The impact of surgical duration on plastic surgery outcomes

Background: Historically, prolonged operative time has been associated with increased risk for morbidity and mortality. However, there is a paucity of clear data regarding the effect of longer operative times on outcomes in the field of plastic surgery. We endeavored to investigate the impact of operative time on postoperative morbidity and mortality in plastic surgery. Methods: Utilizing a multi-institutional surgical outcomes database spanning from 2006 to 2010, we identified 15,289 plastic surgery procedures. Operative time was tracked in 30-min increments. Multivariate logistic regression was utilized to investigate the relationship between operative time and primary outcomes of interest (medical complications, surgical complications, overall complications, and mortality). Subgroup analysis explored the relationship between operative time and outcomes in a homogenous high-risk cohort. Results: When progressing from the shortest surgical duration cohort to the longest, we see an incremental increase in overall complications (6.22 to 24.86 %), surgical complications (2.73 to 13.08 %), and medical complications (3.68 to 15.89 %). Furthermore, for every 30-min increase in operative time, there was a corresponding increased risk for 30-day overall complications (odds ratio (OR) 1.13, 95 % confidence interval (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 significant association with 30-day mortality. Findings were substantiated through subgroup analysis. Conclusions: Drawing from data on over 15,000 plastic surgery procedures, we determined that increased operative time was associated with a higher risk of medical, surgical, and overall complications. As outcome measures take a more prominent role in the care of plastic surgery patients, these findings will advance patient education and practice management. Level of Evidence: Level III, pronostic/risk study