Does Time Spent in Surgery Affect Outcomes?

Orthopaedic & Spine Center

Dr. Jeffrey CarlsonJeffrey R. Carlson, MD

Whenever I discuss an upcoming surgery with my patient, there are lots of questions that come from the patient themselves, their family members and/or their caregivers.  One question that most patients don’t ask is “How long does the actual surgery take to perform?”  In general, patients want the surgeon to “take all the time they need” to make sure the procedure is performed carefully and well.   But can too much time in surgery be dangerous to your health?

There’s a distinction between the time spent in the operating room and the actual surgical procedure time.  The time spent in the OR includes the patient entering the operating room, being placed on the operating table, being prepped and draped, being given anesthesia, having surgery and waking up.  I’m much more interested in the actual time that the surgery takes to be performed, which starts when I make the first surgical incision and ends l when I close the incision with sutures or staples.  Let me explain why that is meaningful to me and should be considered by you as well.

There are some significant complications that can occur as the length of time of the actual surgery increases.  These are often magnified in those patients that already have other medical problems (such as diabetes or high blood pressure), those who have had previous surgery and in the older patient population.

A recent study published in the Global Spine Journal (Hersey, et. Al.), investigated almost 5000 patients over the age of 65 who had undergone lumbar spinal fusion surgery. Those patients with longer surgical times had a more likely occurrence of a complication.  The overall complication rate in this study was about 13% and the average operative time was 3.3 hours.  The number of complications increased with each hour the surgery took to perform.

What are the most commonly seen surgical complications after lengthy spine surgeries? 

  1. The need for a blood transfusion – This seems intuitive, as the longer the surgery takes, the more blood is lost, so the need for a transfusion is more likely.  While rare, blood transfusions carry risks as well, such as having an allergic reaction or contracting a blood borne illness, which we definitely want to avoid after surgery.
  2. Pulmonary Embolism or blood clot in the lung – Patients in surgery are sedated and can’t move their arms and legs to keep their blood from pooling.  As a result, pooled blood can clot and then travel to the lung.  This can be very devastating and may result in death.
  3. Urinary Tract Infection – Catheters are usually inserted in the operating room to drain the patients’ bladder during the surgery.  The anesthesiologist provides needed fluids through the veins to maintain the patients’ blood pressure.  This fluid has to be excreted through the kidneys to the bladder, so the catheter will drain the bladder to keep the fluid from backing up.  The longer the surgery, the longer the catheter is in place and the more likely the patient will have a urinary tract infection.  Recovering from surgery is hard enough, so adding a urinary tract infection on top of that is very taxing on the body and should be avoided.
  4. Surgical wound infections – Patients that have longer surgical times have an increased risk of wound infections.  The longer the wound is open in the operating room and the more surgical trauma the patient endures during surgery allows the potential for bacteria to enter the wound and cause an infection. 

We’ve developed surgical techniques that utilize smaller incisions, reduce surgical time and can be done without a blood transfusion.  These techniques allow me to perform lumbar fusion surgery in under 1.5 hours, which greatly reduces the overall complication rate.  Because the incisions are smaller, the risk of infection and the post-operative pain from the procedure is decreased.  With less pain, patients are able to go home the same day, and walk around the house to keep their blood moving and minimize the risk of blood clots. 

Being your surgeon involves more than just diagnosing you with a spine issue and talking to you about surgery.  I research and develop the best surgical techniques that get my patients in and out of surgery more quickly, to reduce those intra-operative surgical risks we discussed above.  To me, I consider the most successful surgery for you to be one with no post-surgical complications, which allows you to focus entirely on your recovery and getting back to the life you love.