Effect of the surgical day of the week on postoperative outcomes of video-assisted thoracoscopic surgery for early-stage lung cancer patients: A multicenter cohort study

Optimizing elective surgical scheduling is a core component of modern hospital management. While weekend–weekday differences have been reported in selected high-risk settings, evidence regarding intra-week variation in elective thoracic surgery remains limited and inconsistent. This study aims to explore the postoperative outcomes of patients with early-stage lung cancer who underwent video-assisted thoracoscopic surgery early or late in the week. From August 2022 to April 2023, we enrolled patients with early-stage lung cancer who underwent video-assisted thoracoscopic surgery from three hospitals. Patients treated surgically between Monday and Wednesday and between Thursday and Saturday were classified into early and late groups based on institutional scheduling practices, respectively. Propensity score matching(PSM) was performed to minimize confounding bias. Traditional clinical outcomes includuing complications, postoperative length of stay, as well as patient-reported outcomes (PROs) assessing postoperative symptoms and functional recovery, were compared between groups. 203 patients were included in finally analysis. PSM resulted in 148 patients (74 in each) in the subsequent analysis, and there were no significant differences in the demographic and tumor characteristics. No significant differences were observed between early-week and late-week groups in intraoperative complications, in-hospital complications, 30-day postoperative complications, or patient-reported outcomes. Apparent differences in postoperative length of stay were attenuated after stratification by institutional discharge policies.The uniformly low and comparable patient-reported outcome scores observed in both groups suggest that patient-perceived recovery trajectories after VATS are stable across the surgical week These findings suggest that contemporary VATS-based perioperative care for early-stage lung cancer delivers consistent clinical and patient-centered outcomes throughout the surgical week, supporting the stability and reliability of current surgical scheduling practices