Longer operative time associated with prolonged length of stay, non-home discharge and transfusion requirement after anterior cervical discectomy and fusion: an analysis of 24,593 cases

•Increasing single-level anterior cervical discectomy and fusion operative time is associated with a marked rise in the odds of prolonged length of stay, non-home discharge, and blood transfusion postoperatively but not local wound complications.•The risk of the aforementioned events starts to rise after at least 91 minutes of operative time•Highest odds of prolonged length of stay (four-fold), non-home discharge (three-fold), and blood transfusion (six-fold) compared to the 81-100 operative time category (reference) were detected within the ≥221 operative time category. Prolonged operative time of single-level ACDF has been associated with adverse postoperative outcomes. The current literature does not contain a comprehensive quantitative description of these associations This study characterized the associations between single-level anterior cervical discectomy and fusion(ACDF) operative time and (1)30-day postoperative healthcare utilization, and (2)the incidence of local wound complications, need for transfusion and mechanical ventilation. Retrospective database analysis The American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database was queried for single-level ACDF cases(2012–2018) using current procedural terminology codes. A total of 24,593 cases were included. Primary outcomes included healthcare utilization(lengths of stay[LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative time category. The secondary outcome was the incidence of wound complications, blood transfusion and need for ventilation per operative time category. Multivariate regression determined operative time categories associated with increased risk while adjusting for patient demographics and comorbidities. Predictive spline regression models visualized the associations. Compared to the reference operative time of 81-100-minutes, the 101-120-minute category was associated with higher odds of LOS >2 days(OR:1.36,95%CI(1.18–1.568);p2 days(OR:3.367,95%CI(2.719-4.169); p