Operative Time Predicts Hospital Length of Stay and Postoperative Complications Following Nerve Pedicle Transfer Surgery: A Multicenter Study

Introduction: Operative time (OT) has been extensively studied for its impact on postoperative outcomes, revealing a growing body of evidence indicating worse results with prolonged OT. However, the influence of OT on nerve pedicle transfer (NPT) outcomes remains uncertain. This study aims to identify the critical OT threshold associated with increased risk of adverse events and quantify the link between extended OT and postoperative complications following NPT procedures.

Methods: The 2011-2021 American College of Surgeons National Surgical Quality Improvement Program dataset was queried to identify patients undergoing NPT as a primary procedure using Current Procedural Terminology codes 64905 and 64907. Patients were stratified into shorter OT (SOT) and longer OT (LOT) groups based on the cut-off value predicted by ROC curve analysis. A multivariate logistic regression model, controlling for confounders, was used to quantify the risk of prolonged OT on complications following surgery.

Results: A total of 177 patients (35% female, mean age 45.6+/- 15.6) were included in our study. Using ROC curve analysis and the maximum K-S metric analysis, the study categorized the patients into two groups: those with OT either exceeding or falling below 3.025 hours, with 116 (65.5%) in the SOT group and 61 (34.5%) in the LOT group. On t test, LOT group were associated with longer hospital length of stay (LOS) compared to SOT group (1.5+/-2.4 days vs 0.3+/-0.6 days, p< 0.001). Univariate analysis revealed a statistically significant association between LOT and 30-day complications (OR 7.4, CI: 1.5-36.8, p=0.01). On multivariate analysis that controlled for Age, Body Mass Index, American Society of Anesthesiologists Class, and modified 5-item frailty index (mFI-5), LOT was independently associated with an increased risk of overall complications (OR 7.8, CI:1.5 – 40.2, p=0.01).

Conclusion : This study demonstrates that OT>3.025 hours strongly predicts longer hospital LOS and the occurrence of postoperative adverse events following NPT surgery. This data highlights several specific complications that are influenced by OT and further supports the need for future protocols that aim to safely minimize OT for NPT procedures.