Obtaining data which helps surgeons make the best patient-specific operative decisions is essential to developing better protocols that improve patient safety.
Dallas, Texas (PRWEB) August 14, 2014
Dallas plastic surgeon Dr. Jeffrey M. Kenkel, Professor and Vice-Chairman of the Department of Plastic Surgery at UT Southwestern Medical Center, and his colleagues recently studied the link between operative time and post-surgical risk. The goal of the research was to analyze complication rates and the role of operative time as an independent risk factor.
Using retrospective surgical data, Dr. Kenkel and his team identified a critical cut-off time that can be used to develop updated recommendations for surgeons who perform both cosmetic and reconstructive procedures. Findings from their paper, "The Impact of Operative Time on Complications After Plastic Surgery: A Multivariate Regression Analysis" were published in "Aesthetic Surgery Journal," which is complied by the American Society for Aesthetic Plastic Surgery.
As the study's senior author, Dr. Kenkel was assisted by a UT Southwestern Department of Plastic Surgery research team and a number of contributing authors, including Krista L. Hardy, B.S., Kathryn E. Davis, Ph.D., Ryan S. Constantine, B.S., Mo Chen, Ph.D., Rachel Hein, B.S., James L. Jewell, B.S.; Karunakar Dirisala, M.S., Jerzy Lysikowski, Ph.D., and Gary Reed, M.D. To gather data, Dr. Kenkel and his team analyzed records from 1,753 patients who underwent complex surgical procedures at the UT Southwestern Medical Center in Dallas between 2008 and 2012.
Seventy-five percent of these patients underwent combined procedures, including body contouring procedures such as tummy tuck, facelifts, and breast reconstruction. The average patient underwent 4.9 concurrent procedures with operative times ranging from less than an hour to over 23 hours. A detailed analysis of the data demonstrated that operative time was the most significant independent risk factor and had a greater effect on complication rates than the patient's health status prior to surgery or the type of procedure being performed.
Dr. Kenkel and other Dallas plastic surgeons established a strong correlation between elevated complication rates following surgeries over 3.1 hours. Patients with operative times over 4.5 hours were three times more likely to experience complications, and those with operative times over 6.8 hours were nearly five times as likely.
Dr. Kenkel and his team are not suggesting that all procedures be less than 3 hours. On the contrary, they recognize how common this is. This information can be used to properly counsel the patient on their anticipated risks involved with longer surgical procedures.
Unlike other research analyzing operative time, this study focused on many conditions related to wound healing and recovery, not just major medical events. Dr. Kenkel stated, "Studies like this are important tools to improve the safety and outcome of plastic surgery procedures." In the past, surgical guidelines suggested six hours as a recommended cut-off time, but lacked evidence based data to support this claim.
Although operative time was identified as a predictor of risk, it wasn't attributed to a single type of complication. In general, infection, rupture, necrosis, erythema, and fluid accumulations were the most common complications. Furthermore, patients with underlying health issues, such as diabetes, obesity, and hypertension, did had higher complication rates as expected, although the highest complication rate had stronger correlations were with surgical time. UT Southwestern researchers found that complex procedures involving larger incisions, such as body contouring and breast reconstruction, generally have higher complication rates than facelifts, which are temporally longer procedures.
"Operative time, patient selection, and post-operative care are all important considerations," said Dr. Kenkel. "Obtaining data which helps surgeons make the best patient-specific operative decisions is essential to developing better protocols that improve patient safety and reduce the potential for complications."
About Dr. Jeffrey M. Kenkel
Jeffrey M. Kenkel, M.D., F.A.C.S., is a plastic surgeon located in Dallas, Texas. In addition to Program Director, he serves as Professor and Vice-Chairman of the Department of Plastic Surgery at UT Southwestern Medical Center. He is also Director of the Clinical Center for Cosmetic Laser Treatment and Medical Director for the Department of Plastic Surgery. His clinical practice is located at the Outpatient Building on the UT Southwestern campus.
Dr. Kenkel has served as president of The American Society for Aesthetic Plastic Surgery and is certified by the American Board of Plastic Surgery. Dr. Kenkel specializes in cosmetic surgery of the face, breast and body. He balances his surgical practice with nonsurgical cosmetic medicine including the use of injectables, cosmetic lasers, and skin care. Dr. Kenkel is nationally and internationally known for his contributions in cosmetic surgery.