title: Outcomes of Prolonged Laparoscopic Bariatric Operations Compared With Shorter Open Procedures.
abstract: OBJECTIVE
  Prolonged operative time (ORT) is a drawback of laparoscopic bariatric surgery due to concerns for increased morbidity. This study aims to identify the ORT when open procedures are superior to laparoscopic procedures.
  
  
  METHODS
  Thirty-day outcomes for bariatric procedures in the NSQIP database were analyzed comparing laparoscopic ORT to equal or shorter open ORT. Multivariate regression was utilized to control for patient demographics and comorbidities.
  
  
  RESULTS
  Among 48,274 cases, laparoscopic procedures reduced morbidity and mortality compared with open procedures of similar ORT. Laparoscopic procedures ≤3 hours were equal or superior to shorter open procedures. Laparoscopic procedures >6 hours had worse outcomes than open operations <3 hours. Open operations >3 hours had no benefit regardless of ORT.
  
  
  CONCLUSIONS
  Laparoscopic bariatric operations have less mortality and morbidity compared with open procedures of similar ORT. The advantages of laparoscopic procedures are eliminated when ORT exceeds 6 hours compared with shorter open procedures.
authors.affiliation: Department of Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Zettervall
authors.forename: Richard
authors.initials: R
authors.lastname: Amdur
authors.forename: Khashayar
authors.initials: K
authors.lastname: Vaziri
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States