Minnesota Anesthesia Services

Timing Between Major Surgeries

Undergoing major surgery is a significant event that requires careful consideration not only of the surgical procedure itself but also of the timing between successive surgeries. Determining the appropriate timing between major surgeries, known as the interoperative interval, is important for ensuring optimal patient outcomes and minimizing the risk of complications. This article discusses factors that influence the timing between major surgeries and guidelines to help healthcare professionals make informed decisions.

The complexity of the surgical procedures and the anticipated recovery times are key factors in determining the interval between surgeries. Procedures that are more invasive or require longer recovery periods may necessitate a longer interoperative interval to allow the patient’s body to fully recover before undergoing additional surgery. Additionally, the patient’s overall health status and comorbidities play a significant role in determining the appropriate timing between major surgeries. Patients with multiple comorbidities or poor baseline health may require a longer interoperative interval to facilitate adequate recovery and improve postoperative outcomes [1,2]. One study of patients undergoing primary total knee arthroplasty found that having a history of prior knee surgery is associated with a higher risk of revision after the primary surgery [3]. While the study could not discern the underlying causes for why a history of prior surgery influences the risk for revision surgery, they found that a higher risk for revision was associated with a shorter interval time between their previous surgery and the total knee arthroplasty surgery.

During surgery, there is a certain degree of trauma and injury to surrounding tissue despite best efforts, which may impact post-operative recovery. The location of the surgical sites and the types of tissue involved may influence the timing between different operations, especially with the greater injury caused by major surgeries. Areas with rich blood supply, such as muscle tissues, have faster healing rates and may require a shorter interoperative interval compared to surgeries involving areas with poorer blood supply or slower healing rates, such as bone or cartilage [4].

Before scheduling additional surgeries, healthcare providers should conduct a comprehensive evaluation of the patient’s overall health status, surgical history, and current recovery progress. Consultation with a multidisciplinary team, including surgeons, anesthesiologists, and other relevant specialists, can help assess the patient’s readiness for additional procedures and determine the appropriate timing between major surgeries. In cases where multiple surgeries are necessary, healthcare providers should prioritize procedures based on urgency and potential impact on the patient’s health and quality of life. Procedures that address life-threatening conditions or significant functional impairments take precedence over elective or cosmetic surgeries.

The ERAS (Enhanced Recovery After Surgery) protocol was developed to focus on the quality of surgical care recovery through a multimodal and interdisciplinary approach. The guidelines created by ERAS not only decreased length of stay in the hospital, but also improved recovery [5]. Thus, it is important to take these protocols, along with patient-specific factors, into account in perioperative management and when determining timing between major surgeries.

References

Benker M, Citak N, Neuer T, Opitz I, Inci I. Impact of preoperative comorbidities on postoperative complication rate and outcome in surgically resected non-small cell lung cancer patients. Gen Thorac Cardiovasc Surg. 2022;70(3):248-256.

Payá-Llorente, C., Martínez-López, E., Sebastián-Tomás, J.C. et al. The impact of age and comorbidity on the postoperative outcomes after emergency surgical management of complicated intra-abdominal infections. Sci Rep 10, 1631 (2020).

Miozzari HH, Barea C, Hannouche D, Lübbeke A. History of previous surgery is associated with higher risk of revision after primary total knee arthroplasty: a cohort study from the Geneva Arthroplasty Registry. Acta Orthop. 2021;92(6):709-715.

Kirkby Shaw K, Alvarez L, Foster SA, Tomlinson JE, Shaw AJ, Pozzi A. Fundamental principles of rehabilitation and musculoskeletal tissue healing. Veterinary Surgery. 2020; 49: 22–32.