Association of Operative Day of Week with Outcomes after Lung Transplantation

E. W. Etchill, K. Giuliano, A. Chidi, J. Ha, C. Merlo, E. Bush

Research output: Contribution to journalArticle

Abstract

PURPOSE: Some surgeries performed during the weekend have worse outcomes. Lung transplantation is frequently performed on weekends despite a lack of evidence for its safety. We hypothesized that weekend lung transplants have worse outcomes than those performed during weekdays. METHODS: We conducted a retrospective analysis using the Scientific Registry of Transplant Recipients (SRTR) to characterize the safety of weekend lung transplantation. We evaluated adult lung transplantations performed in the USA between 1987 and 2019. Baseline donor and recipient characteristics were stratified by weekday (Monday-Friday) versus weekend (Saturday-Sunday) transplantation and compared using appropriate parametric and non-parametric tests. The primary outcomes were 10-year patient survival, overall graft survival, and death-censored graft survival. Secondary outcomes included post-operative complications, hospital length of stay, readmission, and acute rejection within the first year. Cox proportional hazards and competing risks regression models were used to evaluate the impact of weekend surgery on outcomes. RESULTS: Of the 38,963 lung transplants performed in the United States between 1987 and 2019, 10,286 (36%) were performed during the weekend and 28,677 (64%) during the week. Recipients transplanted during the weekend were slightly older (50.6 years vs. 49.9 years, p=0.0002), more likely to be male (57.8% vs 55.2%, p=0.006), and spent less time on the waitlist (100 days vs 105 days, p=0.0008). There were no other significant differences in baseline characteristics, comorbidities, or transplant indication. There were no differences in donor characteristics. No significant association was found between weekend transplant and 10-year overall patient survival, allograft survival, or death-censored graft survival in the adjusted analyses. (HR 1.0, (95% CI 0.99-1.01), 1.01 (95% CI 0.99-1.02), 1.0). Additionally, no association was found between weekend transplant and secondary outcomes. CONCLUSION: Outcomes for lung transplantation in the USA are not affected by day of surgery, and weekends do not confer an increased risk for mortality, graft failure, or post-operative complications. This is the first study investigating lung transplant outcomes during the weekend. Further study is needed to evaluate differences in outcomes of surgical procedures that occur over the weekend.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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