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Operative Duration Is Associated With Postoperative Complications In Infrainguinal Revascularization
Alasdair Fletcher, BSc
1, Jonah Thomas, MD
2, Sarah J. Carlson, MD
2, Joseph D. Raffetto, MD
2, James T. McPhee, MD
2.
1University of Cambridge, Cambridge, United Kingdom,
2VA Boston Healthcare System, West Roxbury, MA, USA.
OBJECTIVES: This study aims to assess if operative duration is associated with post-operative outcomes in a range of infrainguinal revascularization procedures. Additionally, we aimed to determine the rate of increase of adverse outcomes with an incremental increase in operative duration.
METHODS: This is a retrospective cohort study analyzing data from the multi-institutional Veterans Association Quality improvement Project (VASQIP) database. Patients were stratified into cohorts by 30-minute increments in operative duration, with analyses comparing the likelihood of each adverse postoperative outcome at each of these increments to the shortest operation duration cohort. To control for confounding variables (smoking status, anesthesia type, procedure type, baseline comorbidities, etc.) a backwards elimination logistic regression model was utilized (R, version 4.4.1).
RESULTS: Univariate analysis showed a stepwise increase in odds ratios of various postoperative complications compared to operations lasting fewer than 2 hours as operative duration increased (Figure 1). Multivariable logistic regression, adjusted for factors such as age, demographics, and medical history, revealed that each additional hour of surgery was associated with the following increased odds ratios: major adverse cardiac events (MACE) by 1.12 (95% CI, 1.06-1.18; p < 0.0001), graft failure by 1.21 (95% CI, 1.16-1.26; p < 0.00001), respiratory complications by 1.22 (95% CI, 1.15-1.29; p < 0.00001), return to the operating room by 1.09 (95% CI, 1.07-1.12; p < 0.00001), any NSQIP complication by 1.12 (95% CI, 1.10-1.15; p < 0.00001), and wound complications by 1.14 (95% CI, 1.12-1.17; p < 0.00001).
Figure 1: Unadjusted odds ratios of postoperative complications by operative duration compared to a reference value of an operation of under two hours.
CONCLUSIONS: Operative duration is strongly associated with complications in infrainguinal revascularization procedures, including wound complications, return to operating room, and graft failure. While in many cases it is a surrogate for operative complexity, efforts to reduce operative duration may improve outcomes.
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