How Operative Duration Affects Clinical Outcomes

Infectious complications, particularly surgical site infections (SSIs), are well documented to increase costs, morbidity, mortality, and length of stay (LOS). Surgical operative duration has long been suggested as a risk factor for infectious complications (ICs). The causes for this association may be multifactorial. For example, prolonged tissue exposure to the air can desiccate the wound, increasing tissue death and worsening tissue healing. Increased operative duration has also been associated with increased tissue trauma, which raises the metabolic demand on the body to heal these wounds. Lastly, greater operative duration has been shown in previous research to increase the risk of blood loss, periods of hypothermia during surgery, and the need to re-dose antibiotics perioperatively. Determinants of operative duration can include any of the following: 1. The proficiency of the surgeon. 2. The presence of surgical trainees. 3. Communication among operative professionals. 4. Emergency operation. 5. Operating room (OR) staffing. 6. Technology. 7. Process efficiency. New Study Data In a study published in the January 2010 Journal of the American College of Surgery, my colleagues and I sought to gain a better understanding of the link between operative duration and outcomes, particularly ICs and LOS. Considering that all ICs are significant after surgery, our investigation included some of the most important infections that can impact postoperative surgical patient care, including SSIs, sepsis, urinary tract infections, intravascular catheter-related infections, and pneumonia.   “Strategies that reduce operative duration as well as improve IC rates and LOS need to be identified.” After analyzing nearly 300,000 general surgery operations performed at 173 hospitals with the National Surgical Quality Improvement Program (NSQIP) database, we found...