Abstract
Surgical dogma and objective data support the relationship between increased operative
times and perioperative complications. However, there has been no large-scale, multi-institutional
study that evaluates the impact of increased anesthesia duration on microvascular
free tissue transfer. The National Surgical Quality Improvement Program (NSQIP) database
was retrospectively reviewed to identify all free-flap patients between 2006 and 2011.
Included patients were subdivided into quintiles of anesthesia time. Univariate and
multivariate analyses were performed to assess its impact on 30-day postoperative
complications. The mean anesthesia duration for all patients was 603 ± 222 minutes.
In univariate analysis, 30-day overall/medical complications, reoperation, and free
flap loss demonstrated statistically significant increases as anesthesia duration
increased (p < 0.05). However, in multivariate analyses, these trends and significances were abolished,
with exception of the utilization of postoperative transfusions. Of interest, increasing
anesthesia duration did not predict flap failure on multivariate analysis. We found
that increased anesthesia time correlates with increased postoperative transfusions
in free flap patients. As a result, limiting blood loss and avoiding prolonged anesthesia
times should be goals for the microvascular surgeon. This is the largest multidisciplinary
study to investigate the ongoing debate that longer anesthesia times impart greater
risk.
Keywords
anesthesia duration - microvascular free tissue transfer - NSQIP
