Wymer, Kevin

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.

Introduction: The Revised Cardiac Risk Index (RCRI) and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) are well-recognized tools to predict 30-day postoperative cardiac events in noncardiac surgeries. However, their predictive accuracy is yet to be assessed in minimally invasive transurethral prostate surgery. We compared the RCRI- and NSQIP-predicted postoperative cardiac outcomes with the actual incidence of cardiac events after transurethral prostate surgery. Methods: We conducted a retrospective review of patients who underwent transurethral prostate surgery between July and December of 2022. We assessed for postoperative cardiac events within 30 days, as defined by the seminal cardiac VISION study. The RCRI and NSQIP cardiac event predictions were calculated. Fisher’s exact test was used for analysis. Results: We included 185 patients with an average age of 73 ± 8.4 (standard deviation) years, 86 of whom (46%) had transurethral resection of the prostate, and 99 underwent Holmium Laser Enucleation of the Prostate (54%). Myocardial injury after noncardiac surgery surveillance was needed for 34 patients (18.4%) as per standard practice. No patient had any intraoperative cardiac events. One patient experienced a nonfatal postoperative cardiac event (asystole) within hours of surgery. The 30-day cardiac event prediction by the RCRI was 4.8% of the patient cohort ( n ≈ 9), significantly higher than the observed incidence of 0.5% ( p = 0.0198). NSQIP predicted that 0.54% of the patient cohort ( n = 1) will have a cardiac complication within 30 days, which is not significantly different from the observed cardiac event incidence ( p = 1). Conclusion: The RCRI significantly overestimated the 30-day cardiac risk after transurethral prostate surgery, whereas NSQIP predictions and the observed rate of cardiac events were similar. Utilizing more representative predictive tools helps improve risk stratification and will allow patients and surgeons to make better-informed decisions.