Every minute counts: the association of operative time and postoperative complications for patients undergoing minimally invasive and abdominal myomectomy

To assess whether operative time is independently associated with risk of postoperative complications after myomectomy and whether such relationship differs by surgical approach. Demographic, perioperative variables, and 30-day postoperative complications were extracted from the National Surgical Quality Improvement Program database on patients who underwent abdominal myomectomy (AM) and minimally invasive myomectomy (MIM) between 2014-2021. Complications were categorized as minor or major based on Clavien-Dindo classification. For analysis, covariates associated with operative time and composite complications were identified using general linear model and chi-square or Fisher’s exact test as appropriate. Adjusted spline regression was performed as a test of linearity between operative time and composite complication. Adjusted odds ratio of various complications by 60-minute increments were estimated using Poisson regression with robust error variance. Of the total 27,728 patients captured, 11,071 underwent MIM and 16,657 underwent AM. Mean operative times (standard deviation) were 164.6 (82.0) minutes for MIM and 129.2 (67.0) minutes for AM. Raw composite complication rates were 5.5% for MIM and 15.8% for AM. Adjusted spline regression demonstrated a linear relationship between operative time and odds of composite complications for both MIM and AM (p<0.0001 for both). With each 60-minute increase in operative time, patients undergoing AM had higher odds (aOR, 95%CI) of experiencing specific major complications than patients undergoing MIM, including myocardial infarction (2.55, 1.74-3.72 vs 1.29, 1.19-1.41), cardiac arrest (1.33, 1.02-1.74 vs 1.21, 1.16-1.26), and stroke (1.57, 1.37-1.81). However, with each 60-minute increase in operative time, MIM had higher odds of minor complications than patients undergoing AM, including blood transfusion (1.55, 1.45-1.64 vs 1.29, 1.25-1.34) and urinary tract infection (1.19, 1.02-1.40 vs 0.99, 0.85-1.16). MIM was also associated with higher odds of composite complications (1.31, 1.25-1.38 vs 1.24, 1.19-1.28) and accrued this risk faster (reached aOR 2.0 at 296 minutes vs 461 minutes for AM). Operative time is independently and linearly associated with risk of composite complications for both MIM and AM. While patients undergoing AM have higher odds of specific major complications, those undergoing MIM have overall higher odds of experiencing composite complications and accrue this risk faster.