Surgical Duration Influences Plastic Surgery Outcomes

Increased operative time is associated with a higher risk of medical, surgical, and overall complications, according to a new study.

Researchers at Northwestern University (Chicago, IL, USA) and Vanderbilt University (Nashville, TN, USA) identified 15,289 plastic surgery procedures performed between 2006 and 2010, based on a multi-institutional surgical outcomes database. The researchers tracked operative time in 30-minute increments, analyzing the relationship between operative time and primary outcomes of interest, including medical complications, surgical complications, overall complications, and mortality. A subgroup analysis explored the relationship between operative time and outcomes in a homogenous high-risk cohort.

The results showed that when progressing from the shortest surgical duration cohort to the longest, an incremental increase became evident in overall complications (6.22%–24.86%), surgical complications (2.73%–13.08%), and medical complications (3.68%–15.89%). Furthermore, for every 30-minutes increase in operative time, there was a corresponding increased odds ratio (OR) risk for 30-day overall complications of 1.13, medical complications (1.14), and surgical complications (1.14). There was no significant association with 30-day mortality. The study was published online on May 23, 2013, in the European Journal of Plastic Surgery.

“We endeavored to investigate the impact of operative time on postoperative morbidity and mortality in plastic surgery,” concluded lead author Aksharananda Rambachan, MD, and colleagues of the division of plastic and reconstructive surgery. “As outcome measures take a more prominent role in the care of plastic surgery patients, these findings will advance patient education and practice management.”

Surgical procedures often take a long time to perform and duration of surgery is frequently cited as a major risk factor for postoperative complications. Possible complications can be caused by the surgery itself, the drugs used (anesthesia), or an underlying disease. Examples include bleeding during surgery that may need blood transfusions; damage to internal organs and blood vessels during surgery; surgical site infections (SSIs); blood clots (thromboses); and hypothermia. Slow recovery of functions such as bowel activity following surgery can sometimes also turn into serious problems.

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Northwestern University
Vanderbilt University