• Levi D Procter, Daniel L Davenport, Andrew C Bernard, and Joseph B Zwischenberger.
• Department of Surgery, University of Kentucky College of Medicine, Lexington, KY 40536, USA. ldproc0@email.uky.edu
• J. Am. Coll. Surg. 2010 Jan 1;210(1):60-5.e1-2.

BackgroundStudies of specific procedures have shown increases in infectious complications with operative duration. We hypothesized that operative duration is independently associated with increased risk-adjusted infectious complication (IC) rates in a broad range of general surgical procedures.Study DesignWe queried the American College of Surgeons National Surgical Quality Improvement Program database for general surgical operations performed from 2005 to 2007. ICs (wound infection, sepsis, urinary tract infection, and/or pneumonia) and length of hospital stay (LOS) were evaluated versus operative duration (OD, ie, incision to closure). Multivariable regression adjusted for 38 patient risk variables, operation type and complexity, wound class and intraoperative transfusion. We also analyzed isolated laparoscopic cholecystectomies in patients of American Society of Anesthesiologists class 1 or 2, without intraoperative transfusion and with a clean or clean-contaminated wound class.ResultsIn 299,359 operations performed at 173 hospitals, unadjusted IC rates increased linearly with OD at a rate of close to 2.5% per half hour (chi-square test for linear trend, p < 0.001). After adjustment, IC risk increased for each half hour of OD relative to cases lasting ConclusionsOperative duration is independently associated with increased ICs and LOS after adjustment for procedure and patient risk factors.Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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