126 UNDERUTILIZATION OF IMMEDIATE ADJUVANT INTRAVESICAL CHEMOTHERAPY FOLLOWING TURBT: RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP)

Abstract

INTRODUCTION AND OBJECTIVES: A single peri-operative dose of intravesical chemotherapy (IVC) following transurethral resection of bladder tumors (TURBT) for non-muscle invasive bladder cancer has demonstrated a reduction in recurrence and is recommended by both the American Urological Association and European Association of Urology. A previous study of nationwide claims data from 1997-2004 identified only 0.33% of patients received same day IVC following TURBT. In this study, we investigate whether IVC following TURBT continues to be underutilized. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) user files, a national prospective outcomes-based database designed to measure surgical quality of care, we identified patients undergoing TURBT for small, medium, and large bladder tumors by Current Procedural Terminology (CPT) codes 52234, 52235, and 52240, respectively. We then crossreferenced this group for the CPT code 51720 to identify patients receiving concurrent intravesical therapy. Operative time, length of hospital stay, and perioperative complications were evaluated. RESULTS: From January 1 to December 31, 2010, 1,782 patients underwent TURBT. The median age was 73 years and 74% (n 1326) were male. Based on CPT code, there were 668 (37%) small, 650 (36%) medium, and 464 (26%) large tumors treated. The majority of patients had general anesthesia (84%) and were treated as outpatients (81%). Of all 1,782 patients, only 36 (2%) received concurrent IVC. There was no difference in average operative times (36.8 v. 33.3 mins, p 0.584) or average length of hospital stay (1.5 v 0.3 days, p 0.538) in patients receiving perioperative IVC. In the group not receiving IVC, there were 64 (3.75%) urinary tract infections, 37 (2.1%) incidences of bleeding requiring transfusion, and 10 (0.5%) patients with sepsis or septic shock. There were no reported peri-operative complications in the IVC cohort. CONCLUSIONS: Only 2% of patients received concurrent IVC with TURBT. No added morbidity was observed for patients receiving IVC, although patient selection could account for low perioperative complications in this group. We also acknowledge other limitations of this data set since timing of IVC following TURBT and details regarding specific tumor characteristics and any prior TURBT procedures are not available. In addition, IVC may have been administered and not billed. Despite current recommendations, peri-operative intravesical chemotherapy following TURBT remains underutilized.