Operative time as a marker of quality in bariatric surgery.
BACKGROUND
Few studies have examined the effect of prolonged operative time (OT) on outcomes in laparoscopic bariatric surgery. Existing studies mostly focus on 30-day complications, whereas serious complications may not occur until well after 30 days from the index operation.


OBJECTIVE
To determine the effect of prolonged OT on 1-year morbidity and mortality after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG).


SETTING
The Bariatric Outcomes Longitudinal Database (BOLD).


METHODS
Data on primary LRYGB and LSG cases performed between 2008 and 2012 in the BOLD were analyzed. Converted cases and cases concurrent with other procedures were excluded. Multivariate logistic regression was used to assess the association between OT and 1-year morbidity and mortality, with adjustment for preoperative demographic and clinical characteristics.


RESULTS
A total of 93,051 cases were examined, including 74,745 (80.3%) LRYGB and 18,306 (19.7%) LSG cases. For LRYGB, mean OT was 104 minutes (standard deviation [SD] 46.6). Every additional 10 minutes of OT was associated with increased odds of 1-year mortality (adjusted odds ratio [AOR] 1.04; P = .02), leak (AOR 1.07; P < .0001), and any adverse event (AOR 1.03; P < .001). For LSG, mean OT was 78 minutes (SD 37.4). Every additional 10 minutes of OT was associated with increased odds of 1-year leak (AOR 1.07; P = .0002). Data on patients lost to follow-up was unavailable.


CONCLUSION
Prolonged operative time is associated with a significant increase in the odds of mortality and serious complications after laparoscopic bariatric surgery. Operative time may be a useful marker of quality in primary laparoscopic bariatric surgery.
['Inaba|Colette S|CS|', 'Koh|Christina Y|CY|', 'Sujatha-Bhaskar|Sarath|S|', 'Gallagher|Shea|S|', 'Chen|Yanjun|Y|', 'Nguyen|Ninh T|NT|']
D000328:Adult D005260:Female D005743:Gastrectomy D015390:Gastric Bypass D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D009767:Obesity, Morbid D061646:Operative Time D011183:Postoperative Complications D015996:Survival Rate D016896:Treatment Outcome D015431:Weight Loss
Operative time Bariatric surgery Outcomes Laparoscopic Mortality Gastric bypass Sleeve gastrectomy Leak