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The Impact of Prolonged Operative Time Associated With Minimally Invasive Colorectal Surgery: A Report From the
Kenley R Unruh1, Amir L Bastawrous2, Shalini Kanneganti3
1Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington.
Diseases of the Colon and Rectum
|October 25, 2023
Summary
Prolonged operative time in colorectal surgery is linked to longer hospital stays and more complications. However, minimally invasive approaches may lessen these negative effects, improving patient outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Minimally Invasive Surgery
Background:
- Increased operative time in colorectal surgery correlates with poorer outcomes.
- Laparoscopic and robotic approaches show improved outcomes despite longer operative times.
- A consistent definition for prolonged operative time is lacking.
Discussion:
- Prolonged operative time is defined as the 75th percentile for each procedure and approach.
- Outcomes analyzed include length of stay, discharge destination, and complications.
- Adjusted models accounted for confounding factors in open and minimally invasive surgeries.
Key Insights:
- Prolonged operative time is associated with longer length of stay (7 vs. 5 days open, 5 vs. 4 days laparoscopic, 4 vs. 3 days robotic).
- Complication rates are higher with prolonged operative time (42% vs. 28% open, 24% vs. 17% laparoscopic, 27% vs. 13% robotic).
- Discharge home rates remain similar across operative times (86% vs. 87% open, 94% vs. 94% laparoscopic, 93% vs. 96% robotic).
Outlook:
- Minimally invasive approaches may mitigate the negative impact of prolonged operative time.
- Further research is needed to explore subgroup analyses and address potential confounders.
- Standardizing the definition of prolonged operative time is crucial for future studies.
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