Abstract
Background Increased surgical duration can impact patient outcomes and operative efficiency
metrics. In particular, there are studies suggesting that increased surgical duration
can increase the risk of venous thromboembolism (VTE). One of the longer duration
plastic surgery procedures commonly performed is microsurgical breast reconstruction.
With the widening indications for multiple and “stacked” free flaps to reconstruct
breasts, we endeavored to assess (1) the relationship between duration of microsurgical
breast reconstruction and VTE; and (2) determine if a threshold operative time exists
that connotes VTE higher risk.
Methods Patients from the American College of Surgeons National Surgical Quality Improvement
Program (ACS-NSQIP) between 2005 and 2014 who underwent microsurgical breast reconstruction
were identified by Current Procedural Terminology code. Three models of multivariate
logistic regression were used to characterize the adjusted risk for VTE by operative
duration, bilaterality, the length of stay, and patient demographics.
Results A total of 4,782 patients who underwent microsurgical breast reconstruction were
identified. Overall VTE incidence was 1.13%. The mean operative duration was 8:31
hours:minutes (standard deviation: 2:59). Operative duration was statistically associated
with VTE in continuous, quintile, and dichotomized risk models. Beyond an operative
duration of 11 hours, adjusted VTE risk increases fourfold corresponding to a number
needed to harm of 45.8.
Conclusions Increasing surgical duration heightens the risk of VTE in microsurgical breast reconstruction.
Increasing body mass index and age enhances this VTE risk. Moreover, limiting surgical
duration to 11 hours or less can decrease VTE risk by fourfold vis-à-vis baseline.
Level of Evidence Risk, II.
Keywords
surgical duration - venous thromboembolism - breast reconstruction
