The association of operative time with outcomes in minimally invasive and abdominal myomectomy
Article In Press
Maria V. Vargas, M.D., M.S., Kathryn Denny Larson, M.D., Andrew Sparks, M.S., Samantha L. Margulies, M.D., Cherie Q. Marfori, M.D., Gaby Moawad, M.D., Richard L. Amdur, Ph.D.
To determine the association of operative time (ORT) with perioperative morbidity and whether there is an ORT at which minimally invasive myomectomy becomes inferior to laparotomy.
Retrospective cohort study.
Myomectomy cases identified by CPT code from 2005 to 2016.
Cases were stratified and analyzed by surgical approach and 90-minute intervals.
Main Outcome Measure(s)
Thirty-day postoperative morbidity.
A total of 11,709 myomectomies were identified; 4,673 (39.9%) were minimally invasive, 6,997 (59.8%) were abdominal, and 39 (0.3%) were conversions. The incidence of complications significantly increased with ORT. After adjusting for confounders, mean ORT in minutes (95% confidence interval) was 113 (111–115) for abdominal, 156 (153–159) for minimally invasive, and 172 (148–200) for conversions. Despite shorter ORT, morbidity was greater in abdominal cases (16% vs. 5.7%), with the highest rates in converted cases (20.5%). The minimally invasive approach in general had lower odds of complications (odds ratio, 0.23; 95% confidence interval, 0.19–0.26). However, when minimally invasive surgery ORT reached ≥ 270 minutes, the odds of a composite complication variable increased compared with abdominal cases <90 minutes (odds ratio, 2.30; 95% confidence interval, 1.69–3.13). Of minimally invasive cases, 88% were completed in <270 minutes.
ORT was predictive of complications for both minimally invasive and abdominal myomectomies. Despite longer ORTs, minimally invasive procedures generally had superior 30-day outcomes up to 270 minutes. Careful patient counseling and preparation to increase surgical efficiency should be prioritized for either approach.