Abstract
Background
Longer surgical total procedure times (TPT) have been associated with increased postoperative complications. It is unclear what the effect of TPT is on length-of-stay (LOS) or 30-day readmission rate (RAR).
Methods
We performed a retrospective study of patients undergoing knee arthroplasty (KA), colectomy, and craniectomy at NorthShore University HealthSystem from 1/2007 to 12/2013. Clinical data were extracted from the Data Warehouse and charts were reviewed. We standardized surgery times for each procedure and categorized into two groups: times <75‰ (short procedures) vs. times >75‰ (long procedures). We used χ 2 and t-test to compare categorical and continuous variables. We performed multivariate logistic regression for predictors of surgical site infection (SSI).
Results
In univariate analyses, long procedures were associated with higher incidence of fevers, SSI, longer LOS, and 30-day RAR (Table 1). TPT was not associated with other postoperative complications. TPT remained an independent predictor of SSI in multivariate (MV) analysis (Table 2).
Conclusion
High TPT was associated with increased SSI, LOS, and 30-day RAR. Understanding variation in TPT may help decrease SSI and healthcare utilization.
Table 1:
Variables Stratified by (TPT)
| Characteristic N (%) | Short N = 5920 | Long N = 1980 | P-value |
|---|---|---|---|
| Fever ≥ 100.4 | 1042 (17.6%) | 450 (22.7%) | * |
| Body mass index ≥ 35 | 1143 (19.7%) | 519 (26.6%) | * |
| Female | 3867 (65.3%) | 1117 (56.4%) | * |
| Surgery | |||
| KA | 4788 (80.9%) | 1604 (81.0%) | 0.99 |
| Colectomy | 467 (7.9%) | 155 (7.8%) | |
| Craniectomy | 665 (11.2%) | 221 (11.2%) | |
| Complication | 420 (7.1%) | 154 (7.8%) | 0.31 |
| Urinary tract infection | 76 (1.3%) | 26 (1.3%) | 0.92 |
| Pneumonia | 75 (1.3%) | 28 (1.4%) | 0.62 |
| SSI | 67 (1.1%) | 41 (2.1%) | * |
| Venous thromboembolism | 174 (2.9%) | 61 (3.1%) | 0.75 |
| SSI w/in 30 day of discharge | 84 (1.4%) | 48 (2.4%) | * |
| Mean LOS, days (SD) | 3.69 (2.89) | 4.05 (3.38) | * |
| 30d RAR | 277 (4.7%) | 142 (7.2%) | * |
*P-value < 0.01
Table 2:
MV logistic regression€ of SSI within 30-day of discharge
| OR (95% CI) | P-value | |
|---|---|---|
| Age | 0.99 (0.98–1.01) | 0.97 |
| Female | 1.21 (0.84–1.75) | 0.31 |
| Surgery | ||
| KA | Ref. | * |
| Colectomy | 70.2 (36.6–134.6) | |
| Craniectomy | 20.3 (10.0–41.0) | |
| TPT > 75 th %ile | 1.59 (1.08–2.33) | 0.02 |
| Fever > 100.4 | 4.10 (2.85–5.94) | * |
| Diabetes | 1.92 (1.27–2.91) | * |
€Including only variables with P-value <0.2 in UV analysis.
* P-value <0.01.
Disclosures
All authors: No reported disclosures.