TY - JOUR
T1 - Impact of Nighttime Lung Transplantation on Outcomes and Costs
AU - Yang, Zhizhou
AU - Takahashi, Tsuyoshi
AU - Gerull, William D.
AU - Hamilton, Christy
AU - Subramanian, Melanie P.
AU - Liu, Jingxia
AU - Meyers, Bryan F.
AU - Kozower, Benjamin D.
AU - Patterson, G. Alexander
AU - Nava, Ruben G.
AU - Hachem, Ramsey R.
AU - Witt, Chad A.
AU - Aguilar, Patrick R.
AU - Pasque, Michael K.
AU - Byers, Derek E.
AU - Kulkarni, Hrishikesh S.
AU - Kreisel, Daniel
AU - Puri, Varun
N1 - Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/7
Y1 - 2021/7
N2 - Background: Previous studies in the field of organ transplantation have shown a possible association between nighttime surgery and adverse outcomes. We aim to determine the impact of nighttime lung transplantation on postoperative outcomes, long-term survival, and overall cost. Methods: We performed a single-center retrospective cohort analysis of adult lung transplant recipients who underwent transplantation between January 2006 and December 2017. Data were extracted from our institutional Lung Transplant Registry and Mid-America Transplant services database. Patients were classified into 2 strata, daytime (5 AM to 6 PM) and nighttime (6 PM to 5 AM), based on time of incision. Major postoperative adverse events, 5-year overall survival, and 5-year bronchiolitis obliterans syndrome–free survival were examined after propensity score matching. Additionally we compared overall cost of transplantation between nighttime and daytime groups. Results: Of the 740 patients included in this study, 549 (74.2%) underwent daytime transplantation and 191 (25.8%) underwent nighttime transplantation (NT). Propensity score matching yielded 187 matched pairs. NT was associated with a higher risk of having any major postoperative adverse event (adjusted odds ratio, 1.731; 95% confidence interval, 1.093-2.741; P =.019), decreased 5-year overall survival (adjusted hazard ratio, 1.798; 95% confidence interval, 1.079-2.995; P =.024), and decreased 5-year bronchiolitis obliterans syndrome–free survival (adjusted hazard ratio, 1.556; 95% confidence interval, 1.098-2.205; P =.013) in doubly robust multivariable analyses after propensity score matching. Overall cost for NT and daytime transplantation was similar. Conclusions: NT was associated with a higher risk of major postoperative adverse events, decreased 5-year overall survival, and decreased 5-year bronchiolitis obliterans syndrome–free survival. Our findings suggest potential benefits of delaying NT to daytime transplantation.
AB - Background: Previous studies in the field of organ transplantation have shown a possible association between nighttime surgery and adverse outcomes. We aim to determine the impact of nighttime lung transplantation on postoperative outcomes, long-term survival, and overall cost. Methods: We performed a single-center retrospective cohort analysis of adult lung transplant recipients who underwent transplantation between January 2006 and December 2017. Data were extracted from our institutional Lung Transplant Registry and Mid-America Transplant services database. Patients were classified into 2 strata, daytime (5 AM to 6 PM) and nighttime (6 PM to 5 AM), based on time of incision. Major postoperative adverse events, 5-year overall survival, and 5-year bronchiolitis obliterans syndrome–free survival were examined after propensity score matching. Additionally we compared overall cost of transplantation between nighttime and daytime groups. Results: Of the 740 patients included in this study, 549 (74.2%) underwent daytime transplantation and 191 (25.8%) underwent nighttime transplantation (NT). Propensity score matching yielded 187 matched pairs. NT was associated with a higher risk of having any major postoperative adverse event (adjusted odds ratio, 1.731; 95% confidence interval, 1.093-2.741; P =.019), decreased 5-year overall survival (adjusted hazard ratio, 1.798; 95% confidence interval, 1.079-2.995; P =.024), and decreased 5-year bronchiolitis obliterans syndrome–free survival (adjusted hazard ratio, 1.556; 95% confidence interval, 1.098-2.205; P =.013) in doubly robust multivariable analyses after propensity score matching. Overall cost for NT and daytime transplantation was similar. Conclusions: NT was associated with a higher risk of major postoperative adverse events, decreased 5-year overall survival, and decreased 5-year bronchiolitis obliterans syndrome–free survival. Our findings suggest potential benefits of delaying NT to daytime transplantation.
UR - http://www.scopus.com/inward/record.url?scp=85103986888&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2020.07.060
DO - 10.1016/j.athoracsur.2020.07.060
M3 - Article
C2 - 33065051
AN - SCOPUS:85103986888
SN - 0003-4975
VL - 112
SP - 206
EP - 213
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -