Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;112(1):206-213.
doi: 10.1016/j.athoracsur.2020.07.060. Epub 2020 Oct 13.

Impact of Nighttime Lung Transplantation on Outcomes and Costs

Zhizhou Yang  1 , Tsuyoshi Takahashi  1 , William D Gerull  1 , Christy Hamilton  1 , Melanie P Subramanian  1 , Jingxia Liu  2 , Bryan F Meyers  1 , Benjamin D Kozower  1 , G Alexander Patterson  1 , Ruben G Nava  1 , Ramsey R Hachem  3 , Chad A Witt  3 , Patrick R Aguilar  3 , Michael K Pasque  1 , Derek E Byers  3 , Hrishikesh S Kulkarni  3 , Daniel Kreisel  1 , Varun Puri  4
Affiliations

Impact of Nighttime Lung Transplantation on Outcomes and Costs

Zhizhou Yang et al. Ann Thorac Surg. 2021 Jul.

Abstract

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Propensity score distribution before and after match.
Figure 2.
Figure 2.
Kaplan-Meier curve for 5-year overall survival using matched pairs.
Figure 3.
Figure 3.
Kaplan-Meier curve for 5-year BOS-free survival using matched pairs.
See this image and copyright information in PMC

References

    1. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of Resident Fatigue and Distress with Perceived Medical Errors. JAMA. 2009;302(12): 1294–1300. - PubMed
    1. Gerdes J, Kahol K, Smith M, Leyba MJ, Ferrara JJ. Jack Barney Award: the Effect of Fatigue on Cognitive and Psychomotor Skills of Trauma Residents and Attending Surgeons. Am J Surg. 2008;196(6):813–9. - PubMed
    1. Laupland KB, Shahpori R, Kirkpatrick AW, Stelfox HT. Hospital Mortality Among Adults Admitted to and Discharged from Intensive Care on Weekends and Evenings. J Crit Care. 2008;23(3):317–24. - PubMed
    1. Montaigne D, Marechal X, Modine T, et al. Daytime Variation of Perioperative Myocardial Injury in Cardiac Surgery and Its Prevention by Rev-Erbα Antagonism: A Single-Centre Propensity-Matched Cohort Study and a Randomized Study. Lancet. 2018;391(10115):59–69. - PubMed
    1. Cunningham PS, Maidstone R, Durrington HJ, et al. Incidence of Primary Graft Dysfunction after Lung Transplantation is Altered by Timing of Allograft Implantation. Thorax. 2019;74(4):413–416. - PMC - PubMed

Publication types