Impact of CKD on perioperative outcomes following TURBT: a national NSQIP analysis.

INTRODUCTION

Transurethral resection of bladder tumor (TURBT) is fundamental to the diagnosis and management of bladder cancer and is generally regarded as a low-risk procedure. However, chronic kidney disease (CKD) is common in this population and may increase perioperative morbidity. The impact of baseline renal function on short-term outcomes following TURBT has not been well characterized.

METHODS

We performed a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Adult patients undergoing TURBT were identified using CPT codes 52,234, 52,235, and 52,240. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 equation and categorized as G1 (eGFR ≥ 90 mL/min/1.73 m²), G2-G3 (eGFR 30-89 mL/min/1.73 m²), and G4-G5 (eGFR ≤ 29 mL/min/1.73 m²). Multivariable logistic and linear regression models assessed associations between eGFR category and 30-day postoperative complications, readmission, length of stay, and operative time, adjusting for demographics, comorbidities, functional status, and procedural complexity.

RESULTS

A total of 52,516 patients were included, of whom 18.4% were in G1, 76.4% G2-G3, and 5.2% G4-G5 kidney function group. After multivariable adjustment, patients with G2-G3 CKD were not independently associated with more adverse perioperative outcomes. In contrast, patients in G4-G5 had significantly increased odds of postoperative renal insufficiency (OR 3.38), renal failure (OR 3.54), urinary tract infection (OR 1.87), sepsis (OR 2.97), myocardial infarction (OR 4.07), postoperative bleeding (OR 2.91), and 30-day readmission (OR 1.75). they were also associated with longer operative time and prolonged hospital length of stay. Increased procedural complexity further amplified these risks.

CONCLUSIONS

Severe chronic kidney disease is an independent predictor of increased perioperative morbidity following TURBT, whereas mild-to-moderate CKD does not substantially increase short-term risk. Incorporation of eGFR-based risk stratification into preoperative assessment may improve perioperative planning, patient counseling, and postoperative outcomes in patients undergoing TURBT.