Chu Michael W, Barr Jason S, Hill J Bradford, Weichman Katie E, Karp Nolan S, Levine Jamie P
Division of Plastic and Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York.
J Reconstr Microsurg. 2015 Jul;31(6):401-6. doi: 10.1055/s-0035-1548740. Epub 2015 Mar 31.
Prolonged operative time has been associated with increased postoperative complications and higher costs. Many academic centers have a designated day for didactics that cause cases to start 1 hour later. The purpose of this study is to analyze the late-start effect of microvascular breast reconstructions on operative duration.
A retrospective review was performed on all patients who underwent abdomina-based free flap breast reconstruction from 2007 to 2011 and analyzed by those who had surgery on late-start versus normal-start days. Patient demographics, average operative time, postoperative complications, and individual surgeon effects were analyzed. A Student t-test was used to compare operative times with statistical significance set at p < 0.05. A multivariate regression analysis was performed to control for potential confounders.
A total of 272 patients underwent 461 free flap breast reconstructions. Twenty-one cases were performed on late-start days and 251 cases were performed on normal-start days. Patient demographics and complications were not statistically different between the groups. The average operative time for all reconstructions was 434.3 minutes. The average operative times were significantly longer for late-start days, 517.6 versus 427.3 minutes (p = 0.002). This was true for both unilateral and bilateral reconstructions (432.8 vs. 350.9 minutes, p = 0.05; 551.5 vs. 461.2 minutes, p = 0.007). There were no differences in perioperative complications and multivariate regression showed no statistically significant relationship of confounders to duration of surgery.
Starting cases 1 hour later can increase operative times. Although outcomes were not affected, we recommend avoiding lengthy procedures on late-start days.
手术时间延长与术后并发症增加及成本升高相关。许多学术中心设有专门的教学日，这会导致手术病例开始时间推迟1小时。本研究的目的是分析微血管乳房重建手术延迟开始对手术时长的影响。
对2007年至2011年期间所有接受基于腹部的游离皮瓣乳房重建手术的患者进行回顾性分析，根据手术开始时间是延迟日还是正常日进行分组。分析患者人口统计学特征、平均手术时间、术后并发症以及个体外科医生的影响。采用学生t检验比较手术时间，设定统计学显著性水平为p < 0.05。进行多因素回归分析以控制潜在的混杂因素。
共有272例患者接受了461次游离皮瓣乳房重建手术。其中21例手术在延迟日进行，251例手术在正常日进行。两组患者的人口统计学特征和并发症在统计学上无差异。所有重建手术的平均手术时间为434.3分钟。延迟日的平均手术时间显著更长，分别为517.6分钟和427.3分钟（p = 0.002）。单侧和双侧重建手术均如此（432.8分钟对350.9分钟，p = 0.05；551.5分钟对461.2分钟，p = 0.007）。围手术期并发症无差异，多因素回归分析显示混杂因素与手术时长无统计学显著关系。
手术开始时间推迟1小时会增加手术时间。尽管结果未受影响，但我们建议避免在延迟日进行冗长的手术。
