ACS- NSQIP: PROLONGED OPERATING ROOM TIME IS ASSOCIATED WITH A HIGHER RISK FOR ADVERSE POST-OPERATIVE COMPLICATIONS FOLLOWING LAPAROSCOPIC COLECTOMY
Akshay Pokala*, Beatrix H. Choi, Yuming Ning, Bo Shen
Division of Colorectal Surgery, Columbia University Irving Medical Center, New York, NY
Introduction:
Technical expertise and operative complexity likely influence operative time. Whether operative time independently influences post-operative complications after laparoscopic colectomy, has not been well researched. We evaluate whether operative time influences postoperative complications when accounting for patient, comorbidity, and disease factors.
Methods:
Patients undergoing partial colectomy with colocolonic anastomosis/ileocolonic anastomosis (CPT codes 44204/44205) from 2015-2019 were identified from ACS-NSQIP. Univariate analysis identified association and the estimated effect of demographics, comorbidities, and diagnoses with operating time. Multivariate analysis was performed including significant variables along with operative time, with postoperative complications set as dependent variables using Wald Chi-Square test.
Results:
87,492 patients, mean age was 62.5 ±14.9 years, 53% female, median body mass index (BMI) was 27.9 kg/m2, underwent the procedures for malignancy 45%, polyps/benign lesions 21.9%, diverticulitis 16.3%, inflammatory bowel disease 6.1%, functional bowel diseases 3.6%, and obstruction 1.6%. Mean operating time was 157.0 ±54.8 minutes. Preoperative factors associated with operating time on univariate analysis were age, BMI, diabetes, respiratory comorbidity, disseminated cancer, steroid use, bleeding disorders, pre-existing sepsis, wound infection, and ASA class (all p<0.0001). Complications were superficial surgical site infection (SSI) (n=1942, 2.2%), deep SSI (n= 268, 0.3%), organ space SSI (n= 2439, 2.8%), wound dehiscence (n=333, 0.4%), deep vein thrombosis (DVT) (n=621, 0.7%), pulmonary embolism (PE) (n=333, 0.4%), renal failure (n=230, 0.3%), respiratory complications (n=1042, 1.2%), myocardial infarction (MI) (n=419, 0.5%), cerebrovascular accident (n=165, 0.2%), bleeding (n=4516, 5.2%) and reoperation (n=2773, 3.2%). Multivariate analysis revealed that prolonged operating time was associated with wound dehiscence, superficial and organ space SSI, urinary tract infection (UTI), systemic septic complications, PE, DVT, MI, reoperation, and prolonged length of stay (LOS) when controlling for the other factors.
Conclusions:
Prolonged operating time during colectomy is significantly associated with septic (SSI, UTI, systemic sepsis) and thromboembolic (DVT, PE, MI) complications and prolonged LOS. Awareness of this association will help treatment planning by the perioperative team and counselling of patients who might be at risk. Since surgical technique and patient/operative complexity likely influence operating time, thorough preoperative risk stratification, judicious attention to efficiency of operative technique and compliance with the appropriate evidence-based elements of the perioperative bundle including antibiotics and thromboembolism prophylaxis might improve outcomes even in high-risk patients.
Table: Multivariate analysis of association between prolonged operating time and postoperative complications
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