Many people want to have more than one surgery done at the same time. After all, it seems like a good idea – you only go to sleep once; you only have to recover once; you take less time off work and it costs less. Good idea, right?

The answer is: Sometimes.

There are downsides too. Combining procedures increases the surgery time and that carries several risks. These risks include the possibility of blood clots in the leg. A piece of this clot can break off and go the lung and block the blood vessel as it gets narrower than the clot itself. That can suddenly cut off a vital amount of lung tissue from it’s blood supply. This can cause breathing difficulties, and even be fatal. This risk increases with longer surgeries, where the blood circulation is slow and blood clotting naturally increases. Prevention is much better than treatment, which is long and complex. One way to avoid this problem is to control the length of time you are in surgery. Sometimes it is better to be cautious and split the procedures up into more than one surgery.

So how long is too long?

Most people agree that out patient cosmetic surgeries should be kept to 6 hours or less, if possible. This time limit varies with the procedure and the patient.

Here are some conditions which increase the risk. Overweight patients have an increased risk – body mass index (BMI) greater than 30 is a warning sign. Smokers have a significantly increased risk. Older patients have a higher risk. Having diabetes carries extra risk. Having a tummy tuck is slightly riskier that other procedures. Taking hormones, such as birth control pills, can arguably increase the risk. Having certain diseases at the same time can increase the risk so much that you probably should not be considering cosmetic surgery at all – cancer, heart disease for instance.

There are several things that can be done to minimize the risk, in addition to shortening the surgery time. These are designed to increase the rate of blood flow in the legs, or lessen the amount of blood in the legs. Wearing a tight (TED hose) stocking during and after surgery minimizes the volume of blood in the legs. Wearing a device that massages the blood along the legs works well during and after surgery. Walking about frequently starting right after surgery helps. Never sit with your feet hanging down and don’t stand still. Elevate your legs when at rest and wiggle your toes and ankles as much as you can remember and never cross your legs, is also good advice. Lastly, there are blood thinners that can be administered.

Other risks from longer procedures includes more blood loss. So it is important not to start the procedure already anemic.

… and don’t forget – 6 hours continuously with no breaks is a long time. What about surgeon fatigue?