Is timing everything? Examining operative time in lung transplants from 2006 to 2023

Area of Science:

• Thoracic Surgery
• Transplantation Medicine
• Health Services Research

Background:

• Conflicting evidence exists regarding the impact of lung transplant surgery timing on patient outcomes.
• Previous studies have not definitively established a link between operative times and recipient success.

Purpose of the Study:

• To evaluate the association between the time of lung transplant surgery and recipient outcomes.
• To determine if specific operative times influence post-transplant survival and complications.

Main Methods:

• Analysis of adult primary lung transplants from the United Network for Organ Sharing Database.
• Stratification of patients into four operative time groups (T1-T4).
• Comparative statistics, Kaplan-Meier survival analysis, and multivariate Cox proportional hazard modeling were employed.

Main Results:

• The T4 (6 PM-12 AM) group showed a minor increase in length of stay and primary graft dysfunction.
• No significant difference in long-term survival was observed among the four operative time groups (p=0.55).
• Operative time was not independently associated with decreased long-term mortality; recipient factors like diabetes and creatinine were significant predictors.

Conclusions:

• Peri-operative complications during nighttime lung transplants (T4) did not affect long-term survival.
• Thoracic transplantation can be safely performed at any time.
• Surgical teams may benefit from performing transplants during standard work hours for improved provider well-being.