Time well spent? The impact of operative time on breast reduction outcomes.

[BACKGROUND] Although extended operative duration increases risks in other surgeries, its impact on breast reduction outcomes remains unclear. This retrospective cohort study investigated the relationship between operative time and postoperative morbidity in breast reduction.

[METHODS] The ACS-NSQIP database (2008-2022) was queried to identify adult female patients who underwent elective breast reduction. Preoperative, intraoperative, and postoperative parameters, including 30-day complications, were assessed. Multivariable logistic regression was used to evaluate the impact of operative time on postoperative outcomes, analyzing it as both a continuous and dichotomous variable.

[RESULTS] A total of 45,143 patients were included. Overall complications occurred in 6.4% (n=2870), with reoperation required in 1.8% (n=825) and readmission in 1.1% (n=516). Surgical complications were observed in 4.3% (n=1930), primarily superficial incisional infections (n=1466, 3.2%). Multivariable analysis demonstrated a nuanced association between operative time and complications: For every 1-h increase in operative time, the risk of any complication and surgical complications decreased by 11.4% (OR=0.998, p<0.0001) and 17.4% (OR=0.997, p<0.0001), respectively, whereas the risk of medical complications increased by 19.2% (OR=1.003, p=0.0009). Threshold analyses revealed that operative times >145 min and >147 min were associated with a significantly lower risk of any (OR=0.792, p<0.0001) and surgical complication (OR 0.708, p<0.0001), respectively. Conversely, operative times >156 min correlated with significantly higher odds of medical complications (OR=1.473, p=0.005).

[CONCLUSION] Operative time impacts postoperative outcomes in breast reduction surgery. Longer procedures are linked to lower surgical risks but higher medical complications. Further research is needed to validate these findings and explore the underlying mechanisms.