The Impact of Prolonged Operative Time Associated with Minimally Invasive Colorectal Surgery: A Report from the Surgical Care Outcomes Assessment Program.

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Diseases of the colon and rectum


washington; swedish cancer


BACKGROUND: Increased operative time in colorectal surgery is associated with worse surgical outcomes. Laparoscopic and robotic operations have improved outcomes, despite longer operative times. Further, the definition of "prolonged" operative time has not been consistently defined.

OBJECTIVE: The first objective was to define prolonged operative time across multiple colorectal operations and surgical approaches. The second was to describe the impact of prolonged operative time on length of stay and short-term outcomes.

DESIGN: Retrospective-cohort study.

SETTING: Forty-two hospitals in the Surgical Care Outcomes Assessment Program from 2011-2019.

PATIENTS: There were a total of 23,098 adult patients (age 18 years and older), undergoing 6 common, elective colorectal operations: right colectomy, left/sigmoid colectomy, total colectomy, low anterior resection, ileal-pouch anal anastomosis, or abdominoperineal resection.

MAIN OUTCOME MEASURES: Prolonged operative time defined as the 75th quartile of operative times for each operation and approach. Outcomes were length of stay, discharge home, and complications. Adjusted models were used to account for factors that could impact both operative time and outcomes across the strata of open and minimally invasive approaches.

RESULTS: Prolonged operative time was associated with longer median length of stay (7 vs. 5 days open, 5 vs. 4 days laparoscopic, 4 vs. 3 days robotic), more frequent complications (42% vs. 28% open, 24% vs. 17% laparoscopic, 27% vs. 13% robotic), but similar discharge home (86% vs. 87% open, 94% vs. 94% laparoscopic, 93% vs. 96% robotic). After adjustment, each additional hour of operative time above the median for a given operation was associated with 1.08 (1.06, 1.09) relative risk of longer length of stay for open operations and 1.07 (1.06, 1.09) relative risk for minimally invasive operations.

LIMITATIONS: Our study was limited by being retrospective, resulting in selection bias, possible confounders for prolonged operative time, and lack of statistical power for subgroup analyses.

CONCLUSIONS: Operative time has consistent overlap across surgical approaches. Prolonged operative time is associated with longer length of stay and higher probability of complications, but this negative effect is diminished with minimally invasive approaches.

Clinical Institute


Clinical Institute

Digestive Health