Introduction
Microsurgery is routinely applied in the reconstruction of defects in
the head and neck region to functionally and aesthetically rehabilitate
patients.1,2 Due to the complexity of these
procedures, there is considerable interest in factors associated with
postoperative complications and how operative morbidity can be
minimised.3-7 Longer operative times have been
associated with increased surgical morbidity in many surgical
fields.7,8 In head and neck surgery, studies have
demonstrated an association between longer operative time and septic
shock, surgical site infection, wound dehiscence, blood loss, pneumonia
and thromboembolic events.9 Prolonged operative time
has also been shown to be an independent risk factor for free flap
failure, risk for reoperation, and increased length of
stay.10 Many of these risks remain, even after
controlling for patient characteristics and procedure complexity.9 From a health care utilization perspective, longer
procedures have been related to increase cost of care and hinder
practice productivity.11
Most studies have demonstrated operative time as it relates to surgical
technique, comparing pedicled and free flaps, but have not stratified by
flap type, oncological resection, or comorbidity. Determinants of
operative time are highly surgeon and institution dependent, thus is
unlikely that cut-offs derived from one institution can be universally
applied and will vary between high and low volume units. In addition,
advances in surgical technique and team-based approaches have decreased
operative times for head and neck surgery.12,13Therefore, ongoing data is needed to define the effect of operation time
across a range of institutions. The aim of this study is to investigate
whether increased operative time is associated with adverse
post-operative outcomes and length of stay in patients undergoing
microsurgery reconstruction for surgical defects of the head and neck
after adjusting for the effect of clinically relevant covariates.