The effect of operative duration on the outcome of colon cancer procedures.
Colectomy
Colon cancer
Colorectal cancer
Complications
Operative duration
Operative time
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
23
05
2021
accepted:
07
11
2021
pubmed:
17
11
2021
medline:
7
6
2022
entrez:
16
11
2021
Statut:
ppublish
Résumé
Prolonged operative duration has been associated with increased post-operative morbidity in numerous surgical subspecialties; however, data are limited in operations for colon cancer specifically and existing literature makes unwarranted methodological assumptions of linearity. We sought to assess the effects of extended operative duration on perioperative outcomes in those undergoing segmental colectomy for cancer using a methodologically sound approach. We conducted a retrospective cohort study of patients undergoing segmental colectomy for cancer between 2014 and 2018, logged in the National Surgical Quality Improvement Program datasets. Our primary outcome was a composite of any complication within 30 days; secondary outcomes included length of stay and discharge disposition. Our main factor of interest was operative duration. We analyzed 26,380 segmental colectomy cases, the majority of which were approached laparoscopically (64.95%) and were right sided (62.93%). Median operative duration was 152 (95% CI 112-206) minutes. On multivariable regression, increased operative duration was linearly associated with any complication (OR = 1.003, 95% CI 1.003-1.003, p < 0.0001) in the overall cohort, as was length of stay (p < 0.0001). All subgroups except for the laparoscopic left colectomy group were linearly associated with operative duration. In the laparoscopic left colectomy group, an inflection point in the odds of any complication was found at 176 min (OR = 1.39, 95% CI 1.20-1.61, p < 0.0001). This study suggests that the risk of perioperative complications increases linearly with increasing operative duration, where each additional 30 min increases the odds of complication by 10%. In those undergoing laparoscopic left colectomy, the risk of complications sharply increases after ~ 3 h, suggesting that surgeons should aim to complete these procedures within 3 h where possible.
Sections du résumé
BACKGROUND
Prolonged operative duration has been associated with increased post-operative morbidity in numerous surgical subspecialties; however, data are limited in operations for colon cancer specifically and existing literature makes unwarranted methodological assumptions of linearity. We sought to assess the effects of extended operative duration on perioperative outcomes in those undergoing segmental colectomy for cancer using a methodologically sound approach.
METHODS
We conducted a retrospective cohort study of patients undergoing segmental colectomy for cancer between 2014 and 2018, logged in the National Surgical Quality Improvement Program datasets. Our primary outcome was a composite of any complication within 30 days; secondary outcomes included length of stay and discharge disposition. Our main factor of interest was operative duration.
RESULTS
We analyzed 26,380 segmental colectomy cases, the majority of which were approached laparoscopically (64.95%) and were right sided (62.93%). Median operative duration was 152 (95% CI 112-206) minutes. On multivariable regression, increased operative duration was linearly associated with any complication (OR = 1.003, 95% CI 1.003-1.003, p < 0.0001) in the overall cohort, as was length of stay (p < 0.0001). All subgroups except for the laparoscopic left colectomy group were linearly associated with operative duration. In the laparoscopic left colectomy group, an inflection point in the odds of any complication was found at 176 min (OR = 1.39, 95% CI 1.20-1.61, p < 0.0001).
CONCLUSIONS
This study suggests that the risk of perioperative complications increases linearly with increasing operative duration, where each additional 30 min increases the odds of complication by 10%. In those undergoing laparoscopic left colectomy, the risk of complications sharply increases after ~ 3 h, suggesting that surgeons should aim to complete these procedures within 3 h where possible.
Identifiants
pubmed: 34782967
doi: 10.1007/s00464-021-08871-7
pii: 10.1007/s00464-021-08871-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5076-5083Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Cheng H et al (2018) Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 229:134–144
doi: 10.1016/j.jss.2018.03.022
Jackson TD et al (2011) Does speed matter? The impact of operative time on outcome in laparoscopic surgery. Surg Endosc 25(7):2288–2295
doi: 10.1007/s00464-010-1550-8
Procter LD et al (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210(1):60-65.e2
doi: 10.1016/j.jamcollsurg.2009.09.034
Daley BJ et al (2015) How slow is too slow? Correlation of operative time to complications: an analysis from the Tennessee surgical quality collaborative. J Am Coll Surg 220(4):550–558
doi: 10.1016/j.jamcollsurg.2014.12.040
Cortina CS et al (2019) Longer operative time and intraoperative blood transfusion are associated with postoperative anastomotic leak after lower gastrointestinal surgery. Am Surg 85(2):136–141
doi: 10.1177/000313481908500218
Harrison OJ et al (2014) Operative time and outcome of enhanced recovery after surgery after laparoscopic colorectal surgery. JSLS 18(2):265–272
doi: 10.4293/108680813X13753907291918
Causey MW et al (2012) Initial operative time and metastatic disease recurrence. Mil Med 177(11):1382–1386
doi: 10.7205/MILMED-D-12-00053
Evans C et al (2012) Factors influencing laparoscopic colorectal operative duration and its effect on clinical outcome. Surg Laparosc Endosc Percutan Tech 22(5):437–442
doi: 10.1097/SLE.0b013e31826020a3
Scheer A et al (2009) Laparoscopic colon surgery: does operative time matter? Dis Colon Rectum 52(10):1746–1752
doi: 10.1007/DCR.0b013e3181b55616
Owen RM et al (2013) Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc 27(10):3555–3563
doi: 10.1007/s00464-013-2949-9
Bailey MB et al (2014) Longer operative time: deterioration of clinical outcomes of laparoscopic colectomy versus open colectomy. Dis Colon Rectum 57(5):616–622
doi: 10.1097/DCR.0000000000000114
User Guide for the 2018 ACS NSQIP participant use data file (PUF), in National Surgical Quality Improvement Program. American College of Surgeons.
Davis SS Jr et al (2013) Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes. J Am Coll Surg 216(1):96–104
doi: 10.1016/j.jamcollsurg.2012.08.014
Dull MB et al (2017) Resident impact on operative duration for elective general surgical procedures. Am J Surg 213(3):456–459
doi: 10.1016/j.amjsurg.2016.10.031
Jarry C et al (2021) Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay. Updates Surg 73(1):93–100
doi: 10.1007/s13304-020-00840-4
Sweigert PJ et al (2019) Do prolonged operative times obviate the benefits associated with minimally invasive colectomy? Surgery 166(3):336–341
doi: 10.1016/j.surg.2019.05.006
Nikolian VC et al (2017) Anastomotic leak after colorectal resection: a population-based study of risk factors and hospital variation. Surgery 161(6):1619–1627
doi: 10.1016/j.surg.2016.12.033
Royston P, Altman DG, Sauerbrei W (2006) Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med 25(1):127–141
doi: 10.1002/sim.2331
Shepherd BE et al (2017) Brief report: assessing and interpreting the association between continuous covariates and outcomes in observational studies of HIV using splines. J Acquir Immune Defic Syndr 74(3):e60–e63
doi: 10.1097/QAI.0000000000001221
Petrucciani N et al (2019) Impact of conversion from laparoscopy to open surgery in patients with right colon cancer. Am Surg 85(2):177–182
doi: 10.1177/000313481908500225
McDermott FD et al (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102(5):462–479
doi: 10.1002/bjs.9697
Baloyiannis I et al (2020) Comparing the safety, efficacy, and oncological outcomes of laparoscopic and open colectomy in transverse colon cancer: a meta-analysis. Int J Colorectal Dis 35(3):373–386
doi: 10.1007/s00384-020-03516-y
Clinical Outcomes of Surgical Therapy Study G, et al. (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 350(20): 2050–9.
Lacy AM et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229
doi: 10.1016/S0140-6736(02)09290-5