Papers Regarding Operative Times and Complications Can Be Misleading

We read with interest Dr Kenkel's paper on the impact of operative time on the complications after plastic surgery.1 Although we appreciate an attempt to determine the impact of operative times on complication rates, we believe that plaintiffs’ attorneys would appreciate this study much more than any plastic surgeons. This study suggests that there is a significantly increased risk of complications after 3 hours. In reviewing the study, 5.08 hours for tissue expander breast reconstruction and 6.70 hours for a SMAS flap seem excessively long for an experienced plastic surgeon. This would lead me to believe that many of the surgeries, in fact, were performed by residents, and would have a higher rate of complications. When the stratification was performed by surgery type, the longer and more complicated procedures …