Association of Operative Timing with Clinical Outcomes and Safety in Thoracic Organ Transplantation: A Meta-Analytic Synthesis of Evidence.

In 30 seconds

This PRISMA-guided systematic review and meta-analysis examined whether daytime versus nighttime operative timing was associated with outcomes after heart or lung transplantation. Eight studies were included, with substantial variation in how daytime and nighttime were defined. Daytime transplantation was associated with lower in-hospital mortality (RR, 0.89; 95% CI, 0.82 to 0.97; P = 0.029), but no statistically significant differences were found in mortality at 30 or 90 days or at 1, 3, or 5 years. Most reported complications and resource-use outcomes were comparable between timing groups.

Key findings

• Daytime transplantation was associated with lower in-hospital mortality (RR, 0.89; 95% CI, 0.82 to 0.97; P = 0.029).
• No statistically significant mortality differences were observed at 30 or 90 days or at 1, 3, or 5 years.
• ECMO support, pacemaker implantation, major complications, ICU stay, and overall hospital stay were largely comparable.
• Sensitivity analyses indicated that the in-hospital mortality association was influenced by the largest contributing cohort.

Why it matters

Transplant operations may occur at night because of donor availability and efforts to limit cold ischemia. These pooled findings help frame whether timing is associated with patient outcomes: the in-hospital mortality signal was not sustained at later time points, and most safety and resource outcomes were similar. The results therefore provide context for evaluating timing within structured transplant systems without establishing a broad timing effect.

What to keep in mind

Only eight studies were included, definitions of daytime and nighttime varied considerably, and sensitivity analyses showed the in-hospital mortality association was influenced by the largest cohort.