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Background <p>Lung cancer remains the primary cause of cancer-related mortality worldwide. While prolonged operative duration is increasingly recognised as a modifier of surgical risk, its independent association with prolonged intensive care unit (ICU) stay for more than 24&#xa0;h following thoracoscopic lobectomy remains inadequately quantified. This study evaluated the association between operative duration and prolonged ICU stay for more than 24&#xa0;h, including underlying dose-response relationships.</p> Methods <p>We performed a retrospective cohort study using the Informative Surgical Patient dataset for Innovative Research Environment (INSPIRE) database, analysing 2545 surgical cases diagnosed with malignant bronchial or lung neoplasms undergoing curative-intent thoracoscopic lobectomy (2011–2020). Multivariable logistic regression, a generalised additive model, and a two-piecewise linear regression model were employed to assess the effect of operative duration on prolonged ICU stay for more than 24&#xa0;h, adjusting for potential confounders.</p> Results <p>The cohort comprised 2545 surgical cases. After adjusting for potential confounders, operative duration demonstrated an independent association with prolonged ICU stay for more than 24&#xa0;h (adjusted odds ratio [OR] = 1.2; 95% confidence interval [CI], 1.06–1.36; <i>P</i> = 0.004). A nonlinear relationship was identified, with an inflection point at 2.39&#xa0;h. Below this threshold, the OR was 2.967 (95% CI, 1.995–4.414); above it, the OR was 0.802 (95% CI, 0.633–1.015).</p> Conclusion <p>Operative duration exhibits a nonlinear, time-dependent association with prolonged ICU stay for more than 24&#xa0;h following thoracoscopic lobectomy in lung cancer patients, persisting after rigorous confounder adjustment. The identified threshold of 2.39&#xa0;h provides an evidence-based benchmark for surgical quality improvement initiatives.</p> Trial registration <p>The current secondary analysis was exempt from research registration. The INSPIRE dataset part was registered with ClinicalTrials.gov under the Unique Identifying Number (UIN) NCTO2914444 and is publicly available at https//clinicaltrials.gov/study/NCTO2914444.</p>

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Association between operative duration and prolonged intensive care unit stay for more than 24 h in lung cancer patients following thoracoscopic lobectomy: a retrospective cohort analysis

  • 期刊论文

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  • 发表日期：

    2026年7月31日

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  • Yang Song,
  • Peiyue Wang,
  • Qing Rong,
  • Tingting Xu,
  • Zhaoyang Deng,
  • Mingzhi Shen

摘要

Background

Lung cancer remains the primary cause of cancer-related mortality worldwide. While prolonged operative duration is increasingly recognised as a modifier of surgical risk, its independent association with prolonged intensive care unit (ICU) stay for more than 24 h following thoracoscopic lobectomy remains inadequately quantified. This study evaluated the association between operative duration and prolonged ICU stay for more than 24 h, including underlying dose-response relationships.

Methods

We performed a retrospective cohort study using the Informative Surgical Patient dataset for Innovative Research Environment (INSPIRE) database, analysing 2545 surgical cases diagnosed with malignant bronchial or lung neoplasms undergoing curative-intent thoracoscopic lobectomy (2011–2020). Multivariable logistic regression, a generalised additive model, and a two-piecewise linear regression model were employed to assess the effect of operative duration on prolonged ICU stay for more than 24 h, adjusting for potential confounders.

Results

The cohort comprised 2545 surgical cases. After adjusting for potential confounders, operative duration demonstrated an independent association with prolonged ICU stay for more than 24 h (adjusted odds ratio [OR] = 1.2; 95% confidence interval [CI], 1.06–1.36; P = 0.004). A nonlinear relationship was identified, with an inflection point at 2.39 h. Below this threshold, the OR was 2.967 (95% CI, 1.995–4.414); above it, the OR was 0.802 (95% CI, 0.633–1.015).

Conclusion

Operative duration exhibits a nonlinear, time-dependent association with prolonged ICU stay for more than 24 h following thoracoscopic lobectomy in lung cancer patients, persisting after rigorous confounder adjustment. The identified threshold of 2.39 h provides an evidence-based benchmark for surgical quality improvement initiatives.

Trial registration

The current secondary analysis was exempt from research registration. The INSPIRE dataset part was registered with ClinicalTrials.gov under the Unique Identifying Number (UIN) NCTO2914444 and is publicly available at https//clinicaltrials.gov/study/NCTO2914444.