Not All Operative Time Is Created Equal: Operative Time in Relation to 30-Day Complications in Benign Laparoscopic Hysterectomies

Study Objective To assess the relationship between operative time and specific 30-day postoperative complications across different tertiles of operation duration in total laparoscopic hysterectomies (TLH). Design A retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011-2020. Patients or Participants 131,141 TLH cases. Interventions Eligible cases included benign laparoscopic hysterectomies with operative times between 20 minutes and 499 minutes. We excluded cases involving disseminated cancer, emergency surgery, supracervical approaches, or concomitant procedures. Measurements and Main Results Multivariable logistic regression analysis demonstrated a significant association between operative time and complication occurrence for each complication type investigated, including unplanned readmission, urinary tract infections, superficial surgical site infections, blood transfusion administration, return to the operating room, and deep organ space infections. Multivariable logistic spline regression demonstrated that operative time contributed more strongly to the odds of a complication for shorter procedures than longer procedures. This relationship was more pronounced for major complications than minor complications. Conclusion Operative time is a stronger risk factor for developing complications for shorter duration procedures than longer procedures. This is especially evident in major complications such as return to the operating room and deep organ space infections. Our results suggest that longer procedure duration will not independently increase complication rates, and operative times should not be a primary factor in deciding to convert to laparotomy or alter post-operative management. To assess the relationship between operative time and specific 30-day postoperative complications across different tertiles of operation duration in total laparoscopic hysterectomies (TLH). A retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011-2020. 131,141 TLH cases. Eligible cases included benign laparoscopic hysterectomies with operative times between 20 minutes and 499 minutes. We excluded cases involving disseminated cancer, emergency surgery, supracervical approaches, or concomitant procedures. Multivariable logistic regression analysis demonstrated a significant association between operative time and complication occurrence for each complication type investigated, including unplanned readmission, urinary tract infections, superficial surgical site infections, blood transfusion administration, return to the operating room, and deep organ space infections. Multivariable logistic spline regression demonstrated that operative time contributed more strongly to the odds of a complication for shorter procedures than longer procedures. This relationship was more pronounced for major complications than minor complications. Operative time is a stronger risk factor for developing complications for shorter duration procedures than longer procedures. This is especially evident in major complications such as return to the operating room and deep organ space infections. Our results suggest that longer procedure duration will not independently increase complication rates, and operative times should not be a primary factor in deciding to convert to laparotomy or alter post-operative management.