Operative time as a marker of quality in bariatric surgery

Inaba, Colette S.; Koh, Christina Y.; Sujatha-Bhaskar, Sarath; Gallagher, Shea; Chen, Yanjun; Nguyen, Ninh T.

doi:10.1016/j.soard.2019.04.010

Cited by 34 publications

(16 citation statements)

References 29 publications

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“…Previous studies have suggested that prolonged operation duration increases mortality [14,15], infection risk [7,13], LOS [10], and the cost of operations [16]. Consistent with these studies, our results also suggest that longer operation duration is related to poor prognosis, including increased costs, increased LOS in hospital and in the ICU, and lower OS and DFS.…”

Section: Discussionsupporting

confidence: 90%

Impact of operation duration on short-term and long-term prognosis in patients undergoing radical colorectal surgery

Shen¹,

Zhou²,

Hua³

et al. 2022

J. Cancer

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Purpose:The objective of this study was to evaluate the impact of operation duration on short-and long-term outcomes of colorectal cancer patients following surgical resection. Methods: 6224 consecutive patients who underwent radical colorectal surgery were retrospectively assessed and were divided into short operation duration group (SOD) and long operation duration group (LOD) according to the operation duration cutoff value of 110 minutes. Results: Compared with patients in LOD group, patients in SOD group had significantly lower total costs in hospital, reduced expenses for drugs and antibiotics, shorter length of stay (LOS) in hospital and in the ICU. Moreover, 5-year overall survival (OS) and disease-free survival (DFS) for patients in the SOD group were markedly higher than for patients in the LOD group. Mutivariate regression analysis indicated that longer operation duration was associated with poor prognosis, with a hazard ratio of 1.004 (1.003, 1.005) for OS and 1.005 (1.003, 1.006) for DFS. Finally, surgeons' qualifications had meaningful correlation with operation duration (r= 0.450). Conclusions: Operation duration is an independent risk factor for patients' short-term and long-term outcome after radical colorectal surgery. Improve the surgical skills of the surgeon may shorten the operation duration, and further improve the outcome for patients.

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Section: Discussionsupporting

confidence: 90%

Impact of operation duration on short-term and long-term prognosis in patients undergoing radical colorectal surgery

Shen¹,

Zhou²,

Hua³

et al. 2022

J. Cancer

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“…While ORT was increased in this group, as previously stated, we did not observe the increase in complications which were described in previous publications. 17 Based on these findings, the modest increase in operative time should not preclude the use of TAP blocks.…”

Section: Discussionmentioning

confidence: 99%

“…16 When focusing specifically on bariatric patients, as operative time increases, there is an association with increased staples line leaks as well as mortality. 17 As such, guidelines have established 90 minutes as the benchmark for laparoscopic bariatric procedures. 7 We observed that in patients that did not receive a TAP block, we were able to achieve this benchmark, but in those that underwent a TAP block, we exceeded this benchmark by 14 minutes.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Multimodal Anesthetic Care Incorporating Transversus Abdominis Plane Block Is Associated With Reduced Narcotic Use in Laparoscopic Sleeve Gastrectomy

Martin

Etzel

Aghazarian

et al. 2021

The American Surgeon™

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Background Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgery performed in North America. As our knowledge of the importance in limiting narcotic use in postoperative patients increases, we sought to evaluate the effect of transversus abdominis plane (TAP) blocks on inpatient narcotic use in patients undergoing LSG. Methods A retrospective review of LSG performed at a single institution by 3 bariatric surgeons was performed. All cases over a 15-month period were included, and anesthesia records were reviewed to stratify patients that received a TAP block and those that did not. Demographic, as well as surgical, outcomes were collected for all patients. Narcotic utilization, as reported in morphine equivalents (ME), was evaluated between the 2 groups. Results 384 LSG patients were identified, of which 37 (9.6%) received a TAP block. There was no statistically significant difference in postoperative morbidity, length of stay, or readmission between groups. Median narcotic utilization in hospital days 1 and 2 in patients with TAP blocks was 49 ME (Interquartile Range (IQR) 14.5-84.5) to 82.5 ME (IQR 57.4-106) in the no-TAP group ( P < .001). After controlling for multiple demographic- and patient-related cofactors, multiple linear regression analysis demonstrated TAP block patients utilized 22.48 ME less than the no-TAP group ( P < .001) in the first 2 days of their hospitalization. Discussion Patients that received a TAP block as a part of their perioperative anesthetic care utilized less in-hospital narcotics than those patients that did not receive a TAP block. TAP blocks should be considered as part of a multimodal pain control strategy for patients undergoing LSG.

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“…In the literature, a procedure time of 78 minutes (SD, 37.4 minutes) has been described. 10 We did not differentiate between bleeding of the staple line or parenchymal organs or the omentum.…”

Section: Discussion/conclusionmentioning

confidence: 99%

A Prospective Observational Study Investigating Postoperative Hemorrhage After Laparoscopic Sleeve Gastrectomy Using Bipolar Seal and Cut Caiman (Aesculap AG)

Boeker

Brose

Mall

et al. 2021

International Surgery

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Introduction Postoperative hemorrhage (POH) is the second most important acute complication following laparoscopic sleeve gastrectomy (LSG), with staple line leakage being the first. POH is reported in up to 5% of cases after LSG. Sufficient vessel sealing is crucial in avoiding later complications of POH during mobilization. This study investigated bleeding complications after LSG using the Advanced Bipolar Seal and Cut instrument Caiman 5 by Aesculap AG. Methods All LSG´s were performed using the Caiman 5 (Aesculap AG). Primary outcome was the incidence of POH, defined as the need for revisional surgery and/or blood transfusions. Secondary outcomes were hemoglobin levels preoperatively at the day of surgery (POD 0) and at postoperative days (POD) 1 and 2, volume and duration of drainage at POD 0-2, procedure time, and length of hospital stay. Results 100 patients who had undergone LSG from April 2016 to September 2017 were consecutively included in the study. Patients with contraindications to undergo LSG or were not able to give consent were excluded. Four patients needed treatment due to POH, in 3 of them surgery became necessary. Average operation time was 68.5 min, total volume of drainage was 186 ml. The drain stayed in situ for 2.2 days (mean). Average hospital stay was 3.6 days. Discussion/Conclusion In our study group of 100 LSG procedures POH was 4%. Operation time, volume and duration of drainage, length of hospital stay were not prolonged. LSG using Caiman is feasible and shows comparable results to other vessel sealing instruments at our center.

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Operative time as a marker of quality in bariatric surgery

Cited by 34 publications

References 29 publications

Impact of operation duration on short-term and long-term prognosis in patients undergoing radical colorectal surgery

Impact of operation duration on short-term and long-term prognosis in patients undergoing radical colorectal surgery

Perioperative Multimodal Anesthetic Care Incorporating Transversus Abdominis Plane Block Is Associated With Reduced Narcotic Use in Laparoscopic Sleeve Gastrectomy

A Prospective Observational Study Investigating Postoperative Hemorrhage After Laparoscopic Sleeve Gastrectomy Using Bipolar Seal and Cut Caiman (Aesculap AG)

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