title: Prolonged operative time in laparoscopic appendectomy: Predictive factors and outcomes.
abstract: BACKGROUND
  To our knowledge, this study is the first to identify the predictive factors and outcomes of prolonged operative time associated with laparoscopic appendectomy. We aimed to identify preoperative factors that influence operation time and to determine how operative time affects laparoscopic appendectomy outcomes.
  
  
  METHODS
  The medical records of 3049 patients who had undergone laparoscopic appendectomy between January 2008 and December 2014 were retrospectively reviewed. Prolonged operative time was defined in the top 10% according to distribution (>90 min). A multivariate regression model was generated to assess potential predictive factors and outcomes of prolonged operative time.
  
  
  RESULTS
  In laparoscopic appendectomy for non-perforated appendicitis, independent factors that predict a prolonged operative time as identified through multivariate analysis were elevated C-reactive protein levels, symptom duration of more than 3 days, and computed tomography findings indicating an appendiceal diameter of more than 10 mm. In laparoscopic appendectomy for perforated appendicitis, overweight, elevated C-reactive protein, symptom duration of more than 3 days, and computed tomography findings of abscess were independent predictive factors for prolonged operative time. Prolonged surgery increases the risk of complications, prolonged hospital stay, and readmission.
  
  
  CONCLUSIONS
  Overweight, elevated C-reactive protein, symptom duration of more than 3 days, appendiceal diameter of more than 10 mm, and abscess were independent predictive factors of prolonged operative time. Furthermore, prolonged operative time was associated with adverse postoperative outcomes after laparoscopic appendectomy.
authors: Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea.
authors: Byeong Geon
authors: BG
authors: Jeon
authors: Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea.
authors: Hyuk Jung
authors: HJ
authors: Kim
authors: Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea.
authors: Kuk Hyun
authors: KH
authors: Jung
authors: Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea.
authors: Sang Wook
authors: SW
authors: Kim
authors: Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea.
authors: Jin Soo
authors: JS
authors: Park
authors: Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea.
authors: Ki Ho
authors: KH
authors: Kim
authors: Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Sungnam-si, Republic of Korea.
authors: Il Dong
authors: ID
authors: Kim
authors: Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea. Electronic address: colon@chungbuk.ac.kr.
authors: Sang-Jeon
authors: SJ
authors: Lee
mesh_terms: D000038:Abscess / Q000453:epidemiology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D009929:Organ Size; D050177:Overweight / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: Laparoscopic appendectomy; Operative time; Outcomes; Predictive factors