Is a 16-hour surgical procedure reasonable?

16-Hour Surgical Procedures Are Not Reasonable Due to Increased Complication Risk

A 16-hour surgical procedure is not reasonable and should be avoided due to significantly increased risk of complications, including surgical site infections, respiratory complications, and extended hospital stays. 1, 2

Evidence on Prolonged Operative Time

Risks of Extended Surgery

• Operative duration is independently associated with increased infectious complications and length of hospital stay 1
• For each half-hour increase in operative time, the risk of infectious complications increases by approximately 2.5% 1
• After 2-2.5 hours of surgery, the risk of infectious complications nearly doubles compared to procedures lasting less than 1 hour 1
• Every 15-minute increase in operative time increases the risk of:
  • Anemia requiring transfusion by 9%
  • Wound dehiscence by 13%
  • Renal insufficiency by 9%
  • Sepsis by 10%
  • Surgical site infection by 9%
  • Hospital readmission by 5%
  • Extended hospital stay by 9% 2

Timing Recommendations from Guidelines

• The World Society of Emergency Surgery (WSES) strongly recommends against delaying necessary surgery beyond 24 hours from admission 3
• For necrotizing soft tissue infections, surgical debridement delayed beyond 12 hours from admission is associated with significantly higher mortality, higher incidence of septic shock, renal failure, and more surgical debridements 3
• For emergency general surgery procedures, operations performed after 48 hours from admission have a 54.5% increased risk of 30-day mortality and 46.8% increased risk of morbidity compared to earlier operations 4

Considerations for Extended Procedures

When Long Operations May Be Necessary

• Complex reconstructive procedures may sometimes require extended operative times 5
• However, even in these cases, the type of surgery and patient's general health are more important predictors of outcome than duration alone 5

Mitigating Risks

If a complex procedure is absolutely necessary:

• Consider staging the procedure into multiple shorter operations
• Ensure optimal perioperative management:
  • Maintain normothermia
  • Provide goal-directed fluid therapy
  • Implement enhanced recovery protocols 3
  • Use appropriate thromboprophylaxis
  • Ensure adequate intraoperative monitoring

Recommendations for Surgical Planning

1. Limit operative time to under 6 hours whenever possible
2. For complex cases requiring extended time:
   • Consider breaking the procedure into multiple staged operations
   • Involve multiple surgical teams to reduce operative time
   • Ensure optimal perioperative management to minimize complications
3. For emergency procedures:
   • Perform necessary surgery within 24 hours of admission 3
   • For necrotizing infections, surgical intervention should occur within 12 hours 3

Conclusion

The evidence strongly indicates that prolonged operative times significantly increase the risk of complications and mortality. A planned 16-hour surgical procedure poses unacceptable risks to patient safety and should be reconsidered in favor of alternative approaches that limit operative duration.