Educational Objective: At the conclusion of this presentation, the participants should be able to understand the risk for postoperative complications in patients with prolonged operative times undergoing outpatient tonsillectomy.
Objectives: Prolonged operative times (OT) have been associated with negative outcomes in various surgical fields. We examine the impact of prolonged OT on postoperative complications in patients undergoing tonsillectomy.
Study Design: Retrospective database review.
Methods: The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing outpatient tonsillectomy. Patients receiving concurrent procedures or with missing OT data were excluded. Patients with OT greater than 75th percentile were defined to have prolonged OT. We conducted univariate and multivariate analyses.
Results: A total of 22,187 patients met inclusion criteria. The majority of patients were female (68.8%) and White (65.4%) with a median age of 26 years. Of these cases, 5,174 (23.3%) cases had prolonged OT with a total of 255 (1.1%) patients experiencing a complication. Patients with prolonged OT were significantly more likely to be obese (39.1% vs. 33.3%, p<0.001), have diabetes mellitus (3.3% vs. 2.4%, p<0.001), and smoke (17.4% vs. 15.2%, p<0.001). Multivariate regression analysis demonstrated a significant association between prolonged OT and all complications (OR=1.49 [1.08-2.05], p=0.015), reoperation (OR=1.38 [1.17-1.63], p<0.001), and unplanned readmission (OR=1.49 [1.20-1.84], p<0.001). Individual complication analysis revealed associations with organ space surgical site infection (OR=3.10 [1.20-8.00], p=0.020) and reintubation (OR=3.96 [1.16-13.50], p=0.028).
Conclusions: Prolonged OT in outpatient adult tonsillectomies is associated with increased complications, reoperation, and unplanned readmission. Future study examining risk factors for prolonged OT may be warranted to prevent such complications.