Skip to main content

Advertisement

SpringerLink
Log in

The effect of operative duration on the outcome of colon cancer procedures

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Prolonged operative duration has been associated with increased post-operative morbidity in numerous surgical subspecialties; however, data are limited in operations for colon cancer specifically and existing literature makes unwarranted methodological assumptions of linearity. We sought to assess the effects of extended operative duration on perioperative outcomes in those undergoing segmental colectomy for cancer using a methodologically sound approach.

Methods

We conducted a retrospective cohort study of patients undergoing segmental colectomy for cancer between 2014 and 2018, logged in the National Surgical Quality Improvement Program datasets. Our primary outcome was a composite of any complication within 30 days; secondary outcomes included length of stay and discharge disposition. Our main factor of interest was operative duration.

Results

We analyzed 26,380 segmental colectomy cases, the majority of which were approached laparoscopically (64.95%) and were right sided (62.93%). Median operative duration was 152 (95% CI 112–206) minutes. On multivariable regression, increased operative duration was linearly associated with any complication (OR = 1.003, 95% CI 1.003–1.003, p < 0.0001) in the overall cohort, as was length of stay (p < 0.0001). All subgroups except for the laparoscopic left colectomy group were linearly associated with operative duration. In the laparoscopic left colectomy group, an inflection point in the odds of any complication was found at 176 min (OR = 1.39, 95% CI 1.20–1.61, p < 0.0001).

Conclusions

This study suggests that the risk of perioperative complications increases linearly with increasing operative duration, where each additional 30 min increases the odds of complication by 10%. In those undergoing laparoscopic left colectomy, the risk of complications sharply increases after ~ 3 h, suggesting that surgeons should aim to complete these procedures within 3 h where possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cheng H et al (2018) Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 229:134–144

    Article  Google Scholar 

  2. Jackson TD et al (2011) Does speed matter? The impact of operative time on outcome in laparoscopic surgery. Surg Endosc 25(7):2288–2295

    Article  Google Scholar 

  3. Procter LD et al (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210(1):60-65.e2

    Article  Google Scholar 

  4. Daley BJ et al (2015) How slow is too slow? Correlation of operative time to complications: an analysis from the Tennessee surgical quality collaborative. J Am Coll Surg 220(4):550–558

    Article  Google Scholar 

  5. Cortina CS et al (2019) Longer operative time and intraoperative blood transfusion are associated with postoperative anastomotic leak after lower gastrointestinal surgery. Am Surg 85(2):136–141

    Article  Google Scholar 

  6. Harrison OJ et al (2014) Operative time and outcome of enhanced recovery after surgery after laparoscopic colorectal surgery. JSLS 18(2):265–272

    Article  Google Scholar 

  7. Causey MW et al (2012) Initial operative time and metastatic disease recurrence. Mil Med 177(11):1382–1386

    Article  Google Scholar 

  8. Evans C et al (2012) Factors influencing laparoscopic colorectal operative duration and its effect on clinical outcome. Surg Laparosc Endosc Percutan Tech 22(5):437–442

    Article  Google Scholar 

  9. Scheer A et al (2009) Laparoscopic colon surgery: does operative time matter? Dis Colon Rectum 52(10):1746–1752

    Article  Google Scholar 

  10. Owen RM et al (2013) Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc 27(10):3555–3563

    Article  Google Scholar 

  11. Bailey MB et al (2014) Longer operative time: deterioration of clinical outcomes of laparoscopic colectomy versus open colectomy. Dis Colon Rectum 57(5):616–622

    Article  Google Scholar 

  12. User Guide for the 2018 ACS NSQIP participant use data file (PUF), in National Surgical Quality Improvement Program. American College of Surgeons.

  13. Davis SS Jr et al (2013) Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes. J Am Coll Surg 216(1):96–104

    Article  Google Scholar 

  14. Dull MB et al (2017) Resident impact on operative duration for elective general surgical procedures. Am J Surg 213(3):456–459

    Article  Google Scholar 

  15. Jarry C et al (2021) Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay. Updates Surg 73(1):93–100

    Article  Google Scholar 

  16. Sweigert PJ et al (2019) Do prolonged operative times obviate the benefits associated with minimally invasive colectomy? Surgery 166(3):336–341

    Article  Google Scholar 

  17. Nikolian VC et al (2017) Anastomotic leak after colorectal resection: a population-based study of risk factors and hospital variation. Surgery 161(6):1619–1627

    Article  Google Scholar 

  18. Royston P, Altman DG, Sauerbrei W (2006) Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med 25(1):127–141

    Article  Google Scholar 

  19. Shepherd BE et al (2017) Brief report: assessing and interpreting the association between continuous covariates and outcomes in observational studies of HIV using splines. J Acquir Immune Defic Syndr 74(3):e60–e63

    Article  Google Scholar 

  20. Petrucciani N et al (2019) Impact of conversion from laparoscopy to open surgery in patients with right colon cancer. Am Surg 85(2):177–182

    Article  Google Scholar 

  21. McDermott FD et al (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102(5):462–479

    Article  CAS  Google Scholar 

  22. Baloyiannis I et al (2020) Comparing the safety, efficacy, and oncological outcomes of laparoscopic and open colectomy in transverse colon cancer: a meta-analysis. Int J Colorectal Dis 35(3):373–386

    Article  Google Scholar 

  23. Clinical Outcomes of Surgical Therapy Study G, et al. (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 350(20): 2050–9.

  24. Lacy AM et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229

    Article  Google Scholar 

Download references

Funding

There is no grant support or financial relationship to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Keegan Guidolin, Richard T. Spence, Arash Azin, Dhruvin H. Hirpara, Kimberley Lam-Tin-Cheung, Fayez Quereshy & Sami Chadi

  2. Department of Surgery, University Health Network, Toronto, ON, Canada

    Fayez Quereshy & Sami Chadi

Authors
  1. Keegan Guidolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard T. Spence
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arash Azin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dhruvin H. Hirpara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kimberley Lam-Tin-Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fayez Quereshy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sami Chadi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sami Chadi.

Ethics declarations

Disclosures

Keegan Guidolin, Richard Spence, Arash Azin, Dhruvin Hirpara, Kimberley Lam-Tin-Chueng, Fayez Quereshy, and Sami Chadi declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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.

Appendix 1

Appendix 1

CPT Code

Description

44140

Colectomy, partial, with anastomosis

44141

Colectomy, partial, with skin level cecostomy or colostomy

44143

Colectomy, partial, with end colostomy and closure of distal segment (Hartmann)

44144

Colectomy, partial, with resection, with colostomy or ileostomy and creation of mucofistula

44145

Colectomy, partial, with coloproctostomy (low pelvic anastomosis)

44146

Colectomy, partial, with coloproctostomy (low pelvic anastomosis), with colostomy

44147

Colectomy, partial, abdominal and transanal approach

44160

Colectomy, partial with removal of terminal ileum with ileocolostomy

44204

Laparoscopy, surgical, colectomy, partial with anastomosis

44205

Laparoscopy, surgical colectomy, partial, with removal of terminal ileum with ileocolostomy

44206

Laparoscopy, surgical, colectomy, partial, with end colostomy and closure of distal segment

44207

Laparoscopy, surgical, colectomy, partial, with anastomosis, with coloproctostomy

44208

Laparoscopy, surgical, colectomy, partial with anastomosis, with coloproctostomy, with colostomy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guidolin, K., Spence, R.T., Azin, A. et al. The effect of operative duration on the outcome of colon cancer procedures. Surg Endosc 36, 5076–5083 (2022). https://doi.org/10.1007/s00464-021-08871-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08871-7

Keywords

Search

Navigation