Most of us are familiar with the Benjamin Franklin quote, “Haste makes waste,” but does it apply to the field of plastic surgery? Let me give you an example: You are planning to have a “Mommy Makeover” done with a tummy tuck + breast augment with breast lift. One plastic surgeon you interview tells you that this will take 4 hours and another tells you it will take 6 hours. Should this time difference make a difference to you as you decide between the two surgeons, assuming the reputation for quality work is the same for the two surgeons? According to a recent and most excellent study in the Aesthetic Surgery Journal (ASJ 2014; Vol 34(4):614-622), the answer is, “Yes!” The complication rate is roughly doubled with the longer procedure!!
Conventional wisdom amongst plastic surgeons has been that you try to keep surgical times under 6 hours to minimize complications, but there have not been any good studies to support this notion. In this paper, the authors from the UT Southwestern Medical Center in Dallas looked at the complications from nearly 2,000 plastic surgical procedures that lasted anywhere from 12 minutes to 23 hours, with the average being just under 4 hours. By complications I don’t mean life-threatening events such as heart complications, blood clots to the lungs, or death. We are talking of less serious things like infection, bleeding, wound healing problems, blood clots in the legs, etc. What did the authors discover?
- The overall complication rate was 28%.
- Longer surgeries were associated with a higher complication rate. One exception to this rule was facelift surgery where longer surgery did not seem to be associated with more complications. It would seem that as long as the surgery is confined to a small part of the body, such as the face where delicate procedures may take a long time, complication rates are not affected.
- The complication rate did not begin to increase until the surgery took longer than 3 hours. After 3 hours the complication rate increased by 50%, after 4 1/2 hours it tripled, and then rose to 5 times the complication rate after 7 hours!
- Although certain surgeries had higher complication rates than others, for a given type of surgery, the rate was higher the longer the operation in accord with the numbers just mentioned.
It should be noted that the study was done at a university training hospital. My personal experience is that the longer I have been in practice, the lower my complication rates. Whether or not this affects the results is uncertain.
So how should these findings be interpreted?
- Clearly the shorter the surgery, the lower the complication rate. This does not mean, however, that the surgeon should rush the operation. These complications were relatively minor and a better cosmetic result may well be worth a minor complication.
- Preoperative planning and an organized approach in the operating room tend to produce an operation with less wasted time and fewer complications.
If I were a patient, I would ask the board certified plastic surgeon at the time of consultation about the anticipated length of time for the surgery (from skin incision to skin closure) and would think twice about undergoing any operation much longer than 4 hours other than a facial rejuvenation procedure. It may be that doing the procedure in 2 stages would be the best option.
Your thoughts?
George Sanders, M.D.
