EP371 - Does OR Workflow Matter? The Impact Of Prolonged Operative Time On Ileus And Length Of Stay After Elective Colectomy.

Sunday, May 10, 2026

12:40 PM - 12:45 PM ET

ePoster Presenter(s)

Bryan Szeglin, MD (he/him/his)

Resident Physician
The Johns Hopkins Hospital
The Johns Hopkins Hospital
Baltimore, MD, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Stefano Tassinari, MD

General Surgery Resident
Johns Hopkins Hospital
Laurel, MD, United States

Disclosure information not submitted.
Sophia Diaz, MD, MSE (she/her/hers)

Surgical Resident Physician
Johns Hopkins University
Baltimore, MD, United States

Disclosure information not submitted.
MS

Miloslawa Stem, MS

Research Associate
Johns Hopkins School of Medicine
Balitmore, Maryland, United States

Disclosure information not submitted.
AG

Alodia Gabre-Kidan, MD, MPH

Assistant Professor of Surgery
Johns Hopkins School of Medicine
Baltimore, Maryland, United States

Disclosure information not submitted.
Andrea C. Bafford, MD

Associate Professor of Clinical Surgery
Johns Hopkins University School of Medicine
Baltimore, MD, United States

Disclosure information not submitted.
AG

Ada E. Graham, MD

Assistant Professor of Surgery
Johns Hopkins University
Bethesda, Maryland, United States

Disclosure information not submitted.

Senior Author(s)

JM

John Migaly, MD

Associate Professor
Johns Hopkins University
Baltimore, Maryland, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Bryan Szeglin, MD: This individual has no financial relationships with ineligible companies.

Purpose/Background: Prior studies examining prolonged operative time as an independent risk factor for prolonged post-operative ileus (PPOI) and prolonged length of stay (PLOS) after elective colectomy have been inconclusive, often limited by small sample sizes, outdated cohorts, and limited control for confounders. Over the past decade, laparoscopic and robotic colectomy have become the standard of care and have been associated with reduced PPOI and PLOS. This study aimed to examine the impact of prolonged operative time on PPOI and PLOS in the modern era of minimally invasive colectomy.

Methods/Interventions: Elective colectomy cases for colon cancer, chronic diverticulitis, or non-malignant polyps (2012-2023) were identified in the National Surgical Quality Improvement Program (NSQIP). Cases with stoma creation, multivisceral resections, metastatic disease, ASA 5, or unplanned conversion to open were excluded. PPOI, the primary outcome, was defined per NSQIP criteria; PLOS, the secondary outcome, was defined as post-operative stays greater than or equal to the 90th percentile (7 days). The Youden Index was used to identify the operative time threshold associated with increased risk of PPOI and PLOS. The data was divided into derivation (70%) and validation (30%) cohorts. Multivariable logistic regression was used to test the selected threshold while adjusting for baseline patient characteristics. A subgroup analysis was performed by stratifying patients by indication and approach.

Results/Outcomes: A total of 149,704 patients were included. The median operative time was 2.68 hours. The overall incidence of PPOI was 7.6% and PLOS 13.2%. The Youden Index identified 3.5 hours as the threshold for increased risk of both outcomes. In multivariable analysis, operative times of 3.5-4.5 hours, 4.5-5.5 hours, and >5.5 hours were associated with 36% (OR 1.36, 95% confidence interval [CI] 1.28-1.45), 69% (OR 1.69, 95% CI 1.56-1.85), and 123% increased odds of PPOI (OR 2.23, 95% CI 2.03-2.44), respectively. Corresponding odds of PLOS increased by 61% (OR 1.61, 95% CI 1.53-1.70), 109% (OR 2.09, 95% CI 1.95-2.25), and 262% (OR 3.62, 95% CI 3.36-3.91), respectively (Figure 1). Model performance was moderate in derivation (AUC 0.68 for PPOI, 0.74 for PLOS) and validation cohorts (AUC 0.69 for PPOI, 0.74 for PLOS). The subgroup analysis stratified by approach showed similar results.

Conclusion/Discussion: Prolonged operative time independently increases the risk of PPOI and PLOS regardless of operative approach or indication. These findings suggest that factors driving longer operative duration-such as case complexity, technical difficulty, or workflow inefficiencies-may directly contribute to adverse recovery outcomes. Efforts to identify and address modifiable contributors to prolonged operative times for elective colectomy could help reduce PPOI and PLOS.

Figure 1

Forest plot illustrating the odds of prolonged postoperative ileus (PPOI) and prolonged length of stay (PLOS) across increasing operative times in both the derivation and validation cohorts. A threshold of 3.5 hours was identified (Youden Index) as the point at which prolonged operative time becomes significantly associated with worse odds and was used as the reference for odds ratio calculations. The multivariable logistic regression models were adjusted for age, sex, race, BMI, pre-operative comorbidities, chemotherapy, bowel prep, indication, American Society of Anesthesiologists classification, and case year. All operative time categories were significantly associated with PPOI and PLOS (P < 0.0001). Error bars represent 95% confidence intervals.