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“Every minute counts”: association between operative time and post-operative complications for patients undergoing minimally invasive sacrocolpopexy

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Abstract

Introduction and hypothesis

Our aim was to assess whether operative time is independently associated with post-operative complications for minimally invasive sacrocolpopexy (MISCP).

Methods

Using the National Surgical Quality Improvement Program (NSQIP) database, patients undergoing MISCP from 2015 to 2020 were identified by CPT code. The following data were extracted: demographics, concomitant procedures (hysterectomies, midurethral sling, and anterior or posterior repair), and post-operative complications. Complications were categorized into minor, major, and composite, modeled after the Clavien–Dindo classification. For analysis, covariates associated with operative time and composite complications were identified using a general linear model and Chi-squared or Fisher’s exact test as appropriate. Then, adjusted spline regression was performed as a test of nonlinearity between operative time and composite complications. Adjusted relative risks of complications by 60-min increments were estimated using Poisson regression with robust error variance.

Results

A total of 13,239 patients who underwent MISCP were analyzed. Overall, mean operative time (SD) was 189.5 (78.3) min. Post-operative complication rates were 2.6% for minor, 4.7% for major, and 7.3% for composite complications. Age, smoking, and sling were the only covariates associated with both operative time and post-operative complications. Adjusted spline regression demonstrated linearity (p<0.0001). With each 60-min increase in operative time, adjusted relative risks (95% CI) were 1.14 for composite (1.09, 1.19), 1.16 for minor (1.10, 1.21), and 1.11 (1.03, 1.20) for major complications.

Conclusions

Operative time is independently and linearly associated with post-operative complications for patients undergoing MISCP, even when adjusted for demographic variables and concomitant procedures.

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References

  1. Gabriel B, Nassif J, Barata S, Wattiez A. Twenty years of laparoscopic sacrocolpopexy: where are we now? Int Urogynecol J. 2011;22(9):1165–9.

    Article  Google Scholar 

  2. Linder BJ, Occhino JA, Habermann EB, Glasgow AE, Bews KA, Gershman B. A national contemporary analysis of perioperative outcomes of open versus minimally invasive sacrocolpopexy. J Urol. 2018;200(4):862–7.

    Article  Google Scholar 

  3. Nosti PA, Andy UU, Kane S, White DE, Harvie HS, Lowenstein L, et al. Outcomes of abdominal and minimally invasive sacrocolpopexy: a retrospective cohort study. Female Pelvic Med Reconstr Surg. 2014;20(1):33–7.

    Article  Google Scholar 

  4. Geller EJ, Siddiqui NY, Wu JM, Visco AG. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol. 2008;112(6):1201–6.

    Article  Google Scholar 

  5. Paraiso MFR, Walters MD, Rackley RR, Melek S, Hugney C. Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol. 2005;192(5):1752–8.

    Article  Google Scholar 

  6. Lee RK, Mottrie A, Payne CK, Waltregny D. A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse. Eur Urol. 2014;65(6):1128–37.

    Article  Google Scholar 

  7. Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, et al. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014;123(1):5–12.

    Article  Google Scholar 

  8. Tan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES. Robotic-assisted and laparoscopic sacrocolpopexy: comparing operative times, costs and outcomes. Female Pelvic Med Reconstr Surg. 2011;17(1):44–9.

    Article  Google Scholar 

  9. Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad B, Ferko NC, Cameron CG, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018;229:134–44.

    Article  Google Scholar 

  10. Catanzarite T, Saha S, Pilecki MA, Kim JYS, Milad MP. Longer operative time during benign laparoscopic and robotic hysterectomy is associated with increased 30-day perioperative complications. J Minim Invasive Gynecol. 2015;22(6):1049–58.

    Article  Google Scholar 

  11. ACS NSQIP Participant Use Data File [Internet]. American College of Surgeons. Accessed 25 Aug 2021. Available from: http://www.facs.org/quality-programs/acs-nsqip/participant-use

  12. da Luz MA, Kiran RP, Kirat HT, Remzi FH, Geisler DP, Church JM, et al. Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc. 2010;24(6):1280–6.

    Article  Google Scholar 

  13. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77(2):217–22.

    Article  CAS  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  15. Surace P, Sultan AA, George J, Samuel LT, Khlopas A, Molloy RM, et al. The association between operative time and short-term complications in total hip arthroplasty: an analysis of 89,802 surgeries. J Arthroplast. 2019;34(3):426–32.

    Article  Google Scholar 

  16. Ravi B, Jenkinson R, O’Heireamhoin S, Austin PC, Aktar S, Leroux TS, et al. Surgical duration is associated with an increased risk of periprosthetic infection following total knee arthroplasty: a population-based retrospective cohort study. EClinicalMedicine. 2019;16:74–80.

    Article  Google Scholar 

  17. Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med. 1989;8(5):551–61.

    Article  CAS  Google Scholar 

  18. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.

    Article  Google Scholar 

  19. Siedhoff MT, Carey ET, Findley AD, Riggins LE, Garrett JM, Steege JF. Effect of extreme obesity on outcomes in laparoscopic hysterectomy. J Minim Invasive Gynecol. 2012;19(6):701–7.

    Article  Google Scholar 

  20. Molarius A, Seidell JC, Kuulasmaa K, Dobson AJ, Sans S. Smoking and relative body weight: an international perspective from the WHO MONICA Project. J Epidemiol Community Health. 1997;51(3):252–60.

    Article  CAS  Google Scholar 

  21. Plurphanswat N, Rodu B. The association of smoking and demographic characteristics on body mass index and obesity among adults in the U.S., 1999–2012. BMC Obes. 2014;30(1):18.

    Article  Google Scholar 

  22. Reznick D, Niazov L, Holizna E, Keebler A, Siperstein A. Dedicated teams to improve operative room efficiency. Perioper Care Oper Room Manag. 2016;3:1–5.

    Article  Google Scholar 

  23. Xiao Y, Jones A, Zhang B(B), Bennett M, Mears SC, Mabrey JD, et al. Team consistency and occurrences of prolonged operative time, prolonged hospital stay, and hospital readmission: a retrospective analysis. World J Surg. 2015;39(4):890–6.

    Article  Google Scholar 

  24. Mantoo S, Rigaud J, Naulet S, Lehur PA, Meurette G. Standardized surgical technique and dedicated operating room environment can reduce the operative time during robotic-assisted surgery for pelvic floor disorders. J Robot Surg. 2014;8(1):7–12.

    Article  Google Scholar 

  25. Carter-Brooks CM, Du AL, Bonidie MJ, Shepherd JP. The impact of a dedicated robotic team on robotic-assisted sacrocolpopexy outcomes. Female Pelvic Med Reconstr Surg. 2018;24(1):13–6.

    Article  Google Scholar 

  26. Pan K, Zhang Y, Wang Y, Wang Y, Xu H. A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy. Int J Gynecol Obstet. 2016;132(3):284–91.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Edward K. Kim, Uduak U. Andy & Heidi S. Harvie

  2. Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Jeremy C. Applebaum & Elizabeth S. Kravitz

  3. Department of Biostatics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Stefanie N. Hinkle

  4. Center for Research on Reproductive and Women’s Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Nathanael C. Koelper

Authors
  1. Edward K. Kim
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  2. Jeremy C. Applebaum
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  3. Elizabeth S. Kravitz
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  4. Stefanie N. Hinkle
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  5. Nathanael C. Koelper
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  6. Uduak U. Andy
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  7. Heidi S. Harvie
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Contributions

E.K. Kim: project development, data collection, data analysis, manuscript writing; J.C. Applebaum: project development, data analysis, manuscript writing, manuscript editing; E.S. Kravitz: manuscript writing, manuscript editing; S.N. Hinkle: data analysis; N.C. Koelper: data analysis; U.A. Andy: project development, manuscript editing; H.S. Harvie: project development, data analysis, manuscript editing.

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Correspondence to Edward K. Kim.

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Kim, E.K., Applebaum, J.C., Kravitz, E.S. et al. “Every minute counts”: association between operative time and post-operative complications for patients undergoing minimally invasive sacrocolpopexy. Int Urogynecol J 34, 263–270 (2023). https://doi.org/10.1007/s00192-022-05412-1

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  • DOI: https://doi.org/10.1007/s00192-022-05412-1

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