Influence of median surgeon operative duration on adverse outcomes in bariatric surgery

Abstract

Background Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon’s speed could reflect skill and efficiency, but may alternatively reflect haste. Objectives This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes following laparoscopic Roux-en-Y gastric bypass. Methods We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables. Results A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure [median (Interquartile range) 139 (133–150) vs. 86 (69–91), p<0.001]. After adjustment for patient characteristics only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, ED visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5% vs. 7.1%, p=0.039), prolonged length of stay (14.0% vs. 4.4%, p=0.002), and VTE (0.39% vs. 0.22%, p<0.001). Conclusions Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes following laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery.

Prolonged operative duration is associated with complications: a systematic review and meta-analysis

“…For example, the correlation between SSIs and prolonged operative duration can be attributable to various time-related factors such as prolonged microbial exposure, diminished efficacy of antimicrobial prophylaxis over time, increased tissue retraction leading to tissue ischemia, necrosis, and desiccation, and increased opportunities for violations in sterile technique. 78,[82][83][84][85] In contrast, the increased risk of VTE due to prolonged operative duration has been linked to factors such as increased coagulation, blood stasis, and endothelial damage resulting from longer surgical procedures. [86][87][88][89] Prolonged operative times are also associated with increased surgical team fatigue and extension of anesthesia durationdfactors that enhance the risk for many different types of complications.…”

Anesthesia Duration as an Independent Risk Factor for Early Postoperative Complications in Adults Undergoing Elective ACDF

“…Traditionally, operative duration has been associated with postoperative morbidity and mortality for a variety of general surgical, vascular, orthopedic, and other procedures. 7 , 21 – 24 In the setting of spine surgery, Kim et al 25 analyzed 4588 patients from the ACS-NSQIP database who underwent single-level lumbar fusion and showed that increased operative time was associated with stepwise increase in risk of overall complications, medical complications, surgical complications, and transfusions. Additionally, the type of operation as well as operative length is expected to be indirectly related with anesthesia induction and maintenance times, as it dictates the need for invasive monitoring, special patient positioning, and extent of antiseptic preparation.…”

Risk Factors for Prolonged Length of Hospital Stay and Readmissions After Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass

“…We hypothesize that it may be caused by individualized perioperative care, which was proven in another surgical disciplines [ 7 , 41 – 43 ]. In studies by Reames et al, Carter et al, and Dallall et al, researchers concluded that the longer was the operative time, the greater was the risk for prolonged length of stay [ 17 , 18 , 20 ]. The same relationship was found in our study; however, a multivariate analysis revealed that it was contributing less to the risk of prolonged LOS.…”