Longer Operative Time During Laparoscopic Myomectomy Is Associated with Increased 30-Day Complications and Blood Transfusion
Notice bibliographique
Résumé
Background: An association between operative time and complications is well-established in the general surgery literature, with many studies isolating operative time as an independent risk factor for postoperative complications, including infectious morbidity, ileus, and increased length of hospital stay. However, the potential association between longer operative time and perioperative complications in laparoscopic myomectomy has not yet been delineated clearly. Objective: The aim of this study was to evaluate the association between operative time and 30-day complications after laparoscopic myomectomy. Materials and Methods:Study Design: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized for the evaluation. Data were retrieved retrospectively for laparoscopic myomectomy procedures recorded between 2005 and 2012 at all institutions contributing to the ACS-NSQIP (Canadian Task Force classification II-2). Given utilization of de-identified data, the current authors' institutional review board did not require a formal review. Patients were identified via Current Procedural Terminology codes for laparoscopic myomectomy, namely, 58545 (1–5 intramural myomas weighing ≤250 g and/or surface myomas) and 58546 (≥5 intramural myomas and/or weight >250 g). Outcomes: Primary outcomes included 30-day overall, medical, and surgical complications and return to the operating room. Statistics: Bivariate comparisons to determine associations between clinical and procedural variables, longer operative time, and complications were performed using Chi-square or Fisher's exact tests for categorical variables and independent samples t-tests for continuous variables. Multivariable logistic regression analyses were performed to determine the independent association between operative time and perioperative complications. Results: During the study period 1017, laparoscopic myomectomy procedures were identified. The overall complication rate was 5.3%, with the most common complications being blood transfusion (3.4%), surgical site infection (1.1%), and urinary tract infection (0.5%). Return to the operating room occurred in 0.4% of patients. There were no deaths. Overall and medical complication rates increased as surgical duration increased, with an inflection point noted at 240 minutes. An operative time ≥240 minutes was associated with increased overall complications (13.7% versus 3.1%; p<0.001), medical complications (13.2% versus 2.2%; p<0.001), pneumonia (1.4% versus 0%; p=0.001), and blood transfusion (9.9% versus 1.7%; p<0.001). On multivariable regression analysis, an operative time ≥240 minutes was independently associated with medical complications (odds ratio [OR]: 5.32; 95% confidence interval [CI]: 2.77–10.20; p<0.001), blood transfusion (OR: 4.80; 95% CI: 2.27–10.11; p<0.001), and overall complications (OR 3.92; 95% CI 2.17–7.07; p<0.001). Based on continuous regression modeling of operative time, for each additional hour of operative time, odds of medical complications would be expected to increase by a factor of 1.65, blood transfusion by 1.66, and overall complications by 1.52. Conclusions: This study demonstrated an independent association between longer operative time during laparoscopic myomectomy and higher rates of 30-day overall complications, medical complications, and blood transfusion. Future research should aim to delineate risk factors further for prolonged operative time and morbidity in laparoscopic myomectomy in order to enable surgeons to maximize preoperative planning and optimize patient selection for minimally invasive myomectomy. (J GYNECOL SURG 32:11)
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».