Increased anesthesia duration (mean 603 ± 222 minutes) independently correlated with increased postoperative transfusions, but did not predict flap failure or other 30-day complications.
Cohort (n=1,305)
Yes
Does increased anesthesia duration increase the risk of 30-day postoperative complications in patients undergoing free flap surgery?
Increased anesthesia duration in free flap surgery is independently associated with increased postoperative transfusions, but not with flap failure or other major complications.
p-value: p=<0.05
Surgical dogma and objective data support the relationship between increased operative times and perioperative complications. However, there has been no large-scale, multi-institutional study that evaluates the impact of increased anesthesia duration on microvascular free tissue transfer. The National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed to identify all free-flap patients between 2006 and 2011. Included patients were subdivided into quintiles of anesthesia time. Univariate and multivariate analyses were performed to assess its impact on 30-day postoperative complications. The mean anesthesia duration for all patients was 603 ± 222 minutes. In univariate analysis, 30-day overall/medical complications, reoperation, and free flap loss demonstrated statistically significant increases as anesthesia duration increased (p<0.05). However, in multivariate analyses, these trends and significances were abolished, with exception of the utilization of postoperative transfusions. Of interest, increasing anesthesia duration did not predict flap failure on multivariate analysis. We found that increased anesthesia time correlates with increased postoperative transfusions in free flap patients. As a result, limiting blood loss and avoiding prolonged anesthesia times should be goals for the microvascular surgeon. This is the largest multidisciplinary study to investigate the ongoing debate that longer anesthesia times impart greater risk.
Grant et al. (Fri,) conducted a cohort in Free flap surgery (n=1,305). Increased anesthesia duration vs. Shorter anesthesia duration was evaluated on 30-day postoperative complications (p=<0.05). Increased anesthesia duration (mean 603 ± 222 minutes) independently correlated with increased postoperative transfusions, but did not predict flap failure or other 30-day complications.