Lung transplantation is routinely performed at night because of the unpredictability of donor organ procurement. Late start-times for complex operations such as lung transplantation have been associated with adverse outcomes. There are numerous reasons that delaying transplantation to the morning is preferable: Rested teams perform better; the well-being of the entire team is affected by long after-hours work; and during the day, more help is available for any intraoperative complications.
But is it safe to wait? Can cross clamp and cold ischemia times be extended? How does delaying the surgery impact the outcomes?
Samuel T. Kim and colleagues at the University of California Los Angeles hypothesized that for donors with cross clamp times occurring after 1:30 a.m., the recipient operation could be delayed until morning with acceptable outcomes. Consented adult lung transplant recipients from March 2018 to May 2022 with donor cross-clamp times between 1:30 a.m. and 5:00 a.m. were prospectively enrolled in this study (34 patients; Night cohort); and their skin incision times were set at 6:30 a.m. A control group was identified and included recipients of donors with cross clamp times occurring at any other time of day (68 patients; Day cohort).
Dr. Kim and his team examined short- and medium-term outcomes, including early mortality, a composite of post-operative complications, lengths of stay (ICU and total), 1- and 3-yr survival,) and chronic lung allograft dysfunction at 3-years between the two groups. The results for each of these comparisons were statistically similar.
The group concluded that lung transplant recipients with donor cross clamp times scheduled after 1:30 a.m. can have their operations delayed safely until 6:30 a.m. with acceptable outcomes. And in experienced lung transplant centers, adoption of such a policy may lead to alternative workflow and improved team well-being.
Dr. Kim will present this study Saturday, May, 6, at the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting in Los Angeles.
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Attribution to the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting is requested in all coverage.
ABOUT AATS
The American Association for Thoracic Surgery (AATS) is an international organization that encourages, promotes, and stimulates the scientific investigation of cardiothoracic surgery. Founded in 1917 by a respected group of the earliest pioneers in the field, its original mission was to “foster the evolution of an interest in surgery of the Thorax.” Today, the AATS is the premier association for cardiothoracic surgeons in the world and works to continually enhance the ability of cardiothoracic surgeons to provide the highest quality of patient care. Its more than 1,500 members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease. Visit aats.org to learn more.
