CHICAGO – Longer operative time is independently associated with perioperative morbidity after laparoscopic and robotic hysterectomy, according to a review of cases from the American College of Surgeons National Surgical Quality Improvement Program.
The overall complication rate in the 9,064 laparoscopic and robotic hysterectomies recorded in the database (ACS NSQIP) increased significantly and in tandem with increasing operative time, Dr. Tatiana L. Catanzarite reported in a blue ribbon poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.
For example, the overall complication rate was 2.79% for operative time of 20-59 minutes and 18.75% for operative time greater than 360 minutes, according to Dr. Catanzarite of Northwestern University, Chicago.
Operative time of 240 minutes or longer was associated with increased overall complications, medical complications, surgical complications, reoperation, transfusion, urinary tract infection, and deep vein thrombosis/pulmonary embolism on both bivariate and multivariable regression analysis. Factors associated with operative time of 240 minutes or longer included age over 50 years, obesity, nonsmoking status, hypertension, history of stroke or transient ischemic attack, and American Anesthesiologists Society (ASA) class greater than 3, she noted.
Patients included in the database, which contains prospectively collected data for more than 240 variables from more than 460 participating institutions, underwent total or subtotal laparoscopic hysterectomy between 2006 and 2011. Patients with concomitant procedures, emergency surgery, gynecologic cancer, ASA class 5, or operative time less than 20 minutes were excluded from the analysis.
Similar findings have been reported for general surgery, but studies in gynecology have been conflicting, Dr. Catanzarite noted.
"Future research should aim to identify risk factors for excessive operative time in order to select appropriate candidates for minimally invasive approaches and maximize surgical efficiency," she wrote.
Dr. Catanzarite reported having no relevant financial disclosures.