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.