Operating time: an independent and modifiable risk factor for short-term complications after video-thoracoscopic pulmonary lobectomy

Abstract

Objectives: The relationship between operating time and postoperative morbidity has not been fully characterized in lung resection surgery. We aimed to determine the variables associated with prolonged operative times and their influence on postoperative complications after video-thoracoscopic lobectomy.

Methods: Patients undergoing thoracoscopic lobectomy for lung cancer from December 2016 to March 2018, within the prospective registry of the Spanish Video-Assisted Thoracic Surgery Group were identified. Operating time was stratified by quartiles and complication rates analysed using chi-squared test. Primary outcomes included 30-day overall, pulmonary and cardiovascular complications and wound infection. Multivariable logistic regression analyses were performed to identify variables independently associated with operating time and their influence on the occurrence of postoperative complications.

Results: Data of 1518 cases were examined. The median operating time was 174 min (interquartile range: 130-210 min). Overall morbidity rates significantly increased with surgical duration (20.5% vs 34.4% in the 1st and 4th quartiles, respectively, P < 0.05) and so did pulmonary complications (14.6% vs 26.4% in the 1st and 4th quartiles, respectively, P < 0.05). Differences were not found regarding cardiovascular and wound complications. After multivariable logistic regression analysis, operating time remained as an independent risk factor for overall (odds ratios, 2.05) and pulmonary complications (odds ratios, 2.01). Male sex, predicted postoperative diffusing capacity of the lung for carbon monoxide, number of lymphatic stations harvested, pleural adhesions, fissures completeness, lobectomy site, surgeon seniority, individual video-thoracoscopic surgeon experience and fissureless technique were identified as predictive factors for long operative time.

Conclusions: Prolonged operating time is associated with increased odds of postoperative complications. Modifiable factors contributing to prolonged operating time may serve as a target for quality improvement.

Keywords: Lung resection; Operating time; Postoperative complications; Risk factor; VATS lobectomy.