Longer Operative Time During Laparoscopic Myomectomy Is Associated with Increased 30-Day Complications and Blood Transfusion

Abstract

Abstract

Background: An association between operative time and complications is well-established in the general surgery literature, with many studies isolating operative time as an independent risk factor for postoperative complications, including infectious morbidity, ileus, and increased length of hospital stay. However, the potential association between longer operative time and perioperative complications in laparoscopic myomectomy has not yet been delineated clearly. Objective: The aim of this study was to evaluate the association between operative time and 30-day complications after laparoscopic myomectomy. Materials and Methods: Study Design: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized for the evaluation. Data were retrieved retrospectively for laparoscopic myomectomy procedures recorded between 2005 and 2012 at all institutions contributing to the ACS-NSQIP (Canadian Task Force classification II-2). Given utilization of de-identified data, the current authors' institutional review board did not require a formal review. Patients were identified via Current Procedural Terminology codes for laparoscopic myomectomy, namely, 58545 (1–5 intramural myomas weighing ≤250 g and/or surface myomas) and 58546 (≥5 intramural myomas and/or weight >250 g). Outcomes: Primary outcomes included 30-day overall, medical, and surgical complications and return to the operating room. Statistics: Bivariate comparisons to determine associations between clinical and procedural variables, longer operative time, and complications were performed using Chi-square or Fisher's exact tests for categorical variables and independent samples t-tests for continuous variables. Multivariable logistic regression analyses were performed to determine the independent association between operative time and perioperative complications. Results: During the study period 1017, laparoscopic myomectomy procedures were identified. The overall complication rate was 5.3%, with the most common complications being blood transfusion (3.4%), surgical site infection (1.1%), and urinary tract infection (0.5%). Return to the operating room occurred in 0.4% of patients. There were no deaths. Overall and medical complication rates increased as surgical duration increased, with an inflection point noted at 240 minutes. An operative time ≥240 minutes was associated with increased overall complications (13.7% versus 3.1%; p<0.001), medical complications (13.2% versus 2.2%; p<0.001), pneumonia (1.4% versus 0%; p=0.001), and blood transfusion (9.9% versus 1.7%; p<0.001). On multivariable regression analysis, an operative time ≥240 minutes was independently associated with medical complications (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 2.77–10.20; p<0.001), blood transfusion (OR: 4.80; 95% CI: 2.27–10.11; p<0.001), and overall complications (OR 3.92; 95% CI 2.17–7.07; p<0.001). Based on continuous regression modeling of operative time, for each additional hour of operative time, odds of medical complications would be expected to increase by a factor of 1.65, blood transfusion by 1.66, and overall complications by 1.52. Conclusions: This study demonstrated an independent association between longer operative time during laparoscopic myomectomy and higher rates of 30-day overall complications, medical complications, and blood transfusion. Future research should aim to delineate risk factors further for prolonged operative time and morbidity in laparoscopic myomectomy in order to enable surgeons to maximize preoperative planning and optimize patient selection for minimally invasive myomectomy. (J GYNECOL SURG 32:11)