Operative Time Predicts Long-Term Abdominal Morbidity and Complication Requiring Treatment after DIEP Flap Breast Reconstruction.

Background The relationship between skin-to-skin operative time and long-termcomplications, as well as complications requiring treatment, after deep inferiorepigastric perforator (DIEP)flap breast reconstructions has not been thoroughly investigated. The study objective was to evaluate if operative time would independently prognosticate the type and number of treated complications, as well as long-term abdominal morbidity. Methods Patients who underwent bilateral DIEPflaps from 2010 to 2021 by twosenior surgeons with standardized surgical and postoperative protocols were retro-spectively reviewed. Inclusion required atleast 1 year of postoperative follow-up.Extensive multivariable regression analyses were utilized to adjust for potentialconfounders, including measures of intraoperative complexity. ResultsThree hundred thirty-five patients were entered into multivariable analyses.After risk adjustment, there was a significant increase in the risk of all treated complications per hour. Each hour of operation increased risk of complications requiring extended hospital stay for treatment by 25%,flap-site complications requiring readmission treatment by 24%, and flap-site complications requiring extendedhospital stay for treatment by 26% (allp<0.0001). Long-term abdominal morbidity(abdominal bulge) increased by 25% per hour of operative time (p<0.0001). Thenumber of complications requiring treatment, abdominal donor-site complications,and complications requiring extended hospital stay for treatment had statisticallysignificant linear relationships with the duration of surgery (allp<0.05). Conclusion Operative time predicts long-term abdominal morbidity and complica-tions requiring treatment, especially impacting the odds of developing abdomina bulges and complications requiring extended hospital stay for treatment or readmis-sion treatment. This study emphasizes the importance of reducing operative time to improve DIEPflap breast reconstruction outcomes