Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Quantification Of Operative Time And The Factors That Prolong Microsurgical Breast Free Flap Procedures
Nelson Rodriguez-Unda, MD, Jose M. Flores, MPH, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
Johns Hopkins School of Medicine, Baltimore, MD, USA.

PURPOSE:Despite general consensus regarding the risk factors that increase morbidity
among women undergoing free flaps breast reconstruction surgeries, literature quantifying
which and how extensively such risk factors lengthen operative time is largely absent.
Prolongation of operative time considerably increases costs and could contribute to further
complications. In an effort to provide precise national trends in microsurgical time
utilization, this analysis describes a random sample of surgical patients in the United States
and the intersection of risk factors, the extent to which they cause morbidity, and their
independent contribution to prolonged operative time
METHODS:Demographic and perioperative data were obtained from the National Surgical
Quality Improvement Program (NSQIP) of the American College of Surgeons. All women
undergoing breast free flap procedures (CPT 19364) between 2005 and 2012 were included.
Outcomes included surgical complications (superficial, deep, and organ surgical site
infections, wound infections and dehiscence, graft failure, and return to the operating
room) and systemic complications (pneumonia, sepsis, deep venous thromboembolism,
cardiac arrest, myocardial infarction, coma, stroke, and renal failure). Operative time was
measured in minutes. Preoperative risk factors of morbidity and operative time were
identified using linear and logistic regression.
RESULTS:Among 489 women who underwent breast free flap procedures, the average age
was 50.4 years (SD=9.3), 340 were white (70%), 56 were African American (11.6%), and
34 were Latinas (7.0%). The remaining patients belonged to other ethnicities. Significant
predictors of overall morbidity in multivariable analysis included obesity type II, (BMI > 35)
(OR = 2.56; 95% CI 1.18 - 5.57; p<0.01), lifetime smoking (OR = 2.14; 95% CI 1.01 - 4.52;
p<0.04). Being obese above a BMI of 35 increased the operative time by an average of 55
minutes (95% CI 10.2 - 101.6; p<0.017). Other factors that increased operative time were:
inpatient status (304 minutes; 95% CI 198 - 410; p<0.001), ASA classification type III (483
minutes; 95% CI 123 - 843; p<0.009), hemato-oncologic conditions (62 minutes; 95% CI
6.18 - 118; p<0.03), and having a prior operation in the past 30 days (173 minutes; 95% CI
60 - 286; p<0.05).
CONCLUSION:Clinically and statistically significant differences in risk factors prolong
perioperative times by a magnitude that can vary from 1 to 8 hours on average. Suitable
precautions and planning with regards to time utilization among patients with key risk
factors like morbid obesity, smoking, and patients with a prior operation should be prioritized
to reduce further complications.


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