Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy

Abstract

Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed. We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC. A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3%) patients experienced at least one PPC. Regression modeling demonstrated that for both LC and OC each 60-min increase in operative time up to 480min was associated with 13% increased odds of PPC [odds ratio (OR) 1.13; 95% confidence interval (CI) 1.07-1.19]. Beyond 480min, each additional 60-min interval was associated with 33% increased risk of PPC (OR 1.33; 95% CI 1.12-1.58). Overall, PPCs occurred half as often following LC [270 (2%) laparoscopic vs. 497 (4.3%) open; OR 0.45; 95% CI 0.39-0.53]. Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.