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Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy

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Abstract

Background

Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus 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 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC.

Results

A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for both LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07–1.19]. Beyond 480 min, each additional 60-min 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 LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39–0.53].

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.

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Acknowledgments

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Disclosures

Drs. Owen, Lytle, Patel, Davis, Lin, Sweeney, and Mr. Perez have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of General and Gastrointestinal Surgery, Emory University School of Medicine, 1364 Clifton Road NE, Suite H-124, Atlanta, GA, 30322, US

    Rachel M. Owen, Nathan Lytle, Ankit Patel, S. S. Davis, Edward Lin & John F. Sweeney

  2. Department of Surgery Patient Safety and Data Management Program, Emory University School of Medicine, Atlanta, GA, US

    Rachel M. Owen, Sebastian D. Perez & John F. Sweeney

Authors
  1. Rachel M. Owen
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  2. Sebastian D. Perez
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Correspondence to John F. Sweeney.

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Owen, R.M., Perez, S.D., Lytle, N. et al. Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc 27, 3555–3563 (2013). https://doi.org/10.1007/s00464-013-2949-9

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  • DOI: https://doi.org/10.1007/s00464-013-2949-9

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