Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Prolonged operative time is a known risk factor for poor outcomes in surgery. It increases the risk of infection, length of stay, and rates of readmission. This is especially important in head and neck free flap surgeries which can take anywhere, on average, from 8-12 hours. Some studies have shown that each additional hour of surgery could increase the risk of postoperative complications by 11%. There has also been research to show that prolonged operative time was a large risk factor for flap failure. The goal of this study is to see how prolonged operative times correlate to poor surgical outcomes in head and neck free flap surgery at our institution.
Methods: A retrospective chart review was conducted of patients surgically treated by head and neck otolaryngologists at Shand’s Hospital of the University of Florida between January 1st, 2014, and January 1st, 2023. Only patients who had inpatient head and neck surgery were included in this study. Charts were queried for surgical start times, end times, and total operative time based off incision time and closing time.
We then grouped prolonged surgery time into 3 cohorts: 0-8 hours, 8-10 hours, and 10+ hours. Furthermore, we found the number of patients with no complications, mild complications, and severe complications amongst all the groups.
A two-way ANOVA test was run to determine the differences in complications between these three groups.
Results: A total of 851 patients were included in this study. 123 (14.4%) patients had surgery that took between 0-8 hours, 277 (32.6) patients had surgery between 8-10 hours, and 451 (53.0%) patients had surgery that took 10+ hours. Of the 323 mild complications between all groups, 10+ hour surgery had 184 (57%). Furthermore, of the 127 severe complications, 81 (64%) were from the 10+ hours surgery group. The F-value of the two-way ANOVA analysis between these groups is 14.65 (p-value 0.0144).
Conclusion: A preliminary analysis showed that patients with operative times between 8-10 hours, and 10+ hours had significantly worse outcomes and complications. Further analysis is currently being done to expand on which specific outcomes are worsened such as length of stay, post-op complications, 30-day readmissions, 30-day return to OR, and 30-day mortality. Our goal in this is to understand how prolonged operative time affects all these variables.