Impact of Prolonged Operative Time on Complications Following Endoscopic Sinonasal Surgery

Area of Science:

• Otolaryngology
• Surgical Outcomes Research

Background:

• Endoscopic sinonasal surgery (ESNS) is a common procedure for various sinonasal conditions.
• Understanding factors influencing surgical outcomes is crucial for patient care.
• Prolonged operative time (POT) is a potential indicator of surgical complexity and risk.

Purpose of the Study:

• To investigate the association between prolonged operative time (POT) and 30-day postoperative outcomes in patients undergoing endoscopic sinonasal surgery (ESNS).

Main Methods:

• A retrospective study analyzing data from 1,994 ESNS cases (nonsinus, sinus, extended sinus) between 2005-2018 from the American College of Surgeons National Surgical Quality Improvement database.
• Univariate and multivariate analyses were employed to assess the impact of POT on postoperative outcomes.
• Risk-adjustment was performed to isolate the effect of POT.

Main Results:

• POT was associated with older age, specific racial groups, higher ASA classifications, and comorbidities like obesity and hypertension in sinus procedures.
• For extended sinus procedures, POT correlated with older age, male sex, and lower BMI.
• After risk adjustment, POT independently predicted prolonged hospital stay (LOS) for all ESNS categories.
• POT was also linked to overall surgical complications and postoperative bleeding in sinus and extended sinus procedures.

Conclusions:

• Prolonged operative time (POT) is an independent risk factor for adverse outcomes in endoscopic sinonasal surgery (ESNS), including extended hospital stays and increased complications.
• Preoperative planning should focus on optimizing modifiable patient risk factors contributing to POT.
• Enhancing surgical efficiency by identifying surgeon-specific factors is recommended to improve outcomes.