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

Background: 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.

Methods: 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.

Results: 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.

Conclusions: No association was found between operative start time and the incidence of major morbidity or mortality.