Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy
Background Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. Th...
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| creator | Owen, Rachel M. Perez, Sebastian D. Lytle, Nathan Patel, Ankit Davis, S. S. Lin, Edward Sweeney, John F. |
| description | Background
Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed.
Methods
We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC.
Results
A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for
both
LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07–1.19]. Beyond 480 min, each additional 60-min interval was associated with 33 % increased risk of PPC (OR 1.33; 95 % CI 1.12–1.58). Overall, PPCs occurred half as often following LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39–0.53].
Conclusions
Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration. |
| doi_str_mv | 10.1007/s00464-013-2949-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1433078960</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3073719651</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-5b031fd40c17ae4950393e5168f75a7696ee94f320b1655199899577c59a41df3</originalsourceid><addsrcrecordid>eNp1kE1LxDAQhoMo7rr6A7xIwXN18tV2jrL4BQte9Byy2VS6tk1M2oX992Zdvy5CIIF55p3JQ8g5hSsKUF5HAFGIHCjPGQrM8YBMqeAsZ4xWh2QKyCFnJYoJOYlxDQlHKo_JhHFZiYrBlLw9dl6bIXN15rwNemg2NluNu4frs3S8i8NvxY9t53odtplxnW8b88nFrOmzVnsdXDTONybb2BDHuIvsE9laM7hue0qOat1Ge_Z1z8jL3e3z_CFfPN0_zm8WuRG8GnK5BE7rlQBDS20FSuDIraRFVZdSlwUW1qKoOYMlLaSkiBWiLEsjUQu6qvmMXO5zfXDvo42DWrsx9GmkSnY4lBUWkCi6p0zaOgZbKx-aLn1NUVA7vWqvVyW9aqdXYeq5-Eoel51d_XR8-0wA2wMxlfpXG_6M_jf1A3KBho8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1433078960</pqid></control><display><type>article</type><title>Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Owen, Rachel M. ; Perez, Sebastian D. ; Lytle, Nathan ; Patel, Ankit ; Davis, S. S. ; Lin, Edward ; Sweeney, John F.</creator><creatorcontrib>Owen, Rachel M. ; Perez, Sebastian D. ; Lytle, Nathan ; Patel, Ankit ; Davis, S. S. ; Lin, Edward ; Sweeney, John F.</creatorcontrib><description>Background
Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed.
Methods
We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC.
Results
A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for
both
LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07–1.19]. Beyond 480 min, each additional 60-min interval was associated with 33 % increased risk of PPC (OR 1.33; 95 % CI 1.12–1.58). Overall, PPCs occurred half as often following LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39–0.53].
Conclusions
Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-013-2949-9</identifier><identifier>PMID: 23584820</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject><![CDATA[Abdominal Surgery ; Aged ; Aged, 80 and over ; Bronchoalveolar Lavage Fluid ; Colectomy - methods ; Elective Surgical Procedures - methods ; Elective Surgical Procedures - statistics & numerical data ; Female ; Gastroenterology ; Gynecology ; Health care expenditures ; Hepatology ; Hospital costs ; Hospital Mortality ; Humans ; Intubation ; Intubation, Gastrointestinal ; Laparoscopy ; Laparoscopy - methods ; Laparotomy - methods ; Laparotomy - statistics & numerical data ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity ; Mortality ; Narcotics - adverse effects ; Operative Time ; Ostomy ; Pain Management ; Pain, Postoperative - drug therapy ; Patients ; Pneumonia ; Pneumonia - epidemiology ; Pneumonia - etiology ; Pneumonia - prevention & control ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Proctology ; Respiration, Artificial - statistics & numerical data ; Risk Factors ; Spirometry ; Surgery ; Time Factors ; Ventilators]]></subject><ispartof>Surgical endoscopy, 2013-10, Vol.27 (10), p.3555-3563</ispartof><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-5b031fd40c17ae4950393e5168f75a7696ee94f320b1655199899577c59a41df3</citedby><cites>FETCH-LOGICAL-c438t-5b031fd40c17ae4950393e5168f75a7696ee94f320b1655199899577c59a41df3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-013-2949-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-013-2949-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23584820$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Owen, Rachel M.</creatorcontrib><creatorcontrib>Perez, Sebastian D.</creatorcontrib><creatorcontrib>Lytle, Nathan</creatorcontrib><creatorcontrib>Patel, Ankit</creatorcontrib><creatorcontrib>Davis, S. S.</creatorcontrib><creatorcontrib>Lin, Edward</creatorcontrib><creatorcontrib>Sweeney, John F.</creatorcontrib><title>Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed.
Methods
We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC.
Results
A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for
both
LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07–1.19]. Beyond 480 min, each additional 60-min interval was associated with 33 % increased risk of PPC (OR 1.33; 95 % CI 1.12–1.58). Overall, PPCs occurred half as often following LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39–0.53].
Conclusions
Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bronchoalveolar Lavage Fluid</subject><subject>Colectomy - methods</subject><subject>Elective Surgical Procedures - methods</subject><subject>Elective Surgical Procedures - statistics & numerical data</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Health care expenditures</subject><subject>Hepatology</subject><subject>Hospital costs</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intubation</subject><subject>Intubation, Gastrointestinal</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Laparotomy - methods</subject><subject>Laparotomy - statistics & numerical data</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Narcotics - adverse effects</subject><subject>Operative Time</subject><subject>Ostomy</subject><subject>Pain Management</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>Pneumonia - epidemiology</subject><subject>Pneumonia - etiology</subject><subject>Pneumonia - prevention & control</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Proctology</subject><subject>Respiration, Artificial - statistics & numerical data</subject><subject>Risk Factors</subject><subject>Spirometry</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Ventilators</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1LxDAQhoMo7rr6A7xIwXN18tV2jrL4BQte9Byy2VS6tk1M2oX992Zdvy5CIIF55p3JQ8g5hSsKUF5HAFGIHCjPGQrM8YBMqeAsZ4xWh2QKyCFnJYoJOYlxDQlHKo_JhHFZiYrBlLw9dl6bIXN15rwNemg2NluNu4frs3S8i8NvxY9t53odtplxnW8b88nFrOmzVnsdXDTONybb2BDHuIvsE9laM7hue0qOat1Ge_Z1z8jL3e3z_CFfPN0_zm8WuRG8GnK5BE7rlQBDS20FSuDIraRFVZdSlwUW1qKoOYMlLaSkiBWiLEsjUQu6qvmMXO5zfXDvo42DWrsx9GmkSnY4lBUWkCi6p0zaOgZbKx-aLn1NUVA7vWqvVyW9aqdXYeq5-Eoel51d_XR8-0wA2wMxlfpXG_6M_jf1A3KBho8</recordid><startdate>20131001</startdate><enddate>20131001</enddate><creator>Owen, Rachel M.</creator><creator>Perez, Sebastian D.</creator><creator>Lytle, Nathan</creator><creator>Patel, Ankit</creator><creator>Davis, S. S.</creator><creator>Lin, Edward</creator><creator>Sweeney, John F.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20131001</creationdate><title>Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy</title><author>Owen, Rachel M. ; Perez, Sebastian D. ; Lytle, Nathan ; Patel, Ankit ; Davis, S. S. ; Lin, Edward ; Sweeney, John F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-5b031fd40c17ae4950393e5168f75a7696ee94f320b1655199899577c59a41df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bronchoalveolar Lavage Fluid</topic><topic>Colectomy - methods</topic><topic>Elective Surgical Procedures - methods</topic><topic>Elective Surgical Procedures - statistics & numerical data</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Health care expenditures</topic><topic>Hepatology</topic><topic>Hospital costs</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intubation</topic><topic>Intubation, Gastrointestinal</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Laparotomy - methods</topic><topic>Laparotomy - statistics & numerical data</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Narcotics - adverse effects</topic><topic>Operative Time</topic><topic>Ostomy</topic><topic>Pain Management</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Patients</topic><topic>Pneumonia</topic><topic>Pneumonia - epidemiology</topic><topic>Pneumonia - etiology</topic><topic>Pneumonia - prevention & control</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Proctology</topic><topic>Respiration, Artificial - statistics & numerical data</topic><topic>Risk Factors</topic><topic>Spirometry</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Owen, Rachel M.</creatorcontrib><creatorcontrib>Perez, Sebastian D.</creatorcontrib><creatorcontrib>Lytle, Nathan</creatorcontrib><creatorcontrib>Patel, Ankit</creatorcontrib><creatorcontrib>Davis, S. S.</creatorcontrib><creatorcontrib>Lin, Edward</creatorcontrib><creatorcontrib>Sweeney, John F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Owen, Rachel M.</au><au>Perez, Sebastian D.</au><au>Lytle, Nathan</au><au>Patel, Ankit</au><au>Davis, S. S.</au><au>Lin, Edward</au><au>Sweeney, John F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2013-10-01</date><risdate>2013</risdate><volume>27</volume><issue>10</issue><spage>3555</spage><epage>3563</epage><pages>3555-3563</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed.
Methods
We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC.
Results
A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for
both
LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07–1.19]. Beyond 480 min, each additional 60-min interval was associated with 33 % increased risk of PPC (OR 1.33; 95 % CI 1.12–1.58). Overall, PPCs occurred half as often following LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39–0.53].
Conclusions
Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>23584820</pmid><doi>10.1007/s00464-013-2949-9</doi><tpages>9</tpages></addata></record> |
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| subjects | Abdominal Surgery Aged Aged, 80 and over Bronchoalveolar Lavage Fluid Colectomy - methods Elective Surgical Procedures - methods Elective Surgical Procedures - statistics & numerical data Female Gastroenterology Gynecology Health care expenditures Hepatology Hospital costs Hospital Mortality Humans Intubation Intubation, Gastrointestinal Laparoscopy Laparoscopy - methods Laparotomy - methods Laparotomy - statistics & numerical data Length of Stay Male Medicine Medicine & Public Health Middle Aged Morbidity Mortality Narcotics - adverse effects Operative Time Ostomy Pain Management Pain, Postoperative - drug therapy Patients Pneumonia Pneumonia - epidemiology Pneumonia - etiology Pneumonia - prevention & control Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - prevention & control Proctology Respiration, Artificial - statistics & numerical data Risk Factors Spirometry Surgery Time Factors Ventilators |
| title | Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy |
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