General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay.
Duration of surgery has not been much explored as a possible risk factor for complications in neurosurgery. To explore the possible impact of duration of surgery on the risk of developing extracranial complications and surgical site infections following intracranial tumor surgery. Retrospective review of 1,000 consecutive patients who underwent planned surgery for intracranial tumors at a single institution. Complications within 30 days of surgery were registered. Of all patients, 18.6 % acquired extracranial complications, and they were seen in 14.3, 17.7, 22.1 and 37.4 % after operations lasting <2, 2–4, 4–6 and ≥6 h (p = 0.025). In multivariate analyses, duration of surgery per hour [OR 1.14 (1.04–1.25)], ASA 3–4 [OR 1.37 (1.14–1.63)] and acquired neurological deficits [OR 1.47 (1.02–2.11)] were associated with extracranial complications. For surgical site infections, there was a significant association between increased risk and increased duration of surgery (p < 0.001). Duration of surgery together with comorbidity and acquired neurological deficits is an independent risk factor for extracranial complications after brain tumor surgery. Duration of surgery is also associated with surgical site infections. Knowledge about the potential harm of slow surgery should be of interest to neurosurgeons when deciding on various surgical approaches, surgical tools or providing training. Also if acquiring ethical approval or informed consent in technical research projects, the risks associated with prolonging brain surgery should be considered. Special consideration should be warranted in patients with significant comorbidity, planned long surgery and higher risk of acquiring neurological deficits after surgery.