National complication and cost burden of transurethral resection of bladder tumor for bladder cancer

Background: Transurethral resection of bladder tumor (TURBT) is the gold standard for the diagnosis and treatment of bladder tumors. Although it is a widely-performed urologic surgery, the complication rate and cost burden of TURBT is poorly understood. This study aims to assess factors contributing to increased complications and healthcare cost burden of TURBT. Methods: In this population-based cohort study using Survival Epidemiology, and End Results-Medicare (SEER-Medicare) registry, patients with bladder urothelial carcinoma (UC) who underwent a TURBT between 2004 and 2015 were queried to assess post-TURBT complications and costs. Multivariable logistic regression modeling identified factors associated with 30-day complications. Multivariable linear regression models compared overall costs between patients with and without a complication. Results: In a cohort of 72,284 patients who underwent TURBT for UC, 31,459 (43.5%) of patients experienced at least one complication within 30 days. Factors associated with increased complications include male sex, larger higher grade/stage tumors, repeat TURBTs, concomitant stent placement, and post-TURBT chemotherapy. Having a complication after TURBT was significantly associated with increased overall Medicare cost after multivariable regression adjustment at 30 days ($7393 vs. $3934, P < 0.001), and at multiple time points up to 1 year. Total 30-day Medicare costs measured $207,094,382 (median cost of $2,865 per patient), of which 53% occurred in patients with complications. Conclusions: Complications after TURBT account for a significant proportion of the cost burden of bladder cancer care. A 30-day complication was associated with a 47% increase in per patient Medicare costs. Future studies are needed to reduce complications after TURBT.