Bhojani, Naeem

Abstract Purpose We compared perioperative morbidity after repeat transurethral resection (re-TURP) versus primary TURP, focusing on transfusion and broader bleeding-related complications relevant to counseling and risk stratification. Methods We analyzed the American College of Surgeons National Surgical Quality Improvement Program (2013–2023) to identify men undergoing primary TURP (Current Procedural Terminology [CPT] 52601) or re-TURP (CPT 52630). The primary outcome was 30-day red blood cell transfusion. Secondary outcomes included a prespecified postoperative hematuria endpoint based on ICD-10 codes. Multivariable logistic regression evaluated associations with bleeding endpoints and downstream complications. Results Among 83,539 TURP procedures, 76,983 (92.2%) were primary and 6,556 (7.8%) were repeat. Re-TURP patients were older, had higher ASA class, and more often underwent urgent surgery. Transfusion occurred in 1.9% after re-TURP versus 1.5% after primary TURP; hematuria-coded events occurred in 3.5% versus 1.3%, respectively. After adjustment, re-TURP was associated with postoperative hematuria (adjusted odds ratio [aOR] 2.42, 95% CI 2.03–2.88) but not with transfusion (aOR 1.09, 95% CI 0.87–1.36). Older age, urgent/emergent status, bleeding disorder, and lower hematocrit predicted both bleeding endpoints. Re-TURP was associated with slightly lower odds of readmission (aOR 0.87; 95% CI 0.76–0.99) and was not associated with return to the operating room. Transfusion strongly predicted return to the operating room (aOR 7.21) and readmission (aOR 2.05), whereas hematuria predicted return to the operating room only (aOR 1.50). Conclusions Compared with primary TURP, re-TURP was associated with more hematuria-coded events but not higher adjusted transfusion risk, suggesting a relative shift toward lower-severity bleeding morbidity.