Outcomes of lung transplantation surgery performed at night

The logistics and planning involved in lung transplantation (LuTx) are complex. Recent advancements in LuTx surgery have introduced the possibility of deferring surgery to daytime hours and might reduce the burden on operating personnel and improve patient outcomes; however, this might interfere with the daytime program and could be labor-intensive and costly. Therefore, this study sought to investigate the effect of time of surgery on LuTx outcomes.

Adult patients undergoing LuTx between 2010 and 2022 were included in this single-center retrospective cohort study. Patients were categorized as the night group if at least 1 hour of their operation occurred between 2 am and 6am. Otherwise, they were assigned to the day group. The primary outcome for this study was intensive care unit length of stay. Secondary outcomes included 30-day and 1-year survival, bronchiolitis-obliterans syndrome-free survival, time to extubation, rethoracotomy, need for extracorporeal circulatory support, blood loss and transfusion parameters, and ischemic, implant, and operating times. Both unadjusted comparisons and multivariable regression analyses were performed.

In total, 227 patients (day: n = 142, night: n = 85) were included in this study. After multivariable regression, no differences were found in survival, ICU and hospital length of stay, time to extubation, or operation duration. Additionally, no significant differences were found for bronchiolitis-obliterans free-survival, ischemic and implant times, use of extracorporeal circulation, wound complications, rethoracotomies, and the majority of blood loss and transfusion data in the unadjusted analysis.

No differences were found between the day and night group regarding survival, length of stay, time to extubation and other (post-)operative outcomes. These findings indicate that performing LuTx surgery at night is safe, provided that this complex care is well-organized and delivered by a dedicated team.