Association between operative time and short-term postoperative complications following minimally invasive surgery for stage III-IV endometriosis.

OBJECTIVE: To examine the association between operative time and short-term postoperative complications in patients undergoing surgery for stage III-IV endometriosis. METHODS: This retrospective cohort study was conducted at a quaternary care institution in the United States. We included patients aged 18-51 years with pathology-confirmed stage III-IV endometriosis who underwent minimally invasive surgery for endometriosis between 2013 and 2023. We analyzed the association between operative time and short-term postoperative complications, as well as between operative time and overnight admission. Operative time was assessed both by percentile thresholds (50th: 149 min, 75th: 206 min, 90th: 280 min) and in 60-minute increments. The primary outcome was the occurrence of any short-term postoperative complication relative to operative time. RESULTS: A total of 583 patients were included. At the 50th percentile threshold, longer operative times were associated with a higher rate of intraoperative complications (10.6% vs. 7.9%, p = .038). However, postoperative complication rates did not significantly differ across the 50th, 75th, or 90th percentile thresholds. In multivariable regression analysis, operative time longer than the median, 90th percentile, or any additional 60 min of operation were not associated with postoperative complications, while operative time > 75th percentile was associated with a potential reduction in postoperative complications (adjusted odds ratio [aOR] 0.44, 95% confidence interval [CI] 0.20-0.94). The risk of overnight admission was independently associated with each operative time threshold. Each additional hour of operative time was associated with a 64% increased likelihood of overnight admission. CONCLUSIONS: Among patients undergoing minimally invasive surgery for stage III-IV endometriosis, longer operative times were not associated with increased short-term postoperative complications. However, longer operative times were independently associated with a higher likelihood of overnight admission. These findings underscore the need to prioritize surgical thoroughness over speed in complex endometriosis cases.