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"Every minute counts": association between operative time and post-operative complications for patients undergoing
Edward K Kim1, Jeremy C Applebaum2, Elizabeth S Kravitz2
1Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA. edward.kim@pennmedicine.upenn.edu.
Introduction And Hypothesis:
Our aim was to assess whether operative time is independently associated with post-operative complications for minimally invasive sacrocolpopexy (MISCP).
Methods:
Using the National Surgical Quality Improvement Program (NSQIP) database, patients undergoing MISCP from 2015 to 2020 were identified by CPT code. The following data were extracted: demographics, concomitant procedures (hysterectomies, midurethral sling, and anterior or posterior repair), and post-operative complications. Complications were categorized into minor, major, and composite, modeled after the Clavien-Dindo classification. For analysis, covariates associated with operative time and composite complications were identified using a general linear model and Chi-squared or Fisher's exact test as appropriate. Then, adjusted spline regression was performed as a test of nonlinearity between operative time and composite complications. Adjusted relative risks of complications by 60-min increments were estimated using Poisson regression with robust error variance.
Results:
A total of 13,239 patients who underwent MISCP were analyzed. Overall, mean operative time (SD) was 189.5 (78.3) min. Post-operative complication rates were 2.6% for minor, 4.7% for major, and 7.3% for composite complications. Age, smoking, and sling were the only covariates associated with both operative time and post-operative complications. Adjusted spline regression demonstrated linearity (p<0.0001). With each 60-min increase in operative time, adjusted relative risks (95% CI) were 1.14 for composite (1.09, 1.19), 1.16 for minor (1.10, 1.21), and 1.11 (1.03, 1.20) for major complications.
Conclusions:
Operative time is independently and linearly associated with post-operative complications for patients undergoing MISCP, even when adjusted for demographic variables and concomitant procedures.
Insights
Longer operative times for minimally invasive sacrocolpopexy (MISCP) are linked to increased post-operative complications. This study confirms a linear relationship between surgical duration and patient outcomes, highlighting the importance of operative efficiency.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Minimally invasive sacrocolpopexy (MISCP) is a key procedure for pelvic organ prolapse.
- Understanding factors influencing post-operative complications is crucial for patient safety and surgical planning.
- Operative time is a potential modifiable factor affecting surgical outcomes.
Purpose of the Study:
- To determine if operative time is an independent predictor of post-operative complications in MISCP.
- To assess the nature of the relationship between operative time and complication rates.
- To provide data supporting efforts to optimize surgical efficiency in MISCP.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program (NSQIP) database (2015-2020).
- Inclusion of 13,239 patients undergoing MISCP, with extraction of demographic and procedural data.
- Statistical modeling including general linear models, Chi-squared tests, and adjusted spline and Poisson regression to assess operative time and complication associations.
Main Results:
- Mean operative time was 189.5 minutes; overall complication rates were 7.3% (composite).
- Operative time demonstrated a significant linear association with minor, major, and composite post-operative complications (p<0.0001).
- Each 60-minute increase in operative time was associated with a 14% increase in composite complications (aRR 1.14).
Conclusions:
- Operative time is independently and linearly associated with post-operative complications following MISCP.
- Surgical efficiency and minimizing operative time may be important for reducing complication risks in MISCP.
- These findings emphasize the need to consider operative duration in the context of patient safety and outcomes for MISCP procedures.
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