Operative time in esophagectomy: Does it affect outcomes?

The effect of operative duration on postoperative outcomes of esophagectomy is not well understood. The relationship between operative duration and postoperative complications was explored.

Esophagectomies with gastric reconstruction performed between 2010 and 2015 were queried from the National Surgical Quality Improvement Program. Linear and multivariate regression analyses were used to determine if operative duration correlated with outcomes independent of comorbidities. Subset analysis was performed by the type of esophagectomy.

There were 5,098 patients with a median age and operative time of 64 years and 353 minutes, respectively. In the transhiatal group, longer operative times correlated with increased rates of pneumonia, prolonged intubation, unplanned reintubation, septic shock, unplanned reoperation, duration of stay, and mortality. For Ivor-Lewis esophagectomy, there were similar correlations with postoperative complications but not mortality. With the McKeown approach, there were no correlations between operative duration and postoperative outcomes.

Prolonged operative time has an independent adverse impact on postoperative morbidity, which varies by surgical approach. We have identified unique cut points in the operative time for transhiatal (333 minutes) and Ivor-Lewis esophagectomy (422 minutes), which can be used as a prognostic marker for postoperative outcomes as well as a quality metric in well-selected patients.