Operative Time is Associated With Postoperative Complications After Pulmonary Lobectomy

Abstract

Objective: To investigate the association between operative time and postoperative outcomes.

Background: The association between operative time and morbidity after pulmonary lobectomy has not been characterized fully.

Methods: Patients who underwent pulmonary lobectomy for primary lung cancer at our institution from 2010 to 2018 were reviewed. Exclusion criteria included clinical stage ≥IIb disease, conversion to thoracotomy, and previous ipsilateral lung treatment. Operative time was measured from incision to closure. Relationships between operative time and outcomes were quantified using multivariable mixed-effects models with surgeon-level random effects.

Results: In total, 1651 patients were included. The median age was 68 years (interquartile range, 61-74), and 63% of patients were women. Median operative time was 3.2 hours (interquartile range, 2.7-3.8) for all cases, 3.0 hours for open procedures, 3.3 hours for video-assisted thoracoscopies, and 3.3 hours for robotic procedures ( P =0.0002). Overall, 488 patients (30%) experienced a complication; 77 patients (5%) had a major complication (grade ≥3), and 5 patients (0.3%) died within 30 days of discharge. On multivariable analysis, operative time was associated with higher odds of any complication [odds ratio per hour, 1.37; 95% confidence interval (CI), 1.20-1.57; P <0.0001] and major complication (odds ratio per hour, 1.41; 95% CI, 1.21-1.64; P <0.0001). Operative time was also associated with longer hospital length of stay (β, 1.09; 95% CI, 1.04-1.14; P =0.001).

Conclusions: Longer operative time was associated with worse outcomes in patients who underwent lobectomy. Operative time is a potential risk factor to consider in the perioperative phase.

Figure 1.

CONSORT diagram of the study population.

Figure 2.

Percentage of patients experiencing any (p=0.0002) or major (p=0.001) complication by quartile of operative time.

Figure 3.

Mediation analysis. Larger arrow reports odds ratio for effect of target variable on outcome (i.e., any or major complication) mediated by operative duration. Coefficients reported above arrows are odds ratios from logistic mixed-effects models and beta from linear mixed-effects models. *p<0.05; †p<0.01; NS, not significant. Lack of arrow indicates no mediation.