Impact of Operative Duration on Postoperative Pulmonary Complications in Laparoscopic vs Open Colectomy

Rachel M Owen, MD, Sebastian D Perez, MSPH, S. Scott Davis, MD, Edward Lin, DO, Ankit D Patel, MD, Nathanial Lytle, MD, John F Sweeney, MD

Emory University Department of Surgery, Division of General and Gastrointestinal Surgery

Introduction: Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is commonly associated with longer operative duration when compared to open colectomy (OC), research shows paradoxically decreased morbidity following LC vs. OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC vs. OC has not been analyzed.

Methods: We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 hours, and unplanned intubation) as well as 30-day mortality were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC while controlling for LC vs. OC.

Results: 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed. 765 (3.0%) patients experienced at least one PPC. Regression modeling demonstrated that for both LC and OC, each 60-minute increase in operative time up to 480 minutes was associated with 13% increased odds of PPC (OR 1.13; 95% CI 1.07-1.19). Beyond 480 minutes, each additional 60-minute interval was associated with 33% increased risk of PPC (OR 1.33; 95% CI 1.12-1.58). Overall, PPCs occurred half as often following an LC (270 [2.0%] laparoscopic vs. 497 [4.3%] open; OR 0.45, 95% CI 0.39-0.53).

Figure: Predicted and Actual Rate of Postoperative Pulmonary Complication in Lap vs. Open Colectomy

Conclusions: Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.

Session: Podium Presentation

Program Number: S098

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