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Anesthesia Duration as a Marker for Surgical Complications in Office-Based Plastic Surgery
Brett T. Phillips, MD1, Alexandra J. Rodman, BA2, Michael Beasley, MD3, Sami U. Khan, MD1.
1Stony Brook University Medical Center, Stony Brook, NY, USA, 2Stony Brook University School of Medicine, Stony Brook, NY, USA, 3Charlottle Plastic Surgery Center, Charlotte, NC, USA.
BACKGROUND: Office-based Plastic Surgery has continued to increase throughout the past two decades with the increased demand for cosmetic surgery procedures. Increased regulations on these surgical practices require careful scrutiny on both major and minor anesthetic and surgical complications. The safety of office-based plastic surgery could be identified by looking at complication rates and as a function of anesthesia duration.
METHODS: We retrospectively reviewed a database of 2595 patients who had undergone office-based plastic surgery procedures between October 2000 and January 2005. All patients received general anesthesia for a broad range of cosmetic surgeries. The primary outcome was overall complications, which were anesthetic, surgical, and aesthetic in nature. Complications were looked at as a function of anesthesia duration. The follow-up period was 30 days. Statistical analysis was completed using SPSS v.18.
RESULTS: Patients were on average 41 years old (Range: 11-81), and a vast majority were women (2428, 93.6%). The overall complication rate was 24.2%. For anesthesia durations of < 2 hours, 2-4 hours, and >4 hours the complication rates were 18.1, 29.5%, and 43.3% respectively. The difference in overall complication rate for anesthesia duration > and < 4 hours, was statistically significant (22.5% vs. 43.3%, p<0.0001). Overall, there were 66 (2.5%) patients that required reoperation due to surgical complications (hematoma, seroma, necrosis, dehiscence) of which there was no statistical difference between > and < 4 hours of anesthesia (p = 0.098). We did find a significant increase in the occurrence of surgical complications such as seroma (3.0% vs 5.7%, p = 0.032), hematoma (2.4% vs. 8.1%, p < 0.0001), necrosis (1.3% vs. 3.8%, p=0.0097), urinary retention (0.7% vs. 7.1%, p <0.0001) and PONV (2.7% vs. 5.7%, p = 0.0293). The only major morbidities were one pulmonary embolism (< 4 hours) and one deep vein thrombosis (> 4 hours). Four patients (0.15%) were admitted to the hospital by POD#1 for surgical and/or medical management (3 hematomas, 1 DVT,).
CONCLUSIONS: Duration of general anesthesia in office-based Plastic Surgery does not seem to be an indicator of major morbidity and mortality. Although both surgical and anesthetic complications are significantly increased in patients who are under anesthesia > 4 hours, there was no significant increase in reoperation rates, major morbidities, or hospital admission as a result of the greater operative time.
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