Relationship between operative duration and perioperative outcomes after radical cystectomy.

Unlabelled: INTRODUCTION Prolonged operative times have been associated with an increased risk in complications in other major abdominal surgeries. This study tests the hypothesis that longer operative times will be associated with an increased risk in perioperative complications after radical cystectomy (RC).

Materials And Methods: Adult patients who underwent RC from January 1, 2012, through December 31, 2016, were identified from the National Surgical Quality Improvement Program (NSQIP) database. A natural log transformation was used to determine cutoff points for operative times at 33rd, 67th, and 90th percentiles: 272, 371, and 479 minutes, respectively. Cohorts were A (≤ 272 min), B (273-371 min), C (372-479 min), and D (> 479 min). Multivariable logistic regression analysis was performed to identify associations between operative time and perioperative complications.

Results: Among 5,610 patients, the distribution across cohorts was A, 1,993 patients; B, 1,818; C, 1,171; and D, 628. Cohort D had a higher incidence of pulmonary embolism (PE), deep vein thrombosis (DVT), urinary tract infection (UTI), sepsis, 30-day readmission, and blood transfusion rate and had a longer median hospital length of stay. Multivariable analysis showed that operative time (per 60 min) was associated with increased risk of DVT (OR 1.10, p = .04), PE (OR 1.15, p = .01), UTI (OR 1.08, p = .004), readmission (OR 1.04, p = .03), and blood transfusion (OR 1.23, p < .001).

Conclusions: Longer operative times during RC are associated with a higher rate of perioperative complications. These findings may be confounded by disease stage, surgeon experience, variations in perioperative management protocols, or a combination of the above.