Routine preoperative group and save for TURP and TURBT – need and cost effectiveness

2017 ◽  
Vol 11 (1) ◽  
pp. 33-37
Author(s):  
Hazel Smith ◽  
Rachel Falconer ◽  
Justyna Szczachor ◽  
Sarfraz Ahmad
Keyword(s):  
Risk Factors ◽  
Cost Effectiveness ◽  
Blood Transfusion ◽  
Transurethral Resection ◽  
Bladder Tumour ◽  
Transurethral Resection Of Prostate ◽  
Junior Doctors ◽  
Two Samples ◽  
Muscle Invasive ◽  
One Year

Introduction: Standard practice in our unit is to take a group and save (G+S) blood sample for all patients undergoing a transurethral resection of prostate (TURP) and transurethral resection of bladder tumour (TURBT). Modern studies show the transfusion rates for TURP are 2%–7% and for TURBT 2%. Aims: We will determine how many patients undergoing TURP and TURBT required blood transfusion, analyse the indication, timing and risk factors. Additionally we will assess the cost effectiveness of routine G+S. Methods: A retrospective analysis was conducted between 1 March 2015 and 29 February 2016 (one year). Patients were identified from OPERA database and cross-referenced with blood transfusion records. Electronic case notes for patients receiving transfusions were reviewed. Results: A total of 167 patients underwent TURP. Of these, 0.6% (1/167) received transfusion on day 4 post-op. A total of 160 patients underwent TURBT. Overall 3.8% (6/160) received transfusion: three patients on days 0–1 and three patients on days 2–30. All patients had pre-op Hb <100 g/l. All had large muscle-invasive tumours. Cost in our lab of a G+S sample is £23.52. Two samples are now required before blood can be issued. Discussion: Our study shows that risk factors for transfusion are large prostates, likely muscle-invasive bladder tumours and pre-op Hb <100 g/l. Other risks include coagulopathy. These will usually be identified by the surgeon or pre-assessment clinic prior to the procedure. Change in policy would save money and time of phlebotomists and junior doctors. Conclusions: Routine G+S is not necessary for all patients. Patients with risk factors can be identified preoperatively. This would give a potential saving of over £15,000 per year. This can be implemented without adversely affecting patient safety.

scholarly journals A prospective observational study to evaluate the role of restaging transurethral resection of bladder tumour in patients with non-muscle invasive bladder cancer

2019 ◽  
Vol 7 (11) ◽  
pp. 4134
Author(s):  
Kishan K. Raj ◽  
Yogesh Taneja ◽  
Prateek Ramdev ◽  
Santosh K. Dhaked ◽  
Charan K. Singh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transurethral Resection ◽  
Prospective Observational Study ◽  
Residual Disease ◽  
Bladder Tumour ◽  
Detrusor Muscle ◽  
Residual Tumour ◽  
Muscle Invasive Bladder Cancer ◽  
T1 Stage ◽  
Muscle Invasive

Background: Transurethral resection of bladder tumour (TURBT) is the primary treatment modality for Non-muscle invasive bladder cancer (NMIBC). Restaging transurethral resection of bladder tumour (RETURBT) is indicated to reduce risk of residual disease and correct staging errors after primary TURBT. The aim of the study is to evaluate the risk of residual tumour and upstaging in NMIBC after TURBT and to investigate the risk factors for the same.Methods: A prospective observational study was carried out over 4 years and 87 patients were included in the study. Patients with NMIBC underwent RETURBT after 2-6 weeks of primary TURBT. The incidence of residual tumour and upstaging in RETUBRT was correlated with various histopathological and morphological parameters in primary TURBT.Results: Out of 87 patients, who underwent RETURBT, residual disease was present in 51 patients (58.6%) and upstaging occurred in 22 patients (25.2%).On univariate analysis, T1 stage (p=0.01), high grade (p=0.01), Carcinoma in situ(CIS) (p=0.01) and multifocality (p=0.05) were predictive for residual disease in RETURBT. High grade (p=0.01), CIS (p=0.01) and absence of detrusor muscle in specimen (p=0.03) were risk factors for upstaging in RETURBT.Conclusions: NMIBC have high incidence of residual disease and upstaging after primary TURBT. T1 stage, high tumour grade, CIS, and multifocality are risk factors for residual disease after primary TURBT. High tumour grade, CIS and absence of detrusor muscle are strongly associated with upstaging during RETURBT.

scholarly journals Evaluation of Second-Look Transurethral Resection in Re-Staging of Patients With Superficial Bladder Cancer

2020 ◽  
Vol 18 (1) ◽  
pp. 16-22
Author(s):  
Md Masud Zaman ◽  
Md Sajid Hasan ◽  
Golam Mowla Chowdhury ◽  
Md Shafiqur Rahman ◽  
AKM Mahbubur Rahman
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Transurethral Resection ◽  
Treatment Strategy ◽  
Superficial Bladder Cancer ◽  
Bladder Tumour ◽  
Malignant Tissue ◽  
Second Look ◽  
Muscle Invasive ◽  
Initial Resection

Objective: The Objective of this study was to evaluate the second-look transurethral resection (TUR) from the base of the previously resected bladder tumour in avoidance of staging errors, possibility of changing treatment strategy, and determination of risk factors of up-staging in patients with a diagnosis of superficial bladder cancer. Materials and Methods: In this cross sectional study, 50 cases of superficial bladder cancers (pTa and pT1) were included where muscle coat were absent in histopathologic report of first TURBT. A second-look TUR from the tumour site were done after 4 weeks following the initial resection. At the second-look TUR, resection from the base of the previously resected area was performed for restaging. Finally, histopathologic findings of the second TURBT were compared with those of the initial one by appropriate statistical analysis. Results: Out of 50 patients, 27 (54%) had residual malignant tissue in histopathological report of second-look TUR, while 23 (46%) were tumour free (no residual malignant tissue) at second-look TUR. In this study, total up-staging of tumour found in 18 (36%) patients. Out of them, 6 (12%) and 2(4%) patients were up-staged from pTa to pT1 and PT2 respectively. 10 (20%) were up-staged from PT1 to muscle-invasive (pT2). So, total percentage of staging errors (under staging) detected in second-look TUR was 36% cases. Appearance (sessile), size (>3 cm) and stage (pT1) of the tumour at the initial resection were independent risk factors for up-staging to muscle invasive disease detected at second-look TURBT. Conclusions: Second-look TURBT is a valuable procedure for detection of residual tumour and accurate staging of non-muscle invasive bladder tumour. It also changed the treatment strategy of a significant proportion of patients. It is useful for tumours at high risk of recurrence and progression such as large size, sessile, multiple and T1 high grade tumours, particularly when there is inadequate or no muscularis propria in the specimen. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.16-22

scholarly journals Cost‑effectiveness analysis of hexaminolevulinate (Hexvix®) guided cystoscopy in Non‑Muscle Invasive Bladder Cancer patients (NMIBC) in Italy

2014 ◽  
Vol 15 (3) ◽  
Author(s):  
Craig Bennison ◽  
Stephanie Stephens ◽  
Giario Natale Conti
Keyword(s):  
Bladder Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Bladder Tumour ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Invasive Bladder Cancer ◽  
Base Case ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

OBJECTIVE: To estimate the incremental cost‑effectiveness of hexaminolevulinate (Hexvix®) + Blue Light (H+BL) cystoscopy (compared to white light cystoscopy only) when used at initial transurethral resection of the bladder tumour (TURBT) for patients diagnosed with non‑muscle invasive bladder cancer (NMIBC) in Italy.METHODS: A cost‑effectiveness model has been developed to estimate the incremental cost‑effectiveness of introducing H+BL at initial TURBT for patients diagnosed with NMIBC in Italy. The model consists of two parts: 1) a short term decision tree which estimates the outcome of the initial diagnostic procedure, and 2) a Markov cohort model which is used to estimate long term outcomes through extrapolation based on data and assumptions about patient management, the natural history of the disease and the empirical efficacy of H+BL in improving diagnosis detection and reducing recurrence. Cost‑effectiveness results are expressed as incremental costs per QALY gained. Univariate and probabilistic sensitivity analyses are conducted to test the robustness of the model to changes in inputs and assumptions.RESULTS: Base case results suggest that Hexvix® is a dominant strategy when used in the resection of NMIBC. Hexvix® is expected to be associated with 0.070 incremental QALYs, with cost savings of € 435 per patient. Sensitivity analyses suggest that the cost of Hexvix® and the relative risk of recurrence in intermediate and low risk groups are key drivers in the model. Probabilistic analyses indicate that Hexvix® is expected to be cost‑effective in >99% of iterations, assuming a willingness to pay threshold of € 25,000 per QALY.CONCLUSION: In conclusion, Hexvix® is expected to be a cost‑effective strategy when used in the resection of NMIBC in Italy. 

scholarly journals Predicting peripartum blood transfusion: focusing on pre-pregnancy characteristics

2019 ◽  
Author(s):  
Yung-Taek Ouh ◽  
Kyu-Min Lee ◽  
Ki Hoon Ahn ◽  
Soon-Cheol Hong ◽  
Min-Jeong Oh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Waist Circumference ◽  
Blood Transfusion ◽  
National Health ◽  
Screening Program ◽  
Health Screening ◽  
Current Smoker ◽  
Pregnancy Risk ◽  
Maternal Hypertension ◽  
One Year

Abstract Obstetric hemorrhage is one of the most common causes of obstetrical morbidity and mortality, and transfusion is the most important management for hemorrhage. The aim of our study was to investigate the pre-pregnancy and pregnancy risk factors for peripartum transfusion. Methods: Women who delivered a baby from 2010 to 2014 and participated in the National Health Screening Program for Infants and Children were included. To analyze pre-pregnant risk factors for peripartum transfusion, an additional analysis was done for women who underwent a National Health Screening Examination within one year before pregnancy, including maternal waist circumference, body mass index, blood pressure, laboratory tests and history of smoking. Results: Of the total 1,980,126 women who met the inclusion criteria, 36,868 (1.86%) were transfused at peripartum. In a multivariable regression model, the pregnancy risk factors for peripartum transfusion included maternal age above 35 years [odds ratio (OR): 1.41; 95% confidence interval (CI): 1.32–1.50], preterm birth (OR: 2.39; 95% CI: 2.15–2.65), and maternal hypertension (OR: 2.49; 95% CI: 2.24–2.77). Pre-pregnancy risk factors including fasting glucose level of more than 126 mg/dL (OR: 1.11; 95% CI: 1.02–1.20), current-smoker status (OR: 1.20; 95% CI: 1.06–1.37), and waist-circumference less than 80 cm (OR: 1.18; 95% CI: 1.06–1.30) were independently associated with peripartum blood transfusion. Conclusions: Several pre-pregnancy and pregnancy risk factors were associated with peripartum blood transfusion. Some identified factors are modifiable before conception, and our study validated peripartum blood transfusion as a form of triage. Keywords: Peripartum, Blood transfusion, Postpartum hemorrhage

scholarly journals Perioperative risk factors predict one-year mortality in patients with acute type-A aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yanwei Yang ◽  
Jiayi Xue ◽  
Huixian Li ◽  
Jiaqi Tong ◽  
Mu Jin
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Aortic Dissection ◽  
Serum Creatinine ◽  
Type A ◽  
Perioperative Risk ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Perioperative Risk Factors ◽  
One Year

Abstract Objective The goal of this study was to analyze perioperative risk factors to predict one- year mortality after operation for acute type A aortic dissection (AAD). Methods A total of 121 consecutive patients undergoing Stanford type A AAD surgery in Beijing Anzhen Hospital were enrolled. Preoperative clinical and laboratory data from patients were collected. Results Multivariable Cox regression analysis showed that significant factors associated with increased one-year mortality were elder age (year) (hazard ratio (HR) 1.0985; 95% confidence interval (CI) 1.0334–1.1677), intraoperative blood transfusion ≥2000 mL (HR 8.8081; 95% CI 2.3319–33.2709), a higher level of serum creatinine (μmol/L) at postoperative one day (HR 1.0122; 95% CI 1.0035–1.0190) and oxygenation index (OI) < 200 (mmHg) at the end of surgery (HR 5.7575; 95% CI 1.1695–28.3458). Conclusion In this study, perioperative risk factors to predict one-year prognosis are age, intraoperative blood transfusion ≥2000 mL, postoperative OI < 200 mmHg and level of postoperative serum creatinine. The results aid in the comprehension of surgical outcomes and assist in the optimization of treatment strategies for those with perioperative risk factors to decrease one-year mortality.

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