The Effect of Operative Time on Perioperative Morbidity After Laparoscopic Hysterectomy

摘要

INTRODUCTION: We aimed to determine the effect of operative time on the risk of perioperative morbidity after laparoscopic hysterectomy. METHODS: Deidentified data from the National Surgical Quality Improvement Program Database were reviewed for patients undergoing total or subtotal laparoscopic hysterectomy from 2006 to 2011. Robotic and traditional laparoscopy data were pooled. Primary outcomes were 30-day complication rates in relation to operative time. Demographics, comorbidities, and complications were compared using bivariate and multivariate regression analysis. RESULTS: Nine thousand sixty-four women underwent laparoscopic hysterectomy during the study period. Medical, surgical, and overall complications increased significantly with increasing operative time (Fig. 1). On bivariate analysis, operative times over 240 minutes were associated with significant increases in composite morbidity (13.3% compared with 4.7%, P<.001), surgical complications (4.1% compared with 1.6%, P<.001), medical complications (10.7% compared with 3.3%, P<.001), and reoperation (2.6% compared with 1.2%, P=.013) as well as venous thromboembolis, urinary tract infection, and blood transfusion. These associations remained statistically significant on multivariate analysis. For each additional 10 minutes of operative time, the odds of overall, medical, and surgical complications increased by 5.1%, 6.2%, and 4.1%, respectively, and the odds of reoperation, venous thromboembolism, urinary tract infection, and transfusion increased by 5.1%, 6.2%, 4.1%, and 8.3%, respectively.CONCLUSIONS: We demonstrated a direct, independent correlation between increased operative time during laparoscopic hysterectomy and perioperative morbidity. Operating time exceeding 4 hours was associated with a nearly threefold increase in overall complications. Patients considering laparoscopic hysterectomy who are at risk for excessive operating time may benefit from an alternative surgical approach.