title: Anesthesia duration as a marker for surgical complications in office-based plastic surgery.
abstract: BACKGROUND
  Office-based plastic surgery has continued to rise in the past 2 decades with the increased demand for cosmetic surgery. Although several large studies have shown the safety of office-based surgery, current regulations place some restrictions on ambulatory office-based surgical facilities. To provide further evidence-based literature on the safety of office-based plastic surgery, we examine surgical complication rates as a function of anesthesia duration.
  
  
  METHODS
  This is a retrospective review of 2595 patients who underwent office-based plastic surgery procedures between October 2000 and January 2005. All patients received general anesthesia for a broad range of cosmetic surgeries. The primary measured outcome was minor and major surgical complications. Complication rates were examined as a function of anesthesia duration of less than or greater than 4 hours. The follow-up period was 30 days. Statistical analysis was completed using SPSS v.19.
  
  
  RESULTS
  Most of the patients were female with an average age of 41 years. An increase in the occurrence of minor surgical complications such as postoperative nausea and vomiting (2.8% vs 5.7%, P=0.0175) and urinary retention (0.7% vs 7.6%, P<0.0001) was noted in the greater than 4-hour anesthesia duration group. Overall, there were 66 (2.5%) patients that required reoperation because of surgical complications with no statistical difference between the 2 groups (P=0.098). The only major morbidities were 1 pulmonary embolism (<4 hours) and 1 deep vein thrombosis (>4 hours). Five (0.19%) patients were admitted to the hospital during the follow-up period for surgical and/or medical management (3 hematomas, 1 deep vein thrombosis, and 1 pulmonary embolism). There were no cases of reintubation, major cardiac complications, or death in this series.
  
  
  CONCLUSIONS
  Duration of general anesthesia in office-based plastic surgery does not seem to be an indicator of major morbidity and mortality. Although minor complications such as postoperative nausea and vomiting and urinary retention were higher in patients with anesthesia greater than 4 hours, there was no significant increase in major complications. Change in surgical venue would not likely alter the outcome of the increase in minor complications. Therefore, anesthesia duration should not be used as a guideline for safety of office-based plastic surgery.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stony Brook University Medical Center, Stony Brook University School of Medicine, Stony Brook, NY 11794-8191, USA.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Phillips
authors.forename: Eric D
authors.initials: ED
authors.lastname: Wang
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Rodman
authors.forename: Paul A
authors.initials: PA
authors.lastname: Watterson
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Smith
authors.forename: Stephan J
authors.initials: SJ
authors.lastname: Finical
authors.forename: Felmont F
authors.initials: FF
authors.lastname: Eaves
authors.forename: Michael E
authors.initials: ME
authors.lastname: Beasley
authors.forename: Sami U
authors.initials: SU
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000592:standards; D000768:Anesthesia, General / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data; D002648:Child; D003357:Cosmetic Techniques / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult