Operative time as a marker of quality in bariatric surgery

BackgroundFew 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.ObjectiveTo 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).SettingThe Bariatric Outcomes Longitudinal Database (BOLD).MethodsData 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.ResultsA 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.ConclusionProlonged 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.