Many patients mistakenly believe that the longer the operation, the better the healing results, and that short surgery is a sign that the surgeon is in a hurry or is not meticulous.
These myths can be a major source of anxiety for patients. However, the opposite is true: the longer the surgery time, the more the healing time and the risks associated with the intervention increase.
While it is true that operating time is an important indicator of risk factors and possible complications, the type of surgery and procedural complexity are also determining factors. Although often independent, these risk factors can sometimes be interrelated.
Infections and complications
The link between wound infection and operative time has been known for a long time. Every additional minute of surgery has a direct impact on the rate of wound infection.
As proof, a study on breast reconstruction with implants published in 2019 clearly demonstrated that the possibility of medical complications or wound infections increases when the surgery time goes beyond three hours. There would be a direct causal link between complications, preoperative health conditions, and longer operative time.
While the complication rates vary little for surgeries of less than 3 hours, the risks multiply by 1.6 times after 3 hours. Each successive operating time interval is accompanied by an associated growth in complications, with rates increasing 3-fold after 4.5 hours and almost 5-fold for a 6.8 hours procedure.
When surgery lasts longer than 6 hours, every additional hour increases the risk of cardiovascular, kidney and pulmonary complications. The same goes for the increased rate of infection. Surgeries lasting longer than 3 hours increase the risk of erythema and bruising, and often involve slower healing of the wounds.
The main issue regarding the risk of morbidity is the complexity of the procedure, not the duration of the operation. Indeed, according to a study published in 2014, complications can vary between two surgeries of more or less equal duration. For example, surgeries to the head or neck cause more complications than breast or limb surgeries, although the duration is similar, due to the complexity of these procedures. Delicate procedures on smaller surfaces requiring less manipulation cause less morbidity than reconstruction or dissections or excisions of body contouring procedures. On the other hand, studies indicate that operating times of more than three hours also increase the risk of morbidity. All these factors must be taken into account by the surgeon during the preoperative preparation.
The duration of the operation is therefore a key factor in the recovery of patients and in the severity of postoperative complications. It would be an indicator of complications, with a marked increase in risks if the surgery lasts more than three hours.
Surgeons are highly trained professionals. Although an experienced surgeon works quickly, other factors can contribute to the length of the operation, some of which may be beyond his control, such as excessive bleeding which can slow down the procedure. However, speed of execution does not necessarily guarantee better results, as operating time is not the only factor to consider in the event of complications.
So patients don’t have to worry if the surgery is shorter than expected. This does not indicate shoddy work. Longer surgery will not necessarily give better results. Surgery time is an important factor in recovery, but so too are the type of surgery and procedural complexity. Above all, be sure to ask questions before surgery so that you are fully aware of the risks.