Operative Time is Associated With Postoperative Complications After Pulmonary Lobectomy

Abstract

Objective: To investigate the association between operative time and postoperative outcomes. Background: The association between operative time and morbidity after pulmonary lobectomy has not been characterized fully. Methods: Patients who underwent pulmonary lobectomy for primary lung cancer at our institution from 2010 to 2018 were reviewed. Exclusion criteria included clinical stage ≥ IIb disease, conversion to thoracotomy, and previous ipsilateral lung treatment. Operative time was measured from incision to closure. Relationships between operative time and outcomes were quantified using multivariable mixed-effects models with surgeon-level random effects. Results: In total, 1651 patients were included. The median age was 68 years (interquartile range, 61-74), and 63% of patients were women. Median operative time was 3.2 hours (interquartile range, 2.7-3.8) for all cases, 3.0 hours for open procedures, 3.3 hours for video-assisted thoracoscopies, and 3.3 hours for robotic procedures (P = 0.0002). Overall, 488 patients (30%) experienced a complication; 77 patients (5%) had a major complication (grade ≥ 3), and 5 patients (0.3%) died within 30 days of discharge. On multivariable analysis, operative time was associated with higher odds of any complication [odds ratio per hour, 1.37; 95% confidence interval (CI), 1.20-1.57; P < 0.0001] and major complication (odds ratio per hour, 1.41; 95% CI, 1.21-1.64; P < 0.0001). Operative time was also associated with longer hospital length of stay (β, 1.09; 95% CI, 1.04-1.14; P = 0.001). Conclusions: Longer operative time was associated with worse outcomes in patients who underwent lobectomy. Operative time is a potential risk factor to consider in the perioperative phase.

Lobectomy Versus Sublobar Resection in Simultaneous Bilateral Thoracoscopic Lung Resection

“…SBTLR simultaneous bilateral thoracoscopic lung resection, CT computed tomography p = 0.002), indicating that the operative time had a notable association with the short-term outcome of patients who underwent SBTLR. Our result is consistent with findings from a recent large retrospective study demonstrating that longer operative time is associated with worse outcomes in patients undergoing pulmonary lobectomy [17]. The extent of resection did not have a substantial impact on postoperative complications.…”

Prediction of postoperative pulmonary complications in older patients undergoing lobectomy for lung cancer based on skeletal muscle mass

“…In the present study, age, smoking, and DM were shown to be risk factors for PPCs after lobectomy. Age and smoking has been shown previously to be a predictive factor ( 28 , 29 ), but there has been some controversy regarding DM. Komatsu et al ( 30 ) reported that DM did not influence postoperative recovery in the acute phase.…”

Association of Mechanical Energy and Power with Postoperative Pulmonary Complications in Lung Resection Surgery: A Post Hoc Analysis of Randomized Clinical Trial Data

“…Evidence from studies of MP in experimental lung injury models is consistent with a threshold effect; that is, MP had to be delivered in excess of specific thresholds to cause severe injury. 21,39 In general surgery 40 and thoracic surgery using one-lung ventilation, 41 it appears that injurious ventilatory stimuli must be delivered for a sufficient period of time to induce lung injury. Thus far, in studies linking MP and postoperative pulmonary complications in surgical patients, the relationship between the exposure and outcome appears to be a more graded phenomenon, 25,27 potentially reflecting the very disparate outcome definitions.…”