Operative Time Prognosticates Long-term Abdominal Morbidity And Complication Requiring Treatment After Diep Flap Breast Reconstruction
Y. Edward Wen, BA, Cyrus Steppe, BA, Zhiguo Shang, PhD, Sumeet S. Teotia, MD, Nicholas T. Haddock, MD.
UTSW, Dallas, TX, USA.
PURPOSE: The relationship between skin-to-skin operative time and long-term and treated complications after deep inferior epigastric artery perforator (DIEP) flap breast reconstructions has not been thoroughly investigated. The study objective was to evaluate if operative time would independently prognosticate the type and number of treated complications, as well as long-term abdominal morbidity. METHODS: Patients who underwent bilateral DIEP flaps from 2010-2021 by two senior surgeons with standardized surgical and postoperative protocols were retrospectively reviewed. Inclusion required at least 1 year of postoperative follow-up. Extensive multivariate regression analyses were utilized to adjust for potential confounders, including measures of intraoperative complexity. RESULTS: 336 patients were entered into multivariate analyses. After risk adjustment, there was a significant increase in risk of all treated complications per hour (all p<0.05). Of note, each hour of operation increased risk of complications requiring hospital course treatment by 25% (p<0.00001, Figure 1), flap-site complications requiring readmission treatment by 24% (p<0.00001), and flap-site complications requiring hospital course treatment by 26% (p<0.00001). Long-term abdominal morbidity (abdominal bulge) increased by 25% per hour of operative time (p<0.00001). Number of complications requiring any treatment, abdominal donor-site complications requiring any treatment, and complications requiring hospital course treatment had statistically significant linear relationships with duration of surgery (all p<0.05). CONCLUSION: Operative time independently predicts complications requiring treatment, especially long-term abdominal morbidity and complications requiring hospital course or readmission treatment. 
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