Impact of Nighttime Lung Transplantation on Outcomes and Costs.
Impact of Nighttime Lung Transplantation on Outcomes and Costs.
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夜间肺移植对结果和成本的影响。
DOI：
10.1016/j.athoracsur.2020.07.060
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Puri V
中科院分区：
文献类型：
--
作者：
Yang Z;Takahashi T;Gerull WD;Hamilton C;Subramanian MP;Liu J;Meyers BF;Kozower BD;Patterson GA;Nava RG;Hachem RR;Witt CA;Aguilar PR;Pasque MK;Byers DE;Kulkarni HS;Kreisel D;Puri V
以前在器官移植领域的研究表明夜间手术和不良后果之间可能存在联系。我们的目的是确定夜间肺移植对术后结果、长期生存率和总费用的影响。我们对2006年1月至2017年12月期间接受移植的成人肺移植受者进行了单中心回顾性队列分析。数据来自我们的机构肺移植登记处和中美洲移植服务数据库。根据切口时间将患者分为两个分层（白天5AM至6PM;夜间6PM至5AM）。在倾向评分匹配后检查主要术后不良事件、5年总生存率和5年无BOSS生存率。此外，我们还比较了夜间和日间移植组的总费用。在本研究纳入的740例患者中，549例（74.2%）患者接受了日间移植（DT），191例（25.8%）患者接受了夜间移植（NT）。倾向评分匹配产生了187个匹配对。NT与发生任何重大术后不良事件的风险较高相关（校正OR=1.731，95% CI 1.093-2.741，P=0.019），5年总生存期缩短（校正HR=1.798，95% CI 1.079-2.995，P=0.024），以及5年无BOS生存率降低（调整的HR=1.556，95% CI 1.098-2.205，P=0.013）。NT和DT的总成本相似。NT与术后主要不良事件的风险较高、5年总生存率降低和5年无BOS生存率降低相关。我们的研究结果表明，将NT延迟到白天可能有好处。
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. 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. 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. 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.
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影响因子：
2.9
作者：
de Boer JD;Van der Bogt KEA;Putter H;Ooms-de Vries KM;Haase-Kromwijk BJJM;Pol RA;De Jonge J;Dejong CHC;Nijboer WM;Van der Vliet JA;Braat AE
通讯作者：
Braat AE
影响因子：
8.9
作者：
Shigemura, Norihisa;Orhan, Yucel;Bermudez, Christian A.
通讯作者：
Bermudez, Christian A.
影响因子：
4.6
作者：
Aguilar, Patrick R.;Bemiss, Bradford C.;Hachem, Ramsey R.
通讯作者：
Hachem, Ramsey R.
影响因子：
8.8
作者：
Lonze, B. E.;Parsikia, A.;Ortiz, J. A.
通讯作者：
Ortiz, J. A.
影响因子：
4.6
作者：
Chang, Stephanie H.;Kreisel, Daniel;Puri, Varun
通讯作者：
Puri, Varun