Defining the association between operative time and outcomes in children's surgery.
INTRODUCTION
Prolonged operative time (OT) is considered a reflection of procedural complexity and may be associated with poor outcomes. Our purpose was to explore the association between prolonged OT and complications in children's surgery.


METHODS
182,857 cases from the 2012-2014 NSQIP-Pediatric were organized into 33 groups. OT for each group was analyzed by quartile, and regression models were used to determine the relationship between prolonged OT and complications.


RESULTS
Variations in OT existed for both short and long procedures. Cases in the longest quartile had twice the odds of postoperative complications after adjusting for age, sex and BMI (OR 1.85; 95% CI 1.78-1.91). Procedure-specific prolonged OT was associated with postoperative complications for the majority (85%) of procedural groupings. Prolonged OT was associated with minor complications in gynecologic (OR 4.17; 95% CI 2.19-7.96), urologic (OR 2.88; 95% CI 2.40-3.44), and appendix procedures (OR 2.88; 95% CI 2.49-3.34). There were increased odds of major complications in foregut (OR 6.56; 95% CI 4.99-8.64), gynecologic (OR 3.07; 95% CI 1.84-5.13), and spine procedures (OR 2.99; 95% CI 2.57-3.28).


CONCLUSIONS
Prolonged OT is associated with increased odds of postoperative complications across a spectrum of children's surgical procedures. Factors contributing to prolonged OT merit further investigation and may serve as a target for future quality improvement.


LEVEL OF EVIDENCE
Level III.
['Short|Heather L|HL|', 'Fevrier|Helene B|HB|', 'Meisel|Jonathan A|JA|', 'Santore|Matthew T|MT|', 'Heiss|Kurt F|KF|', 'Wulkan|Mark L|ML|', 'Raval|Mehul V|MV|']
D002648:Child D005260:Female D006801:Humans D008297:Male D061646:Operative Time D011183:Postoperative Complications D058996:Quality Improvement D012307:Risk Factors D013514:Surgical Procedures, Operative D013530:Surgical Wound Infection D013997:Time Factors
Operative time Complications Quality improvement ACS NSQIP-p Pediatric surgery