Journal of plastic, reconstructive & aesthetic surgery : JPRAS
August 17, 2026 · via Europe PMC
Procedural stacking as an independent marker of thirty-day morbidity in plastic surgery: A national cohort study.
Uzoekwe M, Sekhon S, Tompkins-Rhoades C, Patel H, Rajaii R, Hansen SL.
AI summary — for doctors, generated from the abstract only
Adding more procedures to an operation raised 30-day morbidity independent of operative time, mainly reoperation and readmission.
What was studied
Retrospective NSQIP analysis of 286,295 plastic surgery cases (2014-2023) examining 0, 1, 2 or 3 or more additional CPT-coded procedures and 30-day outcomes, adjusting for patient factors, operative time and primary procedure work value.
Key findings
- 55.9% of cases included at least one additional procedure.
- Three or more additional procedures versus none: reoperation OR 1.54, readmission OR 1.41, medical complications OR 1.31, wound complications OR 1.12.
- Absolute increases were small to moderate (0.4 to 1.5 percentage points) and largest in operations of 240 minutes or longer.
Clinical relevance
When planning combined operations, the number and breadth of added procedures matters beyond expected duration, particularly for long cases.
Who should care
Limitations
Observational registry data limited to 30 days with coded procedures and residual confounding, and stacking did not improve outcome prediction (minimal AUC change).
Weigh the number of added procedures, not just operative time, when deciding whether to combine operations, especially for long cases.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Combined procedures are common in plastic surgery, but risk is framed by operative time rather than by the number and burden of additional procedures.
Methods
We analyzed American College of Surgeons National Surgical Quality Improvement Program plastic surgery cases from 2014 to 2023. Stacking burden was 0, 1, 2, or ≥3 additional Current Procedural Terminology-coded procedures. Multivariable logistic regression was used to evaluate 30-day wound complications, reoperation, readmission, and medical complications, adjusting for patient factors, operative time, primary-procedure work relative value units (wRVUs), and procedure family. Moreover, absolute risk differences, wRVU-weighted burden, and operative-time interaction were evaluated.
Results
Among 286,295 cases, 160,098 (55.9%) included ≥1 additional procedure. Compared with none, ≥3 additional procedures were associated with wound complications (odds ratio 1.12, 95% confidence interval 1.07-1.18), reoperation (1.54, 1.46-1.63), readmission (1.41, 1.33-1.50), and medical complications (1.31, 1.21-1.42). Adjusted absolute increases were 0.51, 1.48, 1.01, and 0.40% points (numbers needed to harm, 195, 67, 99, and 251; ΔAUC 0.000-0.005). Weighted burden remained associated with all outcomes (odds ratios 1.04-1.09 per 10 wRVUs). Absolute increases were greatest in operations that lasted ≥240 min (wound complications 1.76, reoperation 2.54, and readmission 1.90% points). Cross-family stacking was associated with wound complications and readmission.
Conclusions
Procedural stacking is associated with higher 30-day morbidity independent of operative time and primary-procedure wRVUs, and it was most strongly associated for reoperation and readmission and during prolonged operations. The number and breadth of additional procedures, although they did not improve discrimination, provide preoperative information that should be weighed alongside expected duration in combined operations.
DOI
10.1016/j.bjps.2026.08.020
PMID
42691931
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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