Hysterectomy: Operative Time Matters

Historically, surgical times were tracked to help operating suite managers schedule operating rooms. For the last 25 years or so, quality managers have watched surgical times with respect to patient outcomes. They’ve come to a growing realization that faster is not always better and slower may not represent careful, deliberate technique. They watch morbidity and mortality statistics closely, and encourage surgeons to monitor patient carefully when a short—or more often a long—operative time is often tied to adverse sequelae. Researchers from Northwestern University in Chicago, IL recently determined that the relationship between operative time and morbidity after vaginal hysterectomy has only rarely been examined. They published an insightful abstract in the May 2015 issue of Obstetrics & Gynecology.

These investigators used the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who had vaginal hysterectomy for benign indications (N=10,311) between 2005 and 2012. Their goal was to determine 30-day complication rates. To do so, they compiled clinical characteristics of patients by operative time and compared complications.

Surgical duration was a good predictor of operative complications, and the investigators found that at 240 minutes, the likelihood of complications increased steeply.

Patients who were older, nonsmokers, hypertensive were more likely to have longer operative times. The presence of chronic obstructive pulmonary disease, higher ASA (American Society of Anesthesiologists) level, inpatient status, general anesthesia, and resident physician involvement also increased operative times.

Once operative time exceeded 240 minutes, rates of overall complications increased. Patients whose surgeries took less than 4 hours had complication rates of 6.7%, while those who were in the surgical suite for more than 4 hours had complication rates more than double that rate (15.7%).

The investigators looked at specific types of adverse outcomes and found medical complications, urinary tract infection, and blood transfusion occurred almost 3 times as often in patients whose surgeries exceeded 4 hours compared to those with shorter surgeries. The rate of blood transfusion was double, as was reoperation.

Mortality rates were similar between the arms.

This research lays the groundwork for future studies to identify modifiable contributors to prolonged operative time.