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Postoperative complications of ACDF may increase with longer operative time
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LAS VEGAS — Researchers found a 38% increased risk for pulmonary embolism among 5,040 patients who underwent one-level anterior cervical discectomy and fusion when the operative time was increased by 15 minutes.
Dustin H. Massel, BS, a fourth-year medical student at University of Miami, and colleagues also found an increase in the operative time by 15 minutes for anterior cervical discectomy and fusion (ACDF) increased the risk for pneumonia, urinary tract infection and surgical site infection by 16%, 17% and 24%, respectively.
“There was an association between increased operative time and incidence of several complications following ACDF. Surgeons should therefore focus on minimizing operative time without compromising the technical components of the procedure,” Massel said during his presentation of the retrospective study at the International Society of the Advancement of Spine Surgery Annual Meeting. “And finally, shorter procedures may lead to a reduction in health care costs and hospital resource utilization.”
According to Massel, the relationship between surgical time and complications has been studied in general surgery.
Dustin H. Massel
“However, little is known regarding the impact of operative time on peri- and postoperative outcomes following orthopedic procedures and, more specifically, spinal procedures. As ACDF is one of the common spine procedures performed in the United States, the goal of this study was to examine the associations between operative time and the occurrence of adverse events following ACDF,” Massel said.
The investigators analyzed the adverse events from preoperatively to 30 days postoperatively in patients who had prospectively collected data in the American College of Surgeons National Surgical Quality Improvement Program surgical registry and met the study’s inclusion criteria of primary, one-level ACDF. There were nearly equal numbers of men and women in the study. About 75% the patients were younger than 60 years, and the mean operative time was 98.8 minutes.
“A 15-minute increase in operative time was demonstrated as having an increased risk for postoperative pneumonia, urinary tract infections, surgical site infections, pulmonary emboli [and] prolonged length of hospital stay, as well as hospital readmissions,” he said. “This increased risk for some postoperative complications may be explained by the prolonged surgical exposure, as well as the additional anesthetic required to complete these operations.” - by Susan M. Rapp
Reference:
Bohl D, et al. Paper #321. Presented at: International Society for the Advancement of Spine Surgery Annual Meeting; April 6-8, 2016; Las Vegas.
Disclosure: Massel reports no relevant financial disclosures.