Singh S, et al. - This study sought to assess the impact of operative time on the development of post-operative medical and surgical complications in patients undergoing minimally-invasive surgery for endometrial cancer. Findings suggested an independent association of increased operative time with increased risk of developing complications after laparoscopic surgery for endometrial cancer.

Methods

• From the ACS-NSQIP database, researchers identified patients who underwent laparoscopic surgery for endometrial cancer from 2005 to 2014.
• They divided operative times initially into hour-long intervals and assessed the complication rates.
• For this study, outcomes assessed were development of any complication, medical complication, or surgical complication.
• In accordance to the operative times < 240 min and operative times ≥ 240 min, 2 groups of patients were formed and subsequently analyzed.
• Using Chi-Squared and Fisher's exact tests, associations between categorical variables were determined.
• Using Student's t-tests, they determined differences between means of continuous variables.
• They used univariate and multivariate analysis using logistic regression to assess the predictors of post-operative complications.

Results

• This study included 9145 patients; 639/9145 (7%) experienced a complication.
• Rates of complications increased with increasing operative time.
• As per findings, operative time ≥ 240 min seemed associated with increased overall complication rate (11.7% vs. 6%, p < 0.001), medical complication rate (9.3% vs. 4.2%, p < 0.001), and surgical complication rate (3.9% vs. 2.4%, p = 0.001).
• When performing multi-variate logistic regression of factors associated with increased complication rates, increased operative time, COPD, hypertension, diabetes, ASA class ≥3, dependent functional status, and chronic steroid use indicated an independent association with increased complications.
• There appeared no correlation of lymphadenectomy with increased operative time or increase in complications.