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

Abstract

Background: Several studies have tried to find a link between timing of lung transplant surgery and patient outcomes. However, there has been conflicting results. This study sought to evaluate the association of operative times and recipient outcomes. Methods: Primary adults lung transplants were identified from the United Network for Organ Sharing Database. Patients were stratified based on time of lung transplant: T1 (12 AM-6 AM); T2 (6 AM-12 PM); T3 (12 PM-6 PM); T4 (6 PM-12 AM). Groups were assessed with comparative statistics. Long-term survival was evaluated using Kaplan-Meier methods and a multivariate Cox proportional hazard model. Results: Within the T4 group, there was a significant increase in length of stay and incidence of primary graft dysfunction, though minor. Unadjusted survival analysis with Kaplan-Meier methods demonstrated that there was no significant difference in long-term survival among the 4 groups (p = 0.55). Following adjustment, no operative time was independently associated with decreased long-term mortality. Variables that were significantly associated with increased long-term mortality included recipient diabetes, creatinine, hospitalization status, intensive care unit status, cigarette use, and donation after circulatory death donor status. Conclusions: Though operative times during the T4 period were associated with increased peri-operative complications, this had no effect on long-term survival. While thoracic transplantation can safely occur no matter what time of day, transplantation should preferentially be performed during normal surgical work hours for the longevity and work life balance of transplant providers and surgeons.

Keywords

• lung transplantation
• donor-cross clamp time
• burnout
• ex vivo lung perfusion
• EVLP