Qiu Cecil S, Jordan Sumanas W, Dorfman Robert G, Vu Michael M, Alghoul Mohammed S, Kim John Y S
Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Reconstr Microsurg. 2018 Jan;34(1):47-58. doi: 10.1055/s-0037-1606339. Epub 2017 Oct 9.
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.
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.
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.
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.
Risk, II.
手术时间延长会影响患者预后及手术效率指标。尤其有研究表明，手术时间延长会增加静脉血栓栓塞症（VTE）的风险。常见的手术时间较长的整形手术之一是显微外科乳房重建术。随着用于乳房重建的多个和“堆叠”游离皮瓣适应证的扩大，我们试图评估（1）显微外科乳房重建术的手术时间与VTE之间的关系；以及（2）确定是否存在暗示VTE高风险的手术时间阈值。
通过当前手术操作术语代码识别2005年至2014年间在美国外科医师学会国家外科质量改进计划（ACS-NSQIP）中接受显微外科乳房重建术的患者。使用三种多因素逻辑回归模型来描述根据手术持续时间、双侧性、住院时间和患者人口统计学特征调整后的VTE风险。
共识别出4782例接受显微外科乳房重建术的患者。总体VTE发生率为1.13%。平均手术时间为8小时31分钟（标准差：2小时59分钟）。在连续、五分位数和二分风险模型中，手术持续时间与VTE在统计学上相关。手术持续时间超过11小时后，调整后的VTE风险增加四倍，相应的伤害所需人数为45.8。
在显微外科乳房重建术中，手术时间延长会增加VTE风险。体重指数和年龄增加会加剧这种VTE风险。此外，将手术时间限制在11小时或更短时间可以使VTE风险相对于基线降低四倍。
风险，II级。
