Increased Operative Duration of Minimally Invasive Prostatectomy is Associated with Significantly Increased Risk of 30-Day Morbidity

Introduction: We examined the effect of operative duration on morbidity in minimally invasive radical prostatectomy. Operative duration has been shown to be a risk factor for negative outcomes in multiple surgical procedures but minimal data exist regarding urological procedures. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried by CPT code from 2011 to 2016. Standard NSQIP morbidities were used. Univariable and multivariable analysis was performed to determine risk factors for complications. Results: A total of 35,105 patients were studied. Operative duration was broken into deciles, by minutes. Several variables were significantly associated with operative duration. The values stated represent variables in the shortest and longest deciles, respectively, including body mass index 27.6 kg/m2 and 29.7 kg/m2, diabetes 11.6% of patients and 14.7%, and smoking 12.5% of patients and 14.5%. Several morbidities were significantly associated with operative duration, with shortest and longest deciles reported respectively, including complications 4.1% and 9.9%, surgical site infection 0.6% and 1.9%, transfusion 0.9% and 3.2%, sepsis 0.3% and 1.2%, pulmonary embolism/deep vein thrombosis 0.6% and 1.8%, renal insufficiency 0.2% and 1.1%, and urinary tract infection 1.5% and 2.9%. The longest 3 deciles were significantly more likely to have complications with increasing odds ratios with increasing operative duration, with an adjusted OR of 1.6, 1.7 and 2.3. Conclusions: Operative duration is an independent predictor of morbidity, even when adjusting for patient specific preoperative factors. Patients in the longest decile were more than twice as likely to have complications. Further study on ideal operative duration, such as nomograms, as well as causation of longer operative duration and ways to increase operating room efficiency is needed.