Co-author Richard Chan Woo Park, MD, assistant professor of otolaryngology at Rutgers New Jersey Medical School, Newark, and his research team explored the impact of increasing duration of anesthesia during surgical microvascular reconstruction of the neck and head. The researchers determined that while both medical and surgical complications were reported with the longer duration, the surgical complications were significantly increased. The surgical complications reported included surgical-site infections, flap failure and wound disruption, and the need for blood transfusion within 24 hours. The medical complications included unplanned reintubation, pulmonary embolism, pneumonia, renal impairment, and the need for prolonged mechanical ventilation.

Researchers used the American College of Surgeons National Surgical Quality Improvement Program database to collect data for 630 patients who reported having surgical head and neck microvascular reconstruction with known duration of anesthesia during the period of January 1, 2005, through December 31, 2013. The patients were divided into five groups based on mean anesthesia duration: 358.1 minutes (n = 126); 563.2 minutes (n = 125); 648.9 minutes (n = 128); 736.5 minutes (n = 125); and 922.1 minutes (n = 126). The team discovered that 30-day complications were higher overall in the longer anesthesia-duration group, with 43.7% complications in group 1 (shortest duration) versus 63.5% in group 5 (longest duration; P = .006); however, there were no statistically significant findings for any specific medical complication or overall medical complication rate.

According to Dr. Park, surgeons should try to reduce anesthesia duration and excessive blood loss to reduce postoperative complications. “I think there are inherent risks the longer the patient is not awake and not breathing on his own, and being given medications and fluids,” he said. “Also, having open wounds, despite operating in a somewhat clean environment, can increase the rate of complications by a contaminated operative field of the head, neck, mouth and throat.”

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