G. Ortega1, N. Bhulani1, M. A. Chaudhary1, R. Manzano1, S. O’Sullivan1, M. Jarman1, C. K. Zogg1, T. M. Fullum2, A. Haider1 1Center for Surgery and Public Health, Brigham and Women’s Hospital,Surgery,Boston, MA, USA 2Howard University College Of Medicine,Surgery,Washington, DC, USA
Introduction:
Operative time is dependent on multifaceted interactions between physician and patient-level factors. Prolonged operation room time is known to have adverse outcomes in patients, however optimal time for individual laparoscopic procedures leading to a lower likelihood of complications remain unknown. Utilizing a national surgical database, our objective is to assess operation room time for major laparoscopic procedures to gain insight into the optimum length of time leading to the best outcomes.
Methods:
Using the ACS-NSQIP database from 2005-2015, we identified 653,119 patients undergoing laparoscopic procedures in the database (appendectomy (AP), cholecystectomy (CC), Roux-en-Y-gastric bypass (RYGB), adjustable gastric banding (AGB), Nissen fundoplication (NFP), inguinal hernia repair (IHR), sigmoidectomy (SG), and splenectomy (SP). The optimum operative time and its relation to adverse outcomes were analyzed for each procedure using nonparametric LOWESS regression to identify time nodes. The time intervals were analyzed in an adjusted multivariable logistic regression for the primary outcome of surgical site infections, intra-operative complications, major and minor postoperative complication.
Results:
Of a total of 653,119 surgical patients who underwent laparoscopic procedures, there were 178,825 AP, 168,413 CC, 5,637 RYGB, 97,589 AGB, 73,867 NFP, 58,051 IHR, 26,101 SG, and 44,266 SP procedures. The overall complication rate was 31.9% (n=208,406). The median time for each surgery is tabulated in table 1. Overall, on univariate analysis, increasing operative time was associated with a higher likelihood of complication for all procedures (P <0.001). Table 1 shows the results of subgroup analysis by procedure type. This analysis showed the optimal operative time associated with the lowest risk-adjusted odds of surgical complications for each laparoscopic procedure. Less than 100 minutes was the optimal time for Roux-en-Y- gastric bypass, inguinal hernia repair, and sigmoidectomy. Less than 120 and 75 minutes were the optimal times for Cholecystectomy and Adjustable gastric banding respectively. The optimal times for appendicectomy, Nissen fundoplication and splenectomy were (1) 20-100 minutes, (2) 120-220 minutes, and 60- 150 minutes respectively.
Conclusion:
We show the optimal operative time associated with lower likelihood of surgical complications for several laparoscopic procedures. Evaluation of the optimum operative times is a valuable tool for training future surgeons and predicting optimal outcomes in surgical patients to reduce morbidities and complications.
