Impact of Operation Time on 30-Day Complications After Adult Spinal Deformity Surgery

STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: There is a paucity of data on the effect of operative duration on postoperative complications during adult spinal deformity surgery (ASDS). The study attempts to explore and quantify the association between increased operation times and postoperative complications. METHODS: A retrospective cohort analysis was performed on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2014. Patients (≥18 years of age) from the NSQIP database undergoing ASDS were separated into cohorts based on quartiles of operation duration. Chi-square and multivariate logistic regression models were used to identify risk factors. RESULTS: A total of 5338 patients met the inclusion criteria and were divided per quartiles based on operative duration in minutes (154, 235, 346, and 1156 minutes). Multivariate logistic regressions revealed that in comparison to the lowest quartile of operative duration, the highest quartile group was associated significantly with length of stay ≥5 days (odds ratio [OR] = 5.85), any complication (OR = 9.88), wound complication (OR = 5.95), pulmonary complication (OR = 2.85, P = .001), venous thromboembolism (OR = 12.37), intra-/postoperative transfusion (OR = 12.77), sepsis (OR = 5.27), reoperations (OR = 1.48), and unplanned readmissions (OR = 1.29). The odds ratio was higher when comparing a higher quartile group with the reference group across all associations. P < .001 unless otherwise noted. CONCLUSION: ASDS operation time is associated with multiple postoperative complications, including, but not limited to, wound and pulmonary complications, venous thromboembolism, postoperative transfusion, length of stay ≥5 days, sepsis, reoperation, and unplanned readmission.