SSAT - THE IMPORTANCE OF PROCEDURIAL INDICATION IN PREDICTING OPERATIVE TIME FOR ELECTIVE ROBOTIC COLON SURGERY

Back to 2025 Posters

THE IMPORTANCE OF PROCEDURIAL INDICATION IN PREDICTING OPERATIVE TIME FOR ELECTIVE ROBOTIC COLON SURGERY
Rachel Ma^*¹, Yosef Nasseri^1,2, Matthew P. Zeller³, Andrea P. Solis- Pazmino¹, Joseph Wetherell³, Moshe Barnajian^1,2, Marcie Feinman³, Jessica Felton³, Joshua H. Wolf³
¹Surgery Group of Los Angeles, Los Angeles, CA; ²Surgery, Cedars Sinai Medical Center, Los Angeles, CA; ³LifeBridge Health Inc, Baltimore, MD

Introduction
Robotic colon surgery (RCS) has been shown to have longer operative time (OT) compared to laparoscopic and open surgery. With increased demand for OR efficiency and streamlined hospital throughput, accurate tools for predicting robotic operative times are essential. Many hospitals rely on "historical averages" for individual surgeons to determine times for case posting. In this study we hypothesized that calculations based on CPT code alone will lead to inaccuracies, and that indication will have a significant impact on OT.

Methods
This was a retrospective study of elective RCS from the NSQIP database (2018 to 2022). Patients who had the 4 most common CPT codes and surgical indications were included in the analysis, and those who underwent emergent or multi-visceral surgery, had disseminated cancers, preoperative sepsis, or ASA>3 were excluded. CPT codes included 44204 (partial colectomy), 44205 (ileocolic resection), 44207 (partial colectomy with coloproctostomy (low)), and 44208 (partial colectomy with coloproctostomy (low) and colostomy). Top indications were cancer, benign neoplasm (BN), uncomplicated diverticulitis (UD), and complicated diverticulitis (CD). OT, defined as time between incision and closure, was evaluated for each CPT/indication combination, excluding subgroups with <50 patients. Kruskal-Wallis tests with post-hoc Bonferroni adjustment were used to compare median OT (mOT). Linear regression models, adjusted for confounders, were used to evaluate relative OTs within each CPT group.

Results
The overall cohort included 12,399 patients. Across all subgroups, the shortest mOT was 171 minutes (44205/BN) and the longest 254 min (44208/Cancer). Within CPT groups, mOTs were significantly different based on indication (p<0.001). The largest difference was in 44208, in which cancer had a mOT that was 45 minutes longer compared to UD (254 vs 209 min, p<0.001). In contrast, with the exception of cancer, mOT was statistically similar for each indication across different CPTs (Table 1). Patients with BN had the shortest mOT in 3 of the subgroups, similar for each CPT (44207/44204/44205; 174 vs. 177 vs. 171 minutes, p=0.385). Multivariate linear regression analysis found that for 44208, cancer was associated with an additional 46.2 minutes compared to UD (p<0.001) and an additional 35.2 minutes compared to BN in 44207 (p<0.001). CD was associated with 26.3 added minutes for 44207 compared to BN, and 18.5 extra minutes compared to BN in 44204 (Table 2).

Discussion
We observed that indication is strongly associated with OT, in most cases more so than the CPT itself. Cancer had longer OT compared to other indications, particularly BN and UD. Use of CPT alone to calculate historical averages, without considering indication, is not sufficient for accurate OT prediction, and can lead to OR inefficiencies and inequities in case time allocation.

Table 1. Median and ranges of operative time in minutes depending on CPT and surgical indication.

Table 2. Multivariable linear regression coefficients of the effect of indication on operative time within CPT groups.

Back to 2025 Posters