Continuous Relationship of Operative Duration with Risk of Adverse Perioperative Outcomes and Early Discharge Undergoing Thoracoscopic Lung Cancer Surgery

SIMPLE SUMMARY: Operative duration is considered an important predictor of poor prognosis in several surgical specialties; however, for patients receiving thoracoscopic lung cancer surgery, whether this association remains, and what the trigger point of operative duration contributing to a dramatic increase in adverse perioperative outcomes (APOs) and a significant decrease in early discharge is, is unknown. This retrospective cohort study included 12,392 patients who underwent this surgical treatment and explored the continuous relationship of operative duration with risk of the six most common APOs and early discharge using restricted cubic spline (RCS). The results showed that the risk of APOs exponentially increases as the operative duration exceeds 90 min, accompanied by a significant decrease in the likelihood of early discharge, indicating that shortening the operative duration to less than 90 min may be an important adjustable factor to greatly reduce APOs and accelerate early discharge. ABSTRACT: Background: For thoracoscopic lung cancer surgery, the continuous relationship and the trigger point of operative duration with a risk of adverse perioperative outcomes (APOs) and early discharge remain unknown. Methods: This study enrolled 12,392 patients who underwent this surgical treatment. Five groups were stratified by operative duration: <60 min, 60–120 min, 120–180 min, 180–240 min, and ≥240 min. APOs included intraoperative hypoxemia, delayed extubation, postoperative pulmonary complications (PPCs), prolonged air leakage (PAL), postoperative atrial fibrillation (POAF), and transfusion. A restricted cubic spline (RCS) plot was used to characterize the continuous relationship of operative duration with the risk of APOs and early discharge. Results: The risks of the aforementioned APOs increased with each additional hour after the first hour. A J-shaped association with APOs was observed, with a higher risk in those with prolonged operative duration compared with those with shorter values. However, the probability of early discharge decreased from 0.465 to 0.350, 0.217, and 0.227 for each additional hour of operative duration compared with counterparts (<60 min), showing an inverse J-shaped association. The 90 min procedure appears to be a tipping point for a sharp increase in APOs and a significant reduction in early discharge. Conclusions: Our findings have important and meaningful implications for risk predictions and clinical interventions, and early rehabilitation, for APOs.