Evaluating the Safety of Cosmetic Surgery Procedures Over 6 Hours: Lessons Learned After a 3-Year Retrospective Review and Cohort Comparison

Abstract

The safety of performing cosmetic surgery procedures longer than 6 hours continues to be debated. A single board-certified cosmetic surgeon’s 3-year experience with all abdominoplasty procedures was retrospectively analyzed. Combined hysterectomy and abdominoplasty procedures were excluded from this analysis. All procedures were performed in a certified ambulatory surgery center or hospital, and under general anesthesia with additional local and tumescence. Two cohorts were identified (long vs short) consisting of procedures lasting greater than or less than 6 hours. Two-sample equal variance, 2-tailed, t-test statistical analysis was performed to compare the groups and differences in complications. A total of 116 consecutive abdominoplasty procedures were performed between June 2012 and July 2015; of them, 62 cases were “long” (>6 hours) and 54 cases were “short” (<6 hours). Age was similar for both groups (40 ± 9 vs 39 ± 10, P = .44). The longer group had a slightly higher body mass index (BMI: 28 ± 4.8 vs 26.1 ± 4.1 kg/m2, P = .02). The average time for the long procedures was 7.6 ± 1.1 vs 4.0 ± 1.1 hours for the short cases ( P < .01). As expected, more procedures were performed in the longer cases (5.3 ± 1.4 vs 2.9 ± 1.1, P < .01). There were no deep vein thromboses (DVTs), pulmonary embolisms (PEs), or deaths. Incidence of major complications for all 116 cases was 8.6% (5 hematomas, 2 flap necrosis, 1 chronic seroma, 1 unplanned admission, and 1 retained laparotomy sponge). Overall, incidence of minor complications was 3.4% (2 localized infections, 1 partial thickness skin slough, and 1 acute seroma). There was no statistically significant difference in the incidence of major (9.6% vs 7.4%, P = .67) or minor (5% vs 4%, P = .77) complications between the long (>6 hours) and short (<6 hours) procedure groups. The average BMI of patients who experienced major complications was significantly higher in both the long and short procedure groups (30 ± 2.4 kg/m2, P < .05). Our data do not support the theory that there is a correlation between length of surgery and the incidence of major or minor complications, specifically as it relates to cosmetic surgery patients. Instead, our data suggest that a BMI > 30 kg/m2 is a significant predictor for complications in cosmetic surgery, both in short and long cases. The incidence of wound dehiscence, seroma, hematoma, and DVT in this series is less than that previously reported in the plastic surgery literature and consistent with more recent abdominoplasty literature.