Association between Operative Time and Short-Term Radical Cystectomy Complications

Area of Science:

• Urology
• Surgical Oncology
• Health Services Research

Background:

• Radical cystectomy (RC) is a major oncologic surgery.
• Understanding factors influencing postoperative complications is crucial for patient safety.

Purpose of the Study:

• To investigate the association between operative time and postoperative complications in RC.
• To identify optimal surgical durations for minimizing adverse events.

Main Methods:

• Analysis of the National Surgical Quality Improvement Program database (2011-2017).
• Inclusion of 10,520 patients who underwent RC.
• Application of generalized linear models with linear splines to assess the operative time-complication relationship.

Main Results:

• A significant association was found between operative time and complication rates.
• Complication rates increased with longer operative times, from 55% at 2.5 hours to 82% at 10 hours.
• Major complications (Clavien-Dindo Classification ≥3) showed an inflection point at 4.5 hours, with the lowest rates (15%) observed around this duration.

Conclusions:

• Operative time is a significant predictor of postoperative complications following RC.
• Surgical durations between 4 and 5 hours demonstrated a trend towards lower complication rates.
• Optimizing surgical time may be a key strategy for enhancing patient care and reducing adverse outcomes after RC.