Chetna Bakshi, MD, Gainosuke Sugiyama, MD, FACS, Charles Choy, MD, FACS, Gene Coppa, MD, FACS, Antonio Alfonso, MD, FACS, Paul Chung, MD. Zucker School of Medicine at Hofstra/Northwell
Background: Laparoscopic cholecystectomy is one of the most common operations performed in general surgery in the United States. It has been suggested that increased operative time (OT) is correlated with increased risk of complications in laparoscopic surgeries across various surgical fields1,2,3.
Objective: To determine if increased operative time is associated with increased risk of complications in laparoscopic cholecystectomy.
Methods: Using ACS NSQIP from 2006-2015, we identified all adult (≥18 years) patients that underwent an emergent laparoscopic cholecystectomy with a postoperative diagnosis of cholecystitis performed within 3 days of admission, by a general surgeon with a wound classification of clean/contaminated or contaminated. We excluded cases with preoperative SIRS/sepsis, ASA class IV or V, and cases that had additional procedures listed. We also limited our analysis to cases with OT ≥15 minutes and ≤360 minutes. Risk variables included age, sex, race, morbid obesity (BMI ≥40 kg/m2), functional status, ASA class, and operative time. Outcome variables included postoperative superficial surgical site infection (SSI), deep SSI, organ-space SSI, dehiscence, pneumonia, reintubation, failure to wean from ventilator, pulmonary embolism, renal failure, urinary tract infection, cardiac arrest, myocardial infarct, bleeding, deep vein thrombosis, sepsis, septic shock, return to the operating room, and death. Multivariable logistic regression was performed adjusting for all risk variables. Postoperative length of stay (LOS) was analyzed using negative binomial regression adjusting for all risk variables.
Results: A total of 7,031 cases met inclusion criteria, of which the majority were women (71.5%), Caucasian (80.0%), with a mean age of 46.1 years. Median OT was 63 minutes, first quartile was 46 minutes and third quartile was 87 minutes. Logistic regression analysis showed that increased OT (third vs first quartile) was an independent risk factor for superficial SSI (OR 1.75, 95% CI 1.36-2.25, p<0.0001), organ-space SSI (OR 1.77, 95% CI 1.33-2.35, p<0.0001), dehiscence (OR 2.03, 95% CI 1.01-4.07, p=0.0470), septic shock (OR 1.81, 95% CI 1.06-3.09, p=0.0286). Increased OT was independently associated with increased LOS (fourth vs 1st quartile: IRR 1.53, p<0.0001; third vs 1st quartile: IRR 1.29, p<0.0001; 2nd vs 1st quartile: IRR 1.16, p<0.0001).
Conclusion: In this large observational study we found that increased OT is independently associated with morbidity and increased postoperative LOS following laparoscopic cholecystectomy for cholecystitis. Prospective studies are warranted to determine whether increased OT from resident training is a contributing factor.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93995
Program Number: P221
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster