Longer Surgeries Lead to More Infections and Longer Hospital Stays

A new study suggests that the longer an operation takes, the greater the risk that a patient will have infectious complications and need to spend extra days at the hospital.

Researchers at the University of Kentucky College of Medicine (Lexington, USA) conducted a retrospective study of nearly 300,000 operations performed at 173 hospitals across the United States from 2005 to 2007. The researchers found that overall, the 30-day rate of infectious complications rose by almost 2.5% for every 30 minutes between incision and closing; the rates ranged from 3.7% for cases lasting up to an hour, to 31.4% for cases that took more than 6 hours. After adjusting for patient variables, type and complexity of surgery, wound class, and need for blood transfusion operative time remained a significant predictor of postoperative infection. Compared to patients whose operations took no more than an hour, those whose surgery lasted 2.1 to 2.5 hours had nearly double the risk of infectious complications.

Researchers found that this pattern was also seen in a subgroup of otherwise healthy patients who had laparoscopic cholecystectomy with a clean or clean-contaminated wound and no blood transfusion. In this subset, infections rates were 0.7% when cases lasted less than 30 minutes, 1.4% in cases lasting from 60 to 90 minutes, and 1.7% in cases longer than 90 minutes. Additionally, the researchers found that across all procedures, hospital stays increased geometrically along with operative times, at a rate of about 6% for every 30 minutes. The study was published in the January 2010 issue of the Journal of the American College of Surgeons (JACS).

"These data show that operative duration remains associated with increasing infectious complications in a broad spectrum of general surgery patients after adjustment for numerous patient and operative risks,” concluded lead author Levi Procter, M.D. and colleagues. "Our data contribute to our understanding of the independent infection risk relative to operative duration across a broad range of procedures in a very large, multicenter contemporary patient population. Strategies to reduce operative duration can reduce infectious complications and length of stay.”

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University of Kentucky College of Medicine