Operative Time Longer Than 180 Minutes in Abdominal Hysterectomy is Predictive of 30-Day Perioperative Complications

Objectives: Hysterectomy remains one of the most commonly performed procedures in women, but risk factors for complications are incompletely understood. We aimed to utilize the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to investigate the impact of operative time on 30-day complication rates after benign abdominal hysterectomy. Materials and Methods: Data from ACS-NSQIP were retrieved for patients undergoing benign abdominal hysterectomy from 2006 to 2011. Given utilization of de-identified data, our Institutional Review Board deemed that formal review was not necessary. Patients were selected using Current Procedural Terminology (CPT) codes for total and subtotal abdominal hysterectomy, namely, 58150 and 58180. Primary outcomes were 30-day rates of medical, surgical, and overall complications and reoperation in relation to operative time. Operative times were divided into 60-minute intervals and complication rates analyzed. Bivariate analysis and multivariate regression modeling were performed to assess the association between operative time and complications. Results: A total of 16,864 abdominal hysterectomy procedures were identified. Rates of 30-day overall, medical, surgical complications, and reoperation were 12.4%, 9.2%, 4.2%, and 1.7%, respectively. Complication rates increased significantly with increasing operative time, with an inflection point noted at 180 minutes. Patients with operative time R180 minutes were more likely to be >50 years old, obese, nonsmokers, diabetic, hypertensive, ASA class 3-4, and to have higher RVU coded for the procedure. On bivariate analysis, operative time R180 minutes was associated with increased overall complications (25% versus 10.4%, p \ 0.001), surgical complications (7.1 versus 3.1%, p \ 0.001), medical complications (19.9% versus 7.5%, p \ 0.001), reoperation (2.5% versus 1.6%, p = 0.001), blood transfusion (14.3% versus 4%, p \ 0.001), deep venous thrombosis (0.5% versus 0.2%, p = 0.002), pulmonary embolism (1.1% versus 0.3%, p \ 0.001), and urinary tract infection (3.8% versus 2.3%, p \ 0.001). Mortality was low in both groups at 0.1%. After multivariable regression analysis, operative time R180 minutes was independently predictive of overall complications (OR = 2.3, 95% CI = 2.0 to 2.5, p \ 0.001), medical complications (OR = 2.4, 95% CI = 2.1 to 2.8, p \ 0.001), surgical complications (OR = 1.6, 95% CI = 1.3 to 1.9, p \ 0.001), blood transfusion (OR = 3.0, 95% CI = 2.5 to 3.4, p \ 0.001), venous thromboembolism (OR = 2.6, 95% CI = 1.7 to 4.0, p \ 0.001), and urinary tract infection (OR = 1.5, 95% CI = 1.2 to 1.9, p = 0.002). Conclusion: We have demonstrated a direct, independent correlation between increased operative time during abdominal hysterectomy and increased 30-day overall complications, medical complications, surgical complications, reoperation, blood transfusion, venous thromboembolism, and urinary tract infection. Additional study is needed regarding risk factors for prolonged operative time in hysterectomy, the comparative advantages and morbidity of minimally invasive hysterectomy relative to abdominal hysterectomy, and the relationship of these differential risks to operative time. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Tatiana Catanzarite: Nothing to disclose Brittany Vieira: Nothing to disclose Sujata Saha: Nothing to disclose John Y. Kim: Nothing to disclose Magdy Milad: Nothing to disclose