Abstract: Increased Operative Time Is Associated With Higher Complication Rates in Plastic Surgery Patients (Plastic Surgery 2013)

Sunday, October 13, 2013: 1:15 PM

Aksharananda Rambachan, BA , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

Lauren M Mioton, BS , Vanderbilt School of Medicine, Nashville, TN

Sujata Saha, BS , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

Neil A Fine, MD , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

Gregory A Dumanian, MD , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

John YS Kim, MD , Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL

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Background

Historically, prolonged operative time has been associated with increased risk for morbidity and mortality. The emergence of safer anesthetics and surgical technique has modernized and ameliorated risks associated with longer surgery.^1,2 However, there is a paucity of clear data on the effect of longer operative times in the field of plastic surgery.

Purpose

We endeavored to investigate the impact of operative time on medical and surgical morbidity as well as mortality.

Methods

Utilizing the American College of Surgeons National Quality Improvement Program from 2006-2010, we identified 15289 plastic surgery procedures that met inclusion criteria (drawn from over 240 institutions and spanning 240 variables). We tracked four major outcomes: 1) 30-day medical complications 2) surgical complications 3) overall complications and 4) mortality. Operative time was tracked in 30-minute increments. Multivariate logistic regression for each outcome was utilized after a bivariate screen, controlling for preoperative demographic variables, comorbidities and clinical characteristics.

Results

For every additional 30 minutes of operative time, there were increased rates of 30-day overall complications (OR 1.13, 95% CI 1.08-1.18), medical complications (OR 1.14, 95% CI 1.06-1.23) and surgical complications (OR 1.14, 95% CI 1.09-1.20). There was no statistically significant association with 30-day mortality. Several other variables associated with a greater overall complication rate included: inpatient status, hypertension, impaired sensorium, obesity, preoperative wound infection, prior operation within 30 days and RVUs.

Conclusion

Drawing from a robust, multi-institutional database of over 15000 plastic surgery procedures, our study determined that increased operative time is associated with a higher rate of medical, surgical and overall complications. However, increased operative time was not associated with increased morality. As outcome measures and cost efficacy take a more prominent role in the institutional and individual care of plastic surgery patients, these findings will advance practice management.

22977 Increased Operative Time Is Associated With Higher Complication Rates in Plastic Surgery Patients