252. Less Is More: Surgical Procedure Time and Risk of Infections, Length-of-Stay, and Readmission across Three Distinct Surgeries
Session: Poster Abstract Session: Clinical: Skin and Soft Tissue
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • RParikh_IDWeek_Final_Less Is More - Surgical Procedure Time and Risk of Infections, LOS, and Readmission across Three Distinct Surgeries (1).pdf (785.3 kB)
  • Background:

    Longer surgical total procedure times (TPT) have been associated with increased postoperative complications. It is unclear what the effect of TPT is on length-of-stay (LOS) or 30 day readmission rate (RAR).

    Methods:

    We performed a retrospective study of patients undergoing knee arthroplasty (KA), colectomy, and craniectomy at NorthShore University HealthSystem from 1/2007-12/2013. Clinical data were extracted from the Data Warehouse and charts were reviewed. We standardized surgery times for each procedure and categorized into two groups: times <75%ile (short procedures) vs. times >75%ile (long procedures). We used X2 and t-test to compare categorical and continuous variables. We performed multivariate logistic regression for predictors of surgical site infection (SSI).

    Results:

    In univariate analyses, long procedures were associated with higher incidence of fevers, SSI, longer LOS, and 30 day RAR (Table 1). TPT was not associated with other postoperative complications. TPT remained an independent predictor of SSI in multivariate (MV) analysis (Table 2).

    Conclusion:

    High TPT was associated with increased SSI, LOS, and 30 day RAR. Understanding variation in TPT may help decrease SSI and healthcare utilization.

     

    Table 1: Variables Stratified by (TPT)

    Characteristic N (%)

    Short N=5920

    Long N=1980

    P-value

    Fever ≥ 100.4

    1042 (17.6%)

    450 (22.7%)

    *

    Body Mass Index ≥ 35

    1143 (19.7%)

    519 (26.6%)

    *

    Female

    3867 (65.3%)

    1117 (56.4%)

    *

    Surgery

    KA

    Colectomy

    Craniectomy

    4788 (80.9%)

    467 (7.9%)

    665 (11.2%)

    1604 (81.0%)

    155 (7.8%)

    221 (11.2%)

    0.99

    Complication

    Urinary Tract Infection

    Pneumonia

    SSI

    Venous thromboembolism

    420 (7.1%)

    76 (1.3%)

    75 (1.3%)

    67 (1.1%)

    174 (2.9%)

    154 (7.8%)

    26 (1.3%)

    28 (1.4%)

    41 (2.1%)

    61 (3.1%)

    0.31

    0.92

    0.62

    *

    0.75

    SSI w/in 30 day of discharge

    84 (1.4%)

    48 (2.4%)

    *

    Mean LOS, days (SD)

    3.69 (2.89)

    4.05 (3.38)

    *

    30d RAR

    277 (4.7%)

    142 (7.2%)

    *

    *P-value < 0.01

    Table 2: MV logistic regression of SSI within 30 day of discharge

    OR (95% CI)

    P-value

    Age

    0.99 (0.98-1.01)

    0.97

    Female

    1.21 (0.84-1.75)

    0.31

    Surgery

    KA

    Colectomy

    Craniectomy


    Ref.

    70.2 (36.6-134.6)

    20.3 (10.0-41.0)

    *

    TPT > 75th%ile

    1.59 (1.08-2.33)

    0.02

    Fever > 100.4

    4.10 (2.85-5.94)

    *

    Diabetes

    1.92 (1.27-2.91)

    *

    Including only variables with p-value <0.2 in UV analysis

    *P-value <0.01

    Ronak Parikh, DO1, Nirav Shah, MD, MPH2, Huma Saeed, M.D.3, Eric Bhaimia, D.O.4, Frances Lahrman, DO3, Moira C. McNulty, MD5, Ari Robicsek, MD6, Rema Padman, PhD7 and Jennifer Grant, MD8, (1)University of Chicago (NorthShore), Evanston, IL, (2)Medicine, Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL, (3)Internal Medicine, University of Chicago (NorthShore), Evanston, IL, (4)Internal Medicine, Univeristy of Chicago (NorthShore), Evanston, IL, (5)Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, (6)Providence Health and Services, Seattle, WA, (7)Healthcare Informatics, Carnegie Mellon University, Pittsburgh, PA, (8)Infectious Disease, NorthShore University HealthSystem, Evanston, IL

    Disclosures:

    R. Parikh, None

    N. Shah, None

    H. Saeed, None

    E. Bhaimia, None

    F. Lahrman, None

    M. C. McNulty, None

    A. Robicsek, None

    R. Padman, None

    J. Grant, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.