Impact of Nighttime Lung Transplantation on Outcomes and Costs

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 two strata (daytime 5AM to 6PM; nighttime 6PM to 5AM) based upon time of incision. Major postoperative adverse events, 5-year overall survival and 5-year BOS-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%) patients underwent daytime transplantation (DT) and 191 (25.8%) patients 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 OR=1.731, 95% CI 1.093-2.741, P=0.019), decreased 5-year overall survival (adjusted HR=1.798, 95% CI 1.079–2.995, P=0.024), as well as decreased 5-year BOS-free survival (adjusted HR=1.556, 95% CI 1.098-2.205, P=0.013) in doubly robust multivariable analyses following propensity score matching. Overall cost for NT and DT were similar. Conclusions NT was associated with higher risk of major postoperative adverse events, decreased 5-year overall survival and decreased 5-year BOS-free survival. Our findings suggest potential benefits of delaying NT to daytime.