LAUSR

OBJECTIVE To investigate the association between operative time and postoperative outcomes. SUMMARY BACKGROUND DATA The association between operative time and morbidity after pulmonary lobectomy has not been characterized fully. METHODS Patients who underwent pulmonary lobectomy for primary lung cancer at our institution from 2010 to 2018 were reviewed. Exclusion criteria included clinical stage ≥IIb disease, conversion to thoracotomy, and previous ipsilateral lung treatment. Operative time was measured from incision to closure. Relationships between operative time and outcomes were quantified using multivariable mixed-effects models with surgeon-level random effects. RESULTS In total, 1651 patients were included. Median age was 68 years (interquartile range, 61-74), and 63% of patients were women. Median operative time was 3.2 h (interquartile range, 2.7-3.8) for all cases, 3.0 h for open procedures, 3.3 h for video-assisted thoracoscopies, and 3.3 h for robotic procedures (P=0.0002). Overall, 488 patients (30%) experienced a complication; 77 patients (5%) had a major complication (grade ≥3), and 5 patients (0.3%) died within 30 days of discharge. On multivariable analysis, operative time was associated with higher odds of any complication (odds ratio per hour, 1.37 [95% CI, 1.20-1.57]; P<0.0001) and major complication (odds ratio per hour, 1.41 [95% CI, 1.21-1.64]; P<0.0001). Operative time was also associated with longer hospital length of stay (beta, 1.09 [95% CI, 1.04-1.14]; P=0.001). CONCLUSIONS Longer operative time was associated with worse outcomes in patients who underwent lobectomy. Operative time is a potential risk factor to consider in the perioperative phase.