Association Between Surgical Start Time and Major Morbidity or Mortality After Pulmonary Resection.

Abstract

The objective of this study was to examine the association between the operative start time of pulmonary resections and the incidence of major morbidity or mortality after resection. The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for patients who underwent lobar or sublobar pulmonary resections for non-small cell lung cancer between 2015 and 2023. Exclusion criteria included missing data on 30-day mortality, sex, and tumor staging, emergent cases, multiple primary procedures, and an American Society of Anesthesiologists score ≥IV or Eastern Cooperative Oncology Group score of ≥4. Open and minimally invasive surgery (MIS) cohorts were analyzed separately. Patients were divided into "early" and "late" groups according to whether the operative start time was before or after 4 cutoff times: 8 am, 12 pm, 3 pm, and 6 pm. Propensity matching was performed for each cutoff. Univariable and multivariable logistic regression analyses were used to evaluate associations between operative start times and the composite outcome of 30-day major morbidity or mortality. A total of 115,020 patients met the inclusion criteria, with a median age of 69 years (interquartile range, 62-74 years); of these, 59% (n = 67,553) were women, and 88% (n = 101,103) underwent MIS resections. The overall mortality rate was 0.8% (895 of 115,020), and the major morbidity rate was 6.4% (7312 of 115,020). After propensity matching in the MIS and open cohorts, no association was found between later operative start times and major morbidity or mortality using cutoffs of 8 am, 12 pm, 3pm, or 6 pm. No association was found between operative start time and the incidence of major morbidity or mortality.