Delayed surgical start tied to postoperative complications in hysterectomy: Study

Baltimore, MD: A new study suggests that delayed surgical start time extended hospital stay and increased blood loss among patients who received a hysterectomy for benign causes. This study was conducted by T.K. Brah and team and the findings were published in the Journal of Minimally Invasive Gynecology in the month of November 2021.

The procedural start time has been linked to operational outcomes in studies from several surgical specialties. Dr. Brah and colleagues aimed to examine these diurnal associations in benign hysterectomy cases.

This was a retrospective cohort analysis taken from five hospital healthcare systems. The general participants were Women undergoing hysterectomy for benign indications from 1 July 2014 to 28 February 2019. Patients were divided into two groups depending on their arrival time in the operation room: AM (before noon) and PM (afternoon). Demographic, clinical, and perioperative data were gathered.

Post-operative outcomes such as estimated blood loss (EBL), length of stay (LOS), and unfavorable perioperative events were assessed by the researchers (blood transfusion, organ injury, conversion to laparotomy, cuff dehiscence, surgical site infection, readmission, reoperation, and death). In addition, hospital expenditures were calculated. Descriptive statistics, t-tests, and multivariate regression models were used in the statistical study.

The study comprised 2894 patients, 1910 in the morning and 984 in the evening. The PM start time group had considerably more EBL, but the AM start time group had a greater same-day discharge. Year, age, BMI, race, comorbidities, uterine size, surgical indication, and surgeon specialism were all included as potential confounding factors in multivariate regression models.

In the PM group, these models continued to demonstrate considerably higher EBL and LOS. There was no link found between operation times or unfavorable perioperative occurrences. In terms of cost, an earlier start time was related to higher hospital charges. These findings were also supported by multivariate regression models.

According to the findings of this study, surgical results may be related to the time of day in which the surgery is performed. While the underlying process is unknown, using this information in surgery planning can help to customize risk reduction and boost same-day discharge. More research is being conducted to determine the time-of-day cost disparities.

Reference:

T.K. Brah, A. AlAshqar, H.Y. Wu, K. Simpson, K.C. Wang, K.E. Patzkowsky, M.A. Borahay, Hysterectomy Outcomes Associated with Surgical Time-of-Day, Journal of Minimally Invasive Gynecology,Volume 28, Issue 11, Supplement,2021,Page S110,ISSN 1553-4650, https://doi.org/10.1016/j.jmig.2021.09.160.