James Allan1, David Goltsman1, Pouria Moradi1, Jeffrey A Ascherman2. 1. Department of Plastic Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia. 2. Division of Plastic Surgery, Columbia University Medical Center, New York-Presbyterian Hospital, 161 Fort Washington Avenue, Suite 509, New York, NY, United States. Electronic address: jaa7@columbia.edu.
Abstract
BACKGROUND: It is a generally accepted relationship that an increase in operative time results in an increase in postoperative morbidity. However, few studies have investigated the minute by minute effect of increased operation time on outcomes in reconstructive breast surgery. The authors examined the association between operation time and postoperative outcomes for autologous and implant-based breast reconstructions. METHODS: Data used in these analyses were extracted from all plastic surgery procedures identified in the 2007-2012 ACS-NSQIP datasets. Logistic regression models were used to examine associations between operation time and adverse outcomes. Generalized linear models using a Poisson distribution and a logarithmic link function were used to examine the association between the two continuous variables of operating time and the length of hospital admission. RESULTS: The results drawn from the database show a statistically significant association between operating length for autologous breast reconstructions and both surgical and medical complications. The OR of 1.0018 and 1.0015 for surgical and medical complications, respectively, reflects a minute by minute increase. For implant-based reconstructions, a similar association was seen with surgical complications with an OR of 1.004. Across both subgroups of breast reconstruction, there was a significant association between an increase in OR time and the length of hospital stay. CONCLUSION: We have shown a linear relationship that conveys a minute by minute increase in the complication profile and the chance of a longer hospital stay for breast reconstruction patients with regard to operative time.
BACKGROUND: It is a generally accepted relationship that an increase in operative time results in an increase in postoperative morbidity. However, few studies have investigated the minute by minute effect of increased operation time on outcomes in reconstructive breast surgery. The authors examined the association between operation time and postoperative outcomes for autologous and implant-based breast reconstructions. METHODS: Data used in these analyses were extracted from all plastic surgery procedures identified in the 2007-2012 ACS-NSQIP datasets. Logistic regression models were used to examine associations between operation time and adverse outcomes. Generalized linear models using a Poisson distribution and a logarithmic link function were used to examine the association between the two continuous variables of operating time and the length of hospital admission. RESULTS: The results drawn from the database show a statistically significant association between operating length for autologous breast reconstructions and both surgical and medical complications. The OR of 1.0018 and 1.0015 for surgical and medical complications, respectively, reflects a minute by minute increase. For implant-based reconstructions, a similar association was seen with surgical complications with an OR of 1.004. Across both subgroups of breast reconstruction, there was a significant association between an increase in OR time and the length of hospital stay. CONCLUSION: We have shown a linear relationship that conveys a minute by minute increase in the complication profile and the chance of a longer hospital stay for breast reconstruction patients with regard to operative time.