How long is too long? The effect of the duration of anaesthesia on the incidence of non‐urological complications after surgery

Routh, Jonathan C.; Bacon, Douglas R.; Leibovich, Bradley C.; Zincke, Horst; Blute, Michael L.; Frank, Igor

doi:10.1111/j.1464-410x.2008.07663.x

Cited by 32 publications

(9 citation statements)

References 9 publications

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“…We also observed that in our cohort, increasing operative time, female gender, and decreasing BMI were associated with increased major complication risks. Although the association of female gender and decreasing BMI is likely an artificial finding with minimal clinical relevance, our findings support previous observations that increasing time under anesthesia may affect postoperative sequelae [29]. …”

Section: Discussionsupporting

confidence: 88%

Objective Measures of Renal Mass Anatomic Complexity Predict Rates of Major Complications Following Partial Nephrectomy

et al. 2011

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Background The association between tumor complexity and postoperative complications after partial nephrectomy (PN) has not been well characterized. Objective We evaluated whether increasing renal tumor complexity, quantitated by nephrometry score (NS), is associated with increased complication rates following PN using the Clavien-Dindo classification system (CCS). Design, setting, and participants We queried our prospectively maintained kidney cancer database for patients undergoing PN from 2007 to 2010 for whom NS was available. Interventions All patients underwent PN. Measurements Tumors were categorized into low- (NS: 4–6), moderate- (NS: 7–9), and high-complexity (NS: 10–12) lesions. Complication rates within 30 d were graded (CCS: I–5), stratified as minor (CCS: I or 2) or major (CCS: 3–5), and compared between groups. Results and limitations A total of 390 patients (mean age: 58.0 ± 11.9 yr; 66.9% male) undergoing PN (44.6% open, 55.4% robotic) for low- (28%), moderate- (55.6%), and high-complexity (16.4%) tumors (mean tumor size: 3.74 ± 2.4 cm; median: 3.2 cm) from 2007 to 2010 were identified. Tumor size, estimated blood loss, and ischemia time all significantly differed (p < 0.0001) between groups; patient age, body mass index (BMI), and operative time were comparable. When stratified by CCS, minor and major complication rates for all patients were 26.7% and 11.5%, respectively. Minor complication rates were comparable (26.6 vs 24.9 vs 32.8%; p = 0.45), whereas major complication rates differed (6.4 vs 11.1 vs 21.9%; p = 0.009) among tumor complexity groups. Controlling for age, gender, BMI, type of surgical approach, operative duration, and tumor complexity, prolonged operative time (odds ratio [OR]: 1.01; confidence interval [CI], 1.0–1.02) and high tumor complexity (OR: 5.4; CI, 1.2–24.2) were associated with the postoperative development of a major complication. Lack of external validation is a limitation of this study. Conclusions Increasing tumor complexity is associated with the development of major complications after PN. This association should be validated externally and integrated into the decision-making process when counseling patients with complex renal tumors.

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Section: Discussionsupporting

confidence: 88%

Objective Measures of Renal Mass Anatomic Complexity Predict Rates of Major Complications Following Partial Nephrectomy

et al. 2011

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“…Previous observation found that longer anesthesia was associated with an increase in the incidence of perioperative nonurological complications. 32 For this reason, we further classified the complication into surgical complication and nonsurgical complication. We found that ZS score had more predictive power of surgical complications than RENAL and PADUA.…”

Section: Discussionmentioning

confidence: 99%

The Zhongshan Score

et al. 2015

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“…The association between increased operative time and morbidity has been well documented in general and procedure-specific analyses. [11][12][13][14] Several studies 11,12,14 have found that a longer operation is associated with increased rates of infection, wound disruption, and thrombotic events in patients undergoing free flap surgery. In addition, prolonged anesthesia duration may be particularly important in microvascular surgery because flap viability is intimately related to the degree of intraoperative hemodynamic control.…”

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confidence: 99%

Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

Brady

Desai

Crippen

et al. 2018

JAMA Facial Plast Surg

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IMPORTANCE Prolonged anesthesia and operative times have deleterious effects on surgical outcomes in a variety of procedures. However, data regarding the influence of anesthesia duration on microvascular reconstruction of the head and neck are lacking.OBJECTIVE To examine the association of anesthesia duration with complications after microvascular reconstruction of the head and neck. DESIGN, SETTING, AND PARTICIPANTS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to collect data. In total, 630 patients who underwent head and neck microvascular reconstruction were recorded in the NSQIP registry from January 1, 2005, through December 31, 2013. Patients who underwent microvascular reconstructive surgery performed by otolaryngologists or plastic surgeons were included in this study. Data analysis was performed from October 15, 2015, to January 15, 2016. EXPOSURES Microvascular reconstructive surgery of the head and neck. MAIN OUTCOMES AND MEASURES Patients were stratified into 5 quintiles based on mean anesthesia duration and analyzed for patient characteristics and operative variables (mean [SD] anesthesia time: group 1, 358.1 [175.6] minutes; group 2, 563.2 [27.3] minutes; group 3, 648.9 [24.0] minutes; group 4, 736.5 [26.3] minutes; and group 5, 922.1 [128.1] minutes). Main outcomes include rates of postoperative medical and surgical complications and mortality. RESULTS A total of 630 patients undergoing head and neck free flap surgery had available data on anesthesia duration and were included (mean [SD] age, 61.6 [13.8] years; 436 [69.3%] male). Bivariate analysis revealed that increasing anesthesia duration was associated with increased 30-day complications overall (55 [43.7%] in group 1 vs 80 [63.5%] in group 5, P = .006), increased 30-day postoperative surgical complications overall (45 [35.7%] in group 1 vs 78 [61.9%] in group 5, P < .001), increased rates of postoperative transfusion (32 [25.4%] in group 1 vs 70 [55.6%] in group 5, P < .001), and increased rates of wound disruption (0 in group 1 vs 10 [7.9%] in group 5, P = .02). No specific medical complications and no overall medical complication rate (24 [19.0%] in group 1 vs 22 [17.5%] in group 5, P = .80) or mortality (1 [0.8%] in group 1 vs 1 [0.8%] in group 5, P = .75) were associated with increased anesthesia duration. On multivariate analysis accounting for demographics and significant preoperative factors including free flap type, overall complications (group 5: odds ratio [OR], 1.98; 95% CI, 1.10-3.58; P = .02), surgical complications (group 5: OR, 2.46; 95% CI, 1.35-4.46; P = .003), and postoperative transfusion (group 5: OR, 2.31; 95% CI, 1.27-4.20; P = .006) remained significantly associated with increased anesthesia duration; the association of wound disruption and increased anasthesia duration was nonsignificant (group 5: OR, 2.0; 95% CI, 0.75-5.31; P = .16). CONCLUSIONS AND RELEVANCEIncreasing anesthesia duration was associated with significantly increased rates of surgical complic...

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How long is too long? The effect of the duration of anaesthesia on the incidence of non‐urological complications after surgery

Cited by 32 publications

References 9 publications

Objective Measures of Renal Mass Anatomic Complexity Predict Rates of Major Complications Following Partial Nephrectomy

Objective Measures of Renal Mass Anatomic Complexity Predict Rates of Major Complications Following Partial Nephrectomy

The Zhongshan Score

Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

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