Operative Time Longer Than 180 Minutes in Abdominal Hysterectomy is Predictive of 30-Day Perioperative Complications

Abstract

to operative time. Operative times were divided into 60-minute intervals and complication rates analyzed. Bivariate analysis and multivariate regression modeling were performed to assess the association between operative time and complications. Results: A total of 16,864 abdominal hysterectomy procedures were identified. Rates of 30-day overall, medical, surgical complications, and reoperation were 12.4%, 9.2%, 4.2%, and 1.7%, respectively. Complication rates increased significantly with increasing operative time, with an inflection point noted at 180 minutes. Patients with operative time R180 minutes were more likely to be >50 years old, obese, nonsmokers, diabetic, hypertensive, ASA class 3-4, and to have higher RVU coded for the procedure. On bivariate analysis, operative time R180 minutes was associated with increased overall complications (25% versus 10.4%, p \ 0.001), surgical complications (7.1 versus 3.1%, p \ 0.001), medical complications (19.9% versus 7.5%, p \ 0.001), reoperation (2.5% versus 1.6%, p = 0.001), blood transfusion (14.3% versus 4%, p \ 0.001), deep venous thrombosis (0.5% versus 0.2%, p = 0.002), pulmonary embolism (1.1% versus 0.3%, p \ 0.001), and urinary tract infection (3.8% versus 2.3%, p \ 0.001). Mortality was low in both groups at 0.1%. After multivariable regression analysis, operative time R180 minutes was independently predictive of overall complications (OR = 2.3, 95% CI = 2.0 to 2.5, p \ 0.001), medical complications (OR = 2.4, 95% CI = 2.1 to 2.8, p \ 0.001), surgical complications (OR = 1.6, 95% CI = 1.3 to 1.9, p \ 0.001), blood transfusion (OR = 3.0, 95% CI = 2.5 to 3.4, p \ 0.001), venous thromboembolism (OR = 2.6, 95% CI = 1.7 to 4.0, p \ 0.001), and urinary tract infection (OR = 1.5, 95% CI = 1.2 to 1.9, p = 0.002). Conclusion: We have demonstrated a direct, independent correlation between increased operative time during abdominal hysterectomy and increased 30-day overall complications, medical complications, surgical complications, reoperation, blood transfusion, venous thromboembolism, and urinary tract infection. Additional study is needed regarding risk factors for prolonged operative time in hysterectomy, the comparative advantages and morbidity of minimally invasive hysterectomy relative to abdominal hysterectomy, and the relationship of these differential risks to operative time.

Predictors of 30‐day morbidity after hysterectomy for benign disease

“…Several studies have reported that prolonged operative time was associated with a negative surgical outcome. 16,17 In a retrospective cohort study of 28 366 women form the NSQIP data, operative time more than 180 minutes was a predictor for surgical site infection in both abdominal hysterectomy and LAVH groups. 16 In a study of 16 864 women who underwent abdominal hysterectomy, operative time more than 180 minutes was independently predictive of overall complications.…”

“…16 In a study of 16 864 women who underwent abdominal hysterectomy, operative time more than 180 minutes was independently predictive of overall complications. 17 Operative time is probably directly proportional to complicated surgery and represents several categories of harmful events, such as insufficient prophylactic antibiotics, breaking sterile technique, tissue damage owing to prolonged traction or manipulation, and risk of thermal dysregulation. 16 Thus, these potential risk factors should be monitored, especially in women subjected to longer surgery.…”

“…In the present study, operative time remained an independent predictor of morbidity. Several studies have reported that prolonged operative time was associated with a negative surgical outcome . In a retrospective cohort study of 28 366 women form the NSQIP data, operative time more than 180 minutes was a predictor for surgical site infection in both abdominal hysterectomy and LAVH groups .…”

“…In a retrospective cohort study of 28 366 women form the NSQIP data, operative time more than 180 minutes was a predictor for surgical site infection in both abdominal hysterectomy and LAVH groups . In a study of 16 864 women who underwent abdominal hysterectomy, operative time more than 180 minutes was independently predictive of overall complications . Operative time is probably directly proportional to complicated surgery and represents several categories of harmful events, such as insufficient prophylactic antibiotics, breaking sterile technique, tissue damage owing to prolonged traction or manipulation, and risk of thermal dysregulation .…”

Reloadable Stapler Use during Peripartum Hysterectomy for Placenta Accreta Spectrum: A Novel Surgical Technique and Case Series

“…[22][23][24] This is important as prolonged operative times are associated with poorer patient outcomes. 25,26 Gestational age at hospitalization (wk) 33 5/7 AE 2 4/7…”