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Are Operative Times Correlated With Hospital Length of Stay in Free Flap Breast Reconstruction? An Analysis of the ACS-NSQIP Database
Casey T. Kraft, MD, Juan L. Rendon, MD, PhD, and Michael J. Miller, MD
The Ohio State University
2018-02-14
Presenter: Casey Kraft
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The project represents the original work of the resident and co-authors.
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
As free flap autologous breast reconstruction becomes increasingly popular, more attention has been given to enhancing recovery and decreasing length of stay. Recent retrospective literature suggests a correlation between decreasing operative time for free flap reconstruction and post-operative length of stay. We sought to study this relationship using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
Methods
The NSQIP database was queried for surgical patients from 2010-2015. Free flap breast reconstruction patients were identified based on CPT code. Patient demographics and co-morbidities were collected, as well as operative time, laterality, total hospital length of stay, and 30-day post-operative complication data. Patients with pedicle-based or implant-based reconstruction, or concurrent surgery at the time of reconstruction were excluded. A Cox regression model was used for statistical analysis.
Results
A total of 4065 free flap breast reconstruction patients were recorded, and 3856 patients were identified after exclusion criteria were applied. Average operating time was 509 minutes +/- 154. Longer operating time was correlated with longer hospital length of stay after adjusting for co-morbidities, laterality, and post-operative complications (p = <0.001). A reduction in operative time of 4 hours is correlated with an average length of stay reduction of 0.73 hospital days.
Conclusions
Operative time is statistically significantly correlated with hospital length of stay, however decreasing operative time to affect length of stay may not be clinically feasible. Microsurgeons should consider focusing on other areas of clinical care to decrease hospital length of stay.
