Operative duration as an independent risk factor for postoperative complications in single-level
lumbar fusion: an analysis of 4588 surgical cases.
lumbar fusion: an analysis of 4588 surgical cases.
“...multivariate risk-adjusted regression models demonstrated that
increasing operative time was associated with step-wise
increase in risk for overall complications (odds ratio [OR], 2.09-5.73),
medical complications (OR, 2.18-6.21),
surgical complications (OR, 1.65-2.90),
superficial surgical site infection (OR, 2.65-3.97), and
postoperative transfusions (OR, 3.25-12.19).
Operative duration of 5 hours or more was also associated with
increased risk of
reoperation (OR, 2.17),
organ/space surgical site infection (OR, 9.72),
sepsis/septic shock (OR, 4.41),
wound dehiscence (OR, 10.98), and
deep vein thrombosis (OR, 17.22).”
increasing operative time was associated with step-wise
increase in risk for overall complications (odds ratio [OR], 2.09-5.73),
medical complications (OR, 2.18-6.21),
surgical complications (OR, 1.65-2.90),
superficial surgical site infection (OR, 2.65-3.97), and
postoperative transfusions (OR, 3.25-12.19).
Operative duration of 5 hours or more was also associated with
increased risk of
reoperation (OR, 2.17),
organ/space surgical site infection (OR, 9.72),
sepsis/septic shock (OR, 4.41),
wound dehiscence (OR, 10.98), and
deep vein thrombosis (OR, 17.22).”
General surgical operative duration is associated with increased risk-adjusted infectious
complication rates and length of hospital stay.
complication rates and length of hospital stay.
“...Multivariable regression adjusted for 38 patient risk variables...
unadjusted infectious complication rates increased linearly with operative duration
at a rate of close to 2.5% per half hour (...p < 0.001).
After adjustment, infectious complication risk increased...
almost doubling at [greater than 2 hours versus less than 1 hour]
(odds ratio = 1.92; 95% CI, 1.82 to 2.03; p < 0.001).”
unadjusted infectious complication rates increased linearly with operative duration
at a rate of close to 2.5% per half hour (...p < 0.001).
After adjustment, infectious complication risk increased...
almost doubling at [greater than 2 hours versus less than 1 hour]
(odds ratio = 1.92; 95% CI, 1.82 to 2.03; p < 0.001).”
How slow is too slow? Correlation of operative time to complications:
an analysis from the Tennessee Surgical Quality Collaborative.
an analysis from the Tennessee Surgical Quality Collaborative.
“104,632 general and vascular cases..."Long" cases had increased rates of
[UTI, SSI, sepsis, prolonged intubation, and pneumonia]
and also deep venous thrombosis, deep incisional infection, and wound disruption...
The highest marginal time risk was for sepsis,
occurring 16.6 times per additional hour of operative time over standard.”
[UTI, SSI, sepsis, prolonged intubation, and pneumonia]
and also deep venous thrombosis, deep incisional infection, and wound disruption...
The highest marginal time risk was for sepsis,
occurring 16.6 times per additional hour of operative time over standard.”
Surgical duration and risk of venous thromboembolism.
“Retrospective...the longest procedures experienced a
1.27-fold (95% CI, 1.21-1.34; adjusted risk difference [ARD], 0.23%)
increase in the odds of developing a VTE...
The robustness of these results was substantiated with several
sensitivity analyses attempting to minimize the effect of
outliers, concurrent complications, procedural differences, and unmeasured confounding variables.
1.27-fold (95% CI, 1.21-1.34; adjusted risk difference [ARD], 0.23%)
increase in the odds of developing a VTE...
The robustness of these results was substantiated with several
sensitivity analyses attempting to minimize the effect of
outliers, concurrent complications, procedural differences, and unmeasured confounding variables.
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