Impact of operative time on 30-day surgical outcomes following tissue expander-based breast reconstruction

Operative duration has been associated with increased risk of postoperative complications in various surgical disciplines. However, its relationship with adverse outcomes in tissue expander-based (TE) breast reconstruction remains underexplored.

We conducted a retrospective cohort analysis of 1874 patients (633 unilateral, 1241 bilateral) undergoing TE-based breast reconstruction. We evaluated the association between operative time and 30-day postoperative outcomes including hematoma, seroma, mastectomy skin flap necrosis (MSFN), unplanned readmission, surgical site infection (SSI), and unplanned reoperation. Logistic regression models were used to estimate odds ratios (OR) for each outcome per 10-minute increase in operative duration for unilateral and bilateral cases, respectively. Both unadjusted and hierarchical adjusted (aOR) models were constructed.

Among unilateral cases, a 10-minute increase in operation duration was significantly associated with higher odds of MSFN (aOR: 1.04; 95% CI, 1.01-1.07) and unplanned reoperation (aOR: 1.03; 95% CI, 1.00-1.06). In bilateral cases, operative duration per 10-minute increase demonstrated similar results with statistically significant increases in MSFN (aOR: 1.02; 95% CI, 1.00-1.05), unplanned readmission (aOR: 1.02; 95% CI, 1.00-1.04), and SSI (aOR: 1.02; 95% CI, 1.00-1.03).

Longer operative time was consistently associated with increased odds of MSFN in both unilateral and bilateral TE-based breast reconstructions. These findings suggest that operative duration may serve as an important predictor of short-term complications, though it likely acts as a surrogate marker for case complexity. Further investigation is warranted to determine whether optimizing intraoperative efficiency and standardizing workflows can improve clinical outcomes.