Prolonged Operative Time Associated with Multiple Adverse Outcomes in Endoscopic Sinonasal Surgery

How does prolonged operative time (POT) impact 30-day outcomes in patients undergoing endoscopic sinonasal surgery (ESNS)?

BOTTOM LINE

POT is independently associated with several adverse outcomes following ESNS, including prolonged hospital length of stay (LOS), overall surgical complications, and bleeding.

BACKGROUND: ESNS is a safe, frequently utilized intervention for benign and malignant sinonasal disease. As the incidence and indications for ESNS increase, it is important to understand how patient factors and intraoperative variables impact postoperative outcomes. POT, associated with increased risk of postoperative complications, is one such variable.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, N.J.

SYNOPSIS: Researchers conducted a database search for adult patients undergoing inpatient and/or outpatient ESNS from 2005 to 2018. Primary outcome was the incidence of medical or surgical postoperative complications, and their relationship to operating time. A total of 1,994 patients’ ESNS procedures were included and categorized by operating time for non-sinus, sinus, and extended sinus procedures (495, 1,191, and 308 patients, respectively). In all categories, findings showed significant associations between POT and surgical complications, as well as prolonged hospital stay. For non-sinus procedures, POT was associated with prolonged LOS; for sinus procedures, POT was associated with postoperative bleeding requiring transfusion, reoperation, medical complications, and prolonged LOS; for extended sinus procedures, POT was associated with wound disruption and pneumonia. Older age was associated with POT in all categories. Non-White patients undergoing ESNS involving the sinuses experienced POT at a higher rate compared to White counterparts. In all categories, POT was associated with higher odds of prolonged hospital LOS. Study limitations included the database’s predetermined available set of variables and outcomes.

CITATION: Pai KK, Omiunu A, Vedula S, et al. Impact of prolonged operative time on complications following endoscopic sinonasal surgery. Laryngoscope. 2023;133:51-58.