Does speed matter? The impact of operative time on outcome in laparoscopic surgery

Abstract

Introduction Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Methods Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005–2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. Results A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p \ 0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n = 10,135), cholecystectomy (n = 37,407), Nissen fundoplication (n = 4,934), and gastric bypass (n = 17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n = 6,430; p = 0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Conclusion Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further.

Teaching surgery takes time: the impact of surgical education on time in the operating room

“…[9][10][11][12][13][14][15][16][17][18][19][20] This association likely reflects multiple confounding factors, including the observation that complex and challenging cases take longer and are associated with higher complication rates. Disentangling the impact of teaching time from other factors that increase surgical duration will be a considerable challenge for future research to address.…”

“…Previous research has also demonstrated a consistent association between prolonged surgery duration and adverse patient outcomes across a wide range of procedures. [9][10][11][12][13][14][15][16][17][18][19][20] Although previous research has shown that trainee involvement is associated with prolonged surgical duration, [1][2][3][4][5][6][7][8] the magnitude of this increase has not been estimated at a population level, nor has previous research adjusted for patient-and surgeon-related factors, such as experience of the attending surgeon. Administrative data from the province of Ontario are ideal to address this research question because surgical training in Ontario is concentrated within a limited number of teaching hospitals, such that the impact of training on surgery duration can be estimated by comparing teaching and nonteaching hospitals.…”

Comparison of Outcomes After Minimally Invasive Versus Open Partial Nephrectomy with Respect to Trainee Involvement Utilizing the American College of Surgeons National Surgical Quality Improvement Program

“…19,20 Intuitively, longer operative times are associated with increased odds of complications. 21 Operative times for both approaches in our analysis had significant differences in operative times between cases with and without trainees. Moreover, increased complications are associated with increased LOS and overall cost of hospitalization.…”

Teaching speed in the operative theatre: Should case duration benchmark efficiency in general surgical residency programs?

“…"It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling." 1 …”