Increased Operative Duration in Minimally Invasive Partial Nephrectomy Is Associated with Significantly Increased Risk of 30-Day Morbidity
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Andrew M Harris1, Andrew James1, Adam Dugan2
11 Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky.
Abstract:
Operative duration (OD) is associated with complications but has been poorly studied in minimally invasive partial nephrectomy (MIPN). We seek to examine the relationship between OD and complications in MIPN. The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2016 by CPT code. Risk factors for complications were determined using univariable and multivariable analysis. In all, 12,018 patients were examined. OD was broken into deciles, ∼1200 patients in each, by minutes, <111, 111 to 131, 132 to 149, 159 to 164, 165 to 180, 181 to 196, 197 to 215, 216 to 238, 239 to 276, >276. Variables significantly associated with OD (values stated are shortest and longest deciles, respectively) include: male 47.8% and 68.2% of patients; body mass index 28.5 and 31.3 kg/m2; diabetes 13.4% and 23.7%; smoking 20.4% and 22.0%; taking medication for hypertension 53.1% and 64.2%. Morbidities significantly associated with OD (shortest and longest deciles reported, respectively) include: complications 4.2% of patients and 14.2%; postoperative transfusion 1.3% and 7.8%; pulmonary embolism (PE)/deep vein thrombosis 0.5% and 1.2%; renal insufficiency 0.3% and 1.7%; cardiac arrest or stroke 0.3% and 1.4%. On multivariable analysis, patients with OD >180 minutes were significantly more likely to have complications odds ratio of 2.0, 2.3, 2.3, 3.2, and 3.7 for deciles 181 to 196, 197 to 215, 216 to 238, 239 to 276, >276, respectively, p < 0.001. Even when adjusting for patient-specific preoperative factors, OD is an independent predictor of significant morbidity. Patients in the longest decile were nearly four times as likely to have complications. Further study is needed to determine reasons for prolonged OD.
Insights
Operative duration (OD) is linked to complications in minimally invasive partial nephrectomy (MIPN). Longer operative times significantly increase the risk of patient morbidity, independent of other factors.
Area of Science:
- Urology
- Surgical Oncology
- Health Services Research
Background:
- Operative duration (OD) is a known risk factor for complications in various surgical procedures.
- However, its specific impact on minimally invasive partial nephrectomy (MIPN) remains understudied.
- Understanding this relationship is crucial for optimizing patient outcomes in MIPN.
Purpose of the Study:
- To investigate the association between operative duration (OD) and postoperative complications in patients undergoing minimally invasive partial nephrectomy (MIPN).
- To identify if OD is an independent predictor of morbidity in MIPN, even after accounting for patient-specific preoperative factors.
Main Methods:
- The study utilized data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database between 2011 and 2016.
- A total of 12,018 patients who underwent MIPN were analyzed.
- Operative duration was stratified into deciles, and univariable and multivariable analyses were performed to assess risk factors for complications.
Main Results:
- Patients with longer operative durations (e.g., >180 minutes) demonstrated a significantly increased likelihood of experiencing complications.
- Multivariable analysis revealed that OD is an independent predictor of morbidity, with odds ratios for complications rising substantially in longer duration deciles (up to 3.7 for the longest decile).
- Specific morbidities like postoperative transfusion, pulmonary embolism/deep vein thrombosis, renal insufficiency, and cardiac events/stroke were also associated with prolonged OD.
Conclusions:
- Operative duration is an independent predictor of significant morbidity following minimally invasive partial nephrectomy (MIPN).
- Patients undergoing longer procedures face a substantially higher risk of complications.
- Further research is warranted to elucidate the underlying reasons for prolonged operative times in MIPN and to develop strategies for mitigation.
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