General Session: Cervical-1
Presented by: D. Massel - View Audio/Video Presentation (Members Only)
D. Bohl(1), J. Ahn(1), B. Mayo(1), D. Massel(1), B. Basques(1), W. Long(1), K. Modi(1), K. Singh(1), J. Grauer(2)
(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
(2) Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT, United States
Background information: Little is known regarding the impact of operative time on perioperative outcomes following spinal procedures. The present study tests for associations between operative time and occurrence of adverse events following an anterior cervical decompression and fusion (ACDF).
Objective: To examine the associations between operative time and occurrence of adverse events following an anterior cervical decompression and fusion (ACDF).
Methods: Patients undergoing a one-level ACDF were identified in the American College of Surgeons National Surgical Quality Improvement Program. Cases were identified based on current procedural terminology coding and excluded for traumatic, oncologic, or infectious indications. Operative time (as a continuous variable) was tested for association with perioperative outcomes using multivariate regression. All regressions were adjusted for differences in patient age, sex, body mass index, and the presence of diabetes, congestive heart failure, dyspnea, hypertension, end-stage renal disease, chronic obstructive pulmonary disease, smoking status, and anemia.
Results: A total of 5,040 patients met inclusion criteria. The mean (± standard deviation) operative time was 98.8 minutes (± 42.2; Figure 1). Following adjustment for all demographics and comorbidities, an increase in the operative time by 15 minutes increased the risk for pneumonia by 16% (95% confidence interval [CI]=1-34%, p=0.038), for urinary tract infection by 17% (95% CI=2-34%, p=0.029), for surgical site infection by 24% (95% CI=8-42%, p=0.002), and for pulmonary embolism by 38% (95% CI=27-50%, p< 0.001; Table 1). Similarly, an increase in the operative time by 15 minutes increased the risk for hospital readmission by 8% (95% CI=1-15%, p=0.031) and for extended hospital length of stay by 14% (95% CI=12-16%, p< 0.001).
Conclusions: The present study suggests that greater operative time increases the risk for multiple postoperative complications including: pneumonia, urinary tract infection, surgical site infection, and pulmonary embolism. This increased risk may be explained by increased exposures during surgery and additional anesthetic. There was also increased associated hospital length of stay and readmission, both of which have important financial implications. It is difficult to fully isolate operative time as an independent variable because it may be closely related to the complexity of the surgical pathology being addressed. Nevertheless, the present study suggests that surgeons should take all possible steps to minimize operative time without compromising the technical components of the surgical procedure.