Longer Operative Time During Laparoscopic Myomectomy Is Associated with Increased 30-Day Complications and Blood Transfusion
Bibliographic record
Abstract
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)
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".