Tags

Type your tag names separated by a space and hit enter

Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications.
J Minim Invasive Gynecol 2015 Sep-Oct; 22(6):1049-58JM

Abstract

STUDY OBJECTIVE

The relationship between operative time and perioperative morbidity has not been fully characterized in gynecology. We aimed to determine the impact of operative time on 30-day perioperative complications after laparoscopic and robotic hysterectomy.

DESIGN

Patients undergoing laparoscopic and robotic hysterectomy for benign disease from 2006 to 2011 within the National Surgical Quality Improvement Program (NSQIP) database were identified by Current Procedural Terminology code. Operative times were stratified into 60-minute intervals and complication rates analyzed. Primary outcomes included 30-day overall, medical, and surgical complications. Bivariate analyses using χ(2), Fisher's exact, and one-way analysis of variance tests were performed to compare clinical and procedural characteristics associated with longer operative time and complications. Multivariable logistic regression analyses were then performed to determine the independent association between operative time and perioperative complications.

DESIGN CLASSIFICATION

Canadian Task Force classification II-2 (Evidence obtained from well-designed cohort or case-control studies preferably from more than 1 center or research group).

SETTING

American College of Surgeons NSQIP.

PATIENTS

Patients who underwent laparoscopic or robotic hysterectomy for benign disease from 2006 to 2011 at any institution participating in NSQIP.

INTERVENTIONS

None, retrospective database study.

MEASUREMENTS AND MAIN RESULTS

Of the 7630 laparoscopic and robotic hysterectomies identified, 399 patients (5.2%) experienced complications, most commonly urinary tract infection (UTI; 2.1%), superficial surgical site infection (1.0%), and blood transfusion (1.0%). Return to the operating room was required in 97 patients (1.3%), and there were 4 deaths, for a mortality rate of .05%. Complications increased steadily with longer operative time. Operative time ≥ 240 minutes was associated with increased overall complications (13.8% vs 4.6%, p < .001), surgical complications (5.4% vs 1.5%, p < .001), medical complications (10.4% vs 3.2%, p < .001), return to the operating room (2.7% vs 1.2%, p = .002), deep venous thrombosis (.5% vs .06%, p = .011), pulmonary embolism (.7% vs .1%, p = .012), and blood transfusion (3.4% vs .8%, p < .001). These associations remained statistically significant after multivariable regression analysis. Based on continuous regression modeling, each additional hour of operative time would be expected to increase odds of overall complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.28-1.54; p < .001), medical complications (OR, 1.42; 95% CI, 1.28-1.57; p < .001), surgical complications (OR, 1.32; 95% CI, 1.17-1.49; p < .001), venous thromboembolism (OR, 1.47; 95% CI, 1.12-1.92; p = .005), UTI (OR, 1.20; 95% CI, 1.05-1.36; p = .006), blood transfusion (OR, 1.42; 95% CI, 1.18-1.71; p < .001), and return to the operating room (OR, 1.25; 95% CI, 1.08-1.45; p = .003).

CONCLUSION

We demonstrated a direct, independent association between operative time and 30-day complications after laparoscopic and robotic hysterectomy. Future research should aim to further delineate risk factors for prolonged operative time and morbidity in laparoscopic hysterectomy to allow surgeons to maximize preoperative planning and optimize patient selection for minimally invasive hysterectomy.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: tcatanza@gmail.com.Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26070725

Citation

Catanzarite, Tatiana, et al. "Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications." Journal of Minimally Invasive Gynecology, vol. 22, no. 6, 2015, pp. 1049-58.
Catanzarite T, Saha S, Pilecki MA, et al. Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications. J Minim Invasive Gynecol. 2015;22(6):1049-58.
Catanzarite, T., Saha, S., Pilecki, M. A., Kim, J. Y., & Milad, M. P. (2015). Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications. Journal of Minimally Invasive Gynecology, 22(6), pp. 1049-58. doi:10.1016/j.jmig.2015.05.022.
Catanzarite T, et al. Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications. J Minim Invasive Gynecol. 2015;22(6):1049-58. PubMed PMID: 26070725.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longer Operative Time During Benign Laparoscopic and Robotic Hysterectomy Is Associated With Increased 30-Day Perioperative Complications. AU - Catanzarite,Tatiana, AU - Saha,Sujata, AU - Pilecki,Matthew A, AU - Kim,John Y S, AU - Milad,Magdy P, Y1 - 2015/06/10/ PY - 2015/01/23/received PY - 2015/05/24/revised PY - 2015/05/28/accepted PY - 2015/6/14/entrez PY - 2015/6/14/pubmed PY - 2016/4/6/medline KW - Gynecologic surgery KW - Laparoscopic hysterectomy KW - Operative time KW - Perioperative complications SP - 1049 EP - 58 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 22 IS - 6 N2 - STUDY OBJECTIVE: The relationship between operative time and perioperative morbidity has not been fully characterized in gynecology. We aimed to determine the impact of operative time on 30-day perioperative complications after laparoscopic and robotic hysterectomy. DESIGN: Patients undergoing laparoscopic and robotic hysterectomy for benign disease from 2006 to 2011 within the National Surgical Quality Improvement Program (NSQIP) database were identified by Current Procedural Terminology code. Operative times were stratified into 60-minute intervals and complication rates analyzed. Primary outcomes included 30-day overall, medical, and surgical complications. Bivariate analyses using χ(2), Fisher's exact, and one-way analysis of variance tests were performed to compare clinical and procedural characteristics associated with longer operative time and complications. Multivariable logistic regression analyses were then performed to determine the independent association between operative time and perioperative complications. DESIGN CLASSIFICATION: Canadian Task Force classification II-2 (Evidence obtained from well-designed cohort or case-control studies preferably from more than 1 center or research group). SETTING: American College of Surgeons NSQIP. PATIENTS: Patients who underwent laparoscopic or robotic hysterectomy for benign disease from 2006 to 2011 at any institution participating in NSQIP. INTERVENTIONS: None, retrospective database study. MEASUREMENTS AND MAIN RESULTS: Of the 7630 laparoscopic and robotic hysterectomies identified, 399 patients (5.2%) experienced complications, most commonly urinary tract infection (UTI; 2.1%), superficial surgical site infection (1.0%), and blood transfusion (1.0%). Return to the operating room was required in 97 patients (1.3%), and there were 4 deaths, for a mortality rate of .05%. Complications increased steadily with longer operative time. Operative time ≥ 240 minutes was associated with increased overall complications (13.8% vs 4.6%, p < .001), surgical complications (5.4% vs 1.5%, p < .001), medical complications (10.4% vs 3.2%, p < .001), return to the operating room (2.7% vs 1.2%, p = .002), deep venous thrombosis (.5% vs .06%, p = .011), pulmonary embolism (.7% vs .1%, p = .012), and blood transfusion (3.4% vs .8%, p < .001). These associations remained statistically significant after multivariable regression analysis. Based on continuous regression modeling, each additional hour of operative time would be expected to increase odds of overall complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.28-1.54; p < .001), medical complications (OR, 1.42; 95% CI, 1.28-1.57; p < .001), surgical complications (OR, 1.32; 95% CI, 1.17-1.49; p < .001), venous thromboembolism (OR, 1.47; 95% CI, 1.12-1.92; p = .005), UTI (OR, 1.20; 95% CI, 1.05-1.36; p = .006), blood transfusion (OR, 1.42; 95% CI, 1.18-1.71; p < .001), and return to the operating room (OR, 1.25; 95% CI, 1.08-1.45; p = .003). CONCLUSION: We demonstrated a direct, independent association between operative time and 30-day complications after laparoscopic and robotic hysterectomy. Future research should aim to further delineate risk factors for prolonged operative time and morbidity in laparoscopic hysterectomy to allow surgeons to maximize preoperative planning and optimize patient selection for minimally invasive hysterectomy. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/26070725/Longer_Operative_Time_During_Benign_Laparoscopic_and_Robotic_Hysterectomy_Is_Associated_With_Increased_30_Day_Perioperative_Complications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(15)00422-7 DB - PRIME DP - Unbound Medicine ER -