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
- 1Department of General Practice, First Medical Center, Chinese PLA General Hospital, Beijing, China
- 2Department of General Practice, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan China
Abstract
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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13019-026-04498-8.
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BibTeX
@article{song2026association,
title = {{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}},
author = {Yang Song and Peiyue Wang and Qing Rong and Tingting Xu and Zhaoyang Deng and Mingzhi Shen},
journal = {Journal of Cardiothoracic Surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04498-8},
url = {https://doi.org/10.1186/s13019-026-04498-8},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Yang Song
AU - Peiyue Wang
AU - Qing Rong
AU - Tingting Xu
AU - Zhaoyang Deng
AU - Mingzhi Shen
PY - 2026
DA - 2026/07/31
JO - Journal of Cardiothoracic Surgery
DO - 10.1186/s13019-026-04498-8
UR - https://doi.org/10.1186/s13019-026-04498-8
AB - 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13019-026-04498-8.
SN - 1749-8090
ER -