Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Can J Urol. 2022 Apr;29(2):11087-11094.
To elucidate the association between operative duration (OD) and postoperative complications, which has been poorly studied in radical cystectomy. We hypothesize an increase in morbidity in radical cystectomy cases which have a longer OD.
Data from the National Surgical Quality Improvement Program (NSQIP) between the years 2012 and 2018 were reviewed for radical cystectomy with ileal conduit urinary diversion or continent diversion. Total operative time was divided into deciles and stratified comparisons were made using univariable and multivariable analysis.
A total of 11,128 patients were examined. OD by minutes was stratified into the following deciles: 90-201, 202-237, 238-269, 270-299, 300-330, 331-361, 362-397, 398-442, 443-508, > 508. Operative times were shorter for patients with advanced age (p < 0.001), male gender (p < 0.001), low body mass index (BMI) (p < 0.001), bleeding diathesis (p = 0.019), COPD (p = 0.004), and advanced ASA class (p < 0.001). Complications significantly associated with prolonged OD included surgical site infection, urinary tract infection, sepsis/septic shock, renal failure and venous thromboembolism. On multivariate analysis, factors predictive of perioperative morbidity included presence of bleeding disorder (OR 1.70, 95% confidence intervals (CI) 1.37-2.12, p < 0.001), ASA Class IV-V compared to I-II (OR 2.26, 95% CI 1.89-2.72, p < 0.001), and prolonged operative time (tenth decile OR 3.05, 95% CI 2.55-3.66, ninth decile OR 2.11 95% CI 1.77-2.50, third decile OR 1.31, 95% CI 1.11-1.56, second decile OR 1.02, 95% CI 0.86-1.21 compared to first decile, p < 0.001) Conclusion: OD is an independent predictor of post-operative morbidity in patients undergoing radical cystectomy, even when adjusting for patient specific factors. Those patients within the longest decile had over 3-fold increase in the risk of morbidity compared to those with shorter OD.
为了阐明手术时间（OD）与术后并发症之间的关系，这在根治性膀胱切除术方面研究得还不够充分。我们假设，手术时间较长的根治性膀胱切除术病例的发病率会增加。
对 2012 年至 2018 年间国家外科质量改进计划（NSQIP）的数据进行了回顾，包括根治性膀胱切除术伴回肠导管或 continent 转流术。总手术时间分为十分位数，并使用单变量和多变量分析进行分层比较。
共检查了 11128 名患者。以分钟为单位的 OD 分为以下十分位数：90-201、202-237、238-269、270-299、300-330、331-361、362-397、398-442、443-508、>508。手术时间随患者年龄（p<0.001）、男性（p<0.001）、低体重指数（BMI）（p<0.001）、出血倾向（p=0.019）、COPD（p=0.004）和高级 ASA 分级（p<0.001）的增加而缩短。与手术时间延长显著相关的并发症包括手术部位感染、尿路感染、败血症/感染性休克、肾衰竭和静脉血栓栓塞。多变量分析显示，围手术期发病率的预测因素包括存在出血障碍（OR 1.70，95%置信区间[CI]1.37-2.12，p<0.001）、ASA 分级 IV-V 与 I-II（OR 2.26，95%CI 1.89-2.72，p<0.001），以及手术时间延长（第十分位数 OR 3.05，95%CI 2.55-3.66，第十分位数 OR 2.11 95%CI 1.77-2.50，第十分位数 OR 1.31，95%CI 1.11-1.56，第十分位数 OR 1.02，95%CI 0.86-1.21 与第一十分位数相比，p<0.001）。结论：OD 是接受根治性膀胱切除术患者术后发病率的独立预测因素，即使在调整患者特定因素后也是如此。与手术时间较短的患者相比，最长十分位数的患者发病率增加了 3 倍以上。
