title: The effect of surgical start time in patients undergoing minimally invasive sacrocolpopexy.
abstract: OBJECTIVE
  The objective was to determine if the surgical start time affects operating room time and the incidence of perioperative adverse events in patients undergoing minimally invasive sacrocolpopexy.
  
  
  METHODS
  This is a retrospective cohort of 396 women who underwent laparoscopic and robotic sacrocolpopexy at a tertiary care center between January 2006 and December 2012. Cases were divided into those with a first, second or third start time. Operating room (OR) time was defined as time the patient entered the room to time out of the room (minutes) and the case time was defined as the period between incision and closure (minutes). Adverse events were defined a priori and also reported using the Clavien-Dindo grading scale. Logistic regression analysis was performed for categorical variables and multiple linear regression analysis for continuous variables.
  
  
  RESULTS
  A total of 145 robotic and 261 conventional laparoscopic minimally invasive sacrocolpopexies were performed. Operating room time data were available for 396 cases. Of the cases, 63.9 % (253 out of 396) had a first start, 32.1 % (127 out of 396) had a second start, and 4 % (16 out of 396) had a third start. Robotic and concomitant rectopexy cases were more likely to be performed as first-start cases and operating room time and case time were longest for first-start cases. However, after adjusting for mode of surgery, concomitant procedures, previous surgeries, BMI, and age, this finding was no longer statistically significant. There was no difference in the rate of perioperative adverse events among first-, and second-/third-start cases.
  
  
  CONCLUSIONS
  Surgical case start time does not appear to be associated with operating time or the incidence of perioperative adverse events in patients undergoing minimally invasive sacrocolpopexy.
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH, 44195, USA. karljallad@gmail.com.
authors.forename: Karl
authors.initials: K
authors.lastname: Jallad
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH, 44195, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH, 44195, USA.
authors.forename: Beri
authors.initials: B
authors.lastname: Ridgeway
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH, 44195, USA.
authors.forename: Marie Fidela R
authors.initials: MF
authors.lastname: Paraiso
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH, 44195, USA.
authors.forename: Cecile A
authors.initials: CA
authors.lastname: Unger
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013997:Time Factors
keywords: Laparoscopic sacrocolpopexy; Operating time; Pelvic organ prolapse; Perioperative complications; Robotic sacrocolpopexy