TY - JOUR
T1 - Impact of Prolonged Operative Time on Complications Following Endoscopic Sinonasal Surgery
AU - Pai, Kavya K.
AU - Omiunu, Ariel
AU - Vedula, Sudeepti
AU - Chemas-Velez, Maria Manuela
AU - Fang, Christina H.
AU - Baredes, Soly
AU - Eloy, Jean Anderson
N1 - Publisher Copyright:
© 2022 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2023/1
Y1 - 2023/1
N2 - Objective: To determine how prolonged operative time (POT) impacts 30-day outcomes in patients undergoing endoscopic sinonasal surgery (ESNS). Study Design: Retrospective study. Methods: Data from patients who underwent ESNS (nonsinus, sinus, and extended sinus) between 2005 to 2018 were collected from the American College of Surgeons National Surgical Quality Improvement database. Univariate and multivariate analyses were performed to evaluate the effect of POT on postoperative outcomes. Results: Among 1,994 ESNS cases, 495 nonsinus procedures, 1,191 sinus procedures, and 308 extended sinus procedures were identified. Median OT was 90 minutes (interquartile range [IQR], 51–165 minutes) for nonsinus procedures, 113 minutes (IQR, 66–189 minutes) for sinus procedures, and 187 minutes (IQR, 137–251 minutes) for extended sinus procedures. Other than older age (P =.008), POT was not significantly associated with baseline demographics and comorbidities for patients undergoing non-sinus procedures. Older age (P <.001), White and Black race (P <.001), ASA physical classifications III or IV (P <.001), and several preoperative comorbidities, including obesity (P =.045), and hypertension (P <.001) were associated with POT for sinus procedures. Older age (P =.030), male sex (P =.010), and lower body mass index (P =.004) were associated with POT for extended sinus procedures. After risk-adjustment, POT was independently associated with prolonged hospital stay (LOS) for all procedure categories, and associated with overall surgical complications and postoperative bleeding for sinus and extended sinus procedures specifically. Conclusion: POT is independently associated with several adverse outcomes following ESNS, including prolonged LOS, overall surgical complications, and bleeding. Preoperative planning should include optimizing modifiable patient risk factors for POT and identifying surgeon-specific factors to enhance surgical efficiency. Level of Evidence: 4 Laryngoscope, 133:51–58, 2023.
AB - Objective: To determine how prolonged operative time (POT) impacts 30-day outcomes in patients undergoing endoscopic sinonasal surgery (ESNS). Study Design: Retrospective study. Methods: Data from patients who underwent ESNS (nonsinus, sinus, and extended sinus) between 2005 to 2018 were collected from the American College of Surgeons National Surgical Quality Improvement database. Univariate and multivariate analyses were performed to evaluate the effect of POT on postoperative outcomes. Results: Among 1,994 ESNS cases, 495 nonsinus procedures, 1,191 sinus procedures, and 308 extended sinus procedures were identified. Median OT was 90 minutes (interquartile range [IQR], 51–165 minutes) for nonsinus procedures, 113 minutes (IQR, 66–189 minutes) for sinus procedures, and 187 minutes (IQR, 137–251 minutes) for extended sinus procedures. Other than older age (P =.008), POT was not significantly associated with baseline demographics and comorbidities for patients undergoing non-sinus procedures. Older age (P <.001), White and Black race (P <.001), ASA physical classifications III or IV (P <.001), and several preoperative comorbidities, including obesity (P =.045), and hypertension (P <.001) were associated with POT for sinus procedures. Older age (P =.030), male sex (P =.010), and lower body mass index (P =.004) were associated with POT for extended sinus procedures. After risk-adjustment, POT was independently associated with prolonged hospital stay (LOS) for all procedure categories, and associated with overall surgical complications and postoperative bleeding for sinus and extended sinus procedures specifically. Conclusion: POT is independently associated with several adverse outcomes following ESNS, including prolonged LOS, overall surgical complications, and bleeding. Preoperative planning should include optimizing modifiable patient risk factors for POT and identifying surgeon-specific factors to enhance surgical efficiency. Level of Evidence: 4 Laryngoscope, 133:51–58, 2023.
KW - Endoscopic sinonasal surgery
KW - National Surgical Quality Improvement Program
KW - database
KW - operative time
KW - otolaryngology
KW - perioperative complications
UR - http://www.scopus.com/inward/record.url?scp=85124770912&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85124770912&partnerID=8YFLogxK
U2 - 10.1002/lary.30057
DO - 10.1002/lary.30057
M3 - Article
C2 - 35174505
AN - SCOPUS:85124770912
SN - 0023-852X
VL - 133
SP - 51
EP - 58
JO - Laryngoscope
JF - Laryngoscope
IS - 1
ER -