Physician Risk Estimation of Operative Time: A Comparison of Risk Factors for Prolonged Operative Time in Robotic and Conventional Laparoscopic Hysterectomy
Article
Objective: The Physician Risk Estimation of Operative Time (PREOpT) project is an effort to identify patient characteristics associated with prolonged operative time in patients undergoing robotic or conventional laparoscopic total hysterectomy. Methods: A retrospective cohort study of 1290 cases of robotic and conventional laparoscopic total hysterectomy was performed over 2 years. Univariate, bivariate, and predictive analysis were performed to determine associations between patient characteristics and prolonged operative time. Setting: The study was performed in urban gynecologic practices in a tertiary care teaching hospital. Results: Of 1290 patients who underwent minimally invasive hysterectomy, 732 patients had conventional laparoscopic hysterectomy (TLH) and 558 had robotic hysterectomy (RTH). Prolonged operative time was defined as >= 180 minutes. Mean operative time for all cases was 115.79 minutes (standard deviation [SD] +/- 60.37). Obesity was associated with increased operative time (odds ratio [OR] = 2.33, 95% confidence interval [CI] 1.40-3.89). Patients with history of myomectomy had 2.77 increased odds of prolonged operative time (95% CI 1.42-5.4; p = 0.003). If the myomectomy was performed laparoscopically, the OR was 3.76 (95% CI 1.30-11.01; p = 0.015), but if it was performed via laparotomy, the odds increased to 4.15 (95% CI 1.40-12.32; p = 0.01. This effect disappeared when a surgeon with a high volume of patients performed the surgery. `` High volume'' surgeons had a 56% reduced risk of long operative time OR= 0.44 (95% CI 0.31-0.63). Conclusions: Obesity, large uterine size, previous history of myomectomy, and lack of surgeon experience were associated with long operative time in patients undergoing laparoscopic or robotic hysterectomy for benign disease.