperative complications and prolonged length of hospital stay (LOS) following TUR-BT.

Materials and methods

We analyzed data from 803 patients who underwent bipolar TUR-BT between 01/2012 and 10/2024. Demographic, clinical, and pathological variables were evaluated, including age, sex, ASA score, tumor size, number, morphology, grade, stage, resection status, intravesical treatment, history of prior TUR-BT, and reTUR-BT. Complications occurring within 30 days were classified according to the Clavien–Dindo system. A hospital stay exceeding the study’s median LOS (>3 days) was defined as prolonged. Logistic regression models were used to identify independent predictors of complications and prolonged LOS.

Results

Postoperative complications occurred in 10.6% of cases, most of which were low-grade (Clavien–Dindo I–II, 82.3%). Hematuria and urinary tract infections were the most common events. Independent predictors of complications included higher ASA scores (3−4) (OR = 2.075, p = 0.016), tumor multiplicity (OR = 1.878, p = 0.021), incomplete resection (OR = 2.247, p = 0.018), pT2 stage (OR = 3.188, p = 0.002), and CIS (OR = 3.476, p = 0.017). Prolonged LOS was independently associated with larger tumor size (OR = 1.009, p = 0.005), non-papillary morphology (OR = 1.903, p = 0.001), incomplete resection (OR = 1.904, p = 0.035), reTUR-BT (OR = 1.926, p = 0.001), and the presence of complications (OR = 4.777, p < 0.001).

Conclusions

TUR-BT is generally safe; however, early morbidity and prolonged hospitalization are influenced by tumor characteristics, operative factors, and patient comorbidity, informing perioperative risk stratification.