Data examined by the Getting It Right First Time (GIRFT) programme suggests that patients undergoing bladder tumour resection surgery as a day case have at least as good HES-reported outcomes as those having an overnight stay.
The findings have been published in the Journal of Clinical Urology following a study of 2017/18 data for all NHS transurethral resection of bladder tumour (TURBT) surgery. The study compared outcomes of day-case surgery alongside outcomes for patients who stayed more than one night in hospital for a TURBT procedure.
The study was undertaken by GIRFT’s senior research associate William K Gray, pictured left, working with GIRFT’s urology clinical lead Simon Harrison, pictured right, who authored GIRFT’s national report on urology services in England. They were supported by the programme’s Chief Information Officer Jamie Day, and GIRFT chair Professor Tim Briggs.
They found that of the 19,387 TURBT procedures carried out across 143 NHS trusts in England, just 17.9% were performed as day-case surgery. There was significant variation across NHS trusts with regard to the percentage of patients who underwent a TURBT procedure as day-case surgery. Of the 128 trusts that performed more than ten procedures during 2017/18 almost one third performed 90% of TURBT procedures with an overnight stay.
At a trust level, there was no association between day-case surgery rates and outcomes. Yet at a patient level, outcomes were significantly better for those undergoing day-case surgery after adjustment for the effects of age, gender, frailty and comorbidity.
The study supports GIRFT’s recommendation, published in its urology national report in July 2018, to increase day surgery rates in line with the view of the British Association of Day Surgery (BADS) that trusts could be more ambitious in delivering TURBT procedures as day surgery.
TURBT is one of the procedures which BADS includes in a category of operations that could be conducted as day surgery in up to 60% of cases. Historically, many urologists have regarded the BADS assessment of day surgery opportunities as somewhat aspirational. However, the GIRFT national report takes the view that it is reasonable for trusts to aim to meet such a target, given that the BADS recommendations are based on day case rates that are already being achieved by 5% of UK trusts.
The TURBT study acknowledges that many patients will be deemed clinically unsuitable for day-case surgery, but concludes that the extensive variation in rates of day surgery suggests greater scope for increasing the use of day-case surgery for TURBT with evidence to suggest that hospital readmission and mortality rates for patients undergoing TURBT as day-case surgery are at least as good as for those who have an overnight stay.
The Journal of Clinical Urology is the official publication of the British Association of Urological Surgeons. Members can read the study Transurethral resection of bladder tumour as a day-case surgery: Evidence of effectiveness from the UK Getting it Right First Time (GIRFT) programme at: https://www.baus.org.uk/about/journals/jcu.aspx
To read the GIRFT Urology National Report click here