The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases.
BACKGROUND
Little evidence within plastic surgery literature supports the precept that longer operative times lead to greater morbidity.


OBJECTIVE
The authors investigate surgery duration as a determinant of morbidity, with the goal of defining a clinically relevant time for increased risk.


METHODS
A retrospective chart review was conducted of patients who underwent a broad range of complex plastic surgical procedures (n = 1801 procedures) at UT Southwestern Medical Center in Dallas, Texas, from January 1, 2008 to January 31, 2012. Adjusting for possible confounders, multivariate logistic regression assessed surgery duration as an independent predictor of morbidity. To define a cutoff for increased risk, incidence of complications was compared among quintiles of surgery duration. Stratification by type of surgery controlled for procedural complexity.


RESULTS
A total of 1753 cases were included in multivariate analyses with an overall complication rate of 27.8%. Most operations were combined (75.8%), averaging 4.9 concurrent procedures. Each hour increase in surgery duration was associated with a 21% rise in odds of morbidity (P < .0001). Compared with the first quintile of operative time (<2.0 hours), there was no change in complications until after 3.1 hours of surgery (odds ratio, 1.6; P = .017), with progressively greater odds increases of 3.1 times after 4.5 hours (P < .0001) and 4.7 times after 6.8 hours (P < .0001). When stratified by type of surgery, longer operations continued to be associated with greater morbidity.


CONCLUSIONS
Surgery duration is an independent predictor of complications, with a significantly increased risk above 3 hours. Although procedural complexity undoubtedly affects morbidity, operative time should factor into surgical decision making.
UT Southwestern Medical Center, Dallas, Texas.
Krista L
KL
Hardy
Kathryn E
KE
Davis
Ryan S
RS
Constantine
Mo
M
Chen
Rachel
R
Hein
James L
JL
Jewell
Karunakar
K
Dirisala
Jerzy
J
Lysikowski
Gary
G
Reed
Jeffrey M
JM
Kenkel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003357:Cosmetic Techniques / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
morbidity; operative time; postoperative complications; research; surgery duration; wound complications