Impact of Surgical Start Time on Clinical Outcomes in Urologic Surgery: A Single-Center Study of Major Oncologic surgeries and Adrenalectomy

Impact of Surgical Start Time on Clinical Outcomes in Urologic Surgery: A Single-Center Study of Major Oncologic surgeries and Adrenalectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Surgical Start Time on Clinical Outcomes in Urologic Surgery: A Single-Center Study of Major Oncologic surgeries and Adrenalectomy Kohei Kobatake, Keisuke Goto, Yuki Kohada, Miki Naito, Shunsuke Miyamoto, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9268541/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background The impact of surgical start time on perioperative outcomes remains controversial, and evidence in urologic oncology is limited. We aimed to evaluate the association between surgical start time and clinical outcomes across major urologic procedures. Methods We retrospectively analyzed 2,827 patients who underwent major urologic surgeries at a single institution from 2010 to 2025. Patients were categorized into morning (8:00–12:00) and afternoon (after 12:00) groups. Propensity score matching (PSM) was performed to adjust for baseline differences. Perioperative outcomes, including operative time, estimated blood loss, complications, and overall survival, were compared. Linear regression analyses were used to assess the association between surgical start time and operative duration. Results Before PSM, the morning group included patients with higher perioperative risk, and operative time, estimated blood loss, and overall survival were significantly worse than in the afternoon group. After PSM, 954 patients with balanced baseline characteristics were included in each group. In the matched cohort, estimated blood loss and overall survival were comparable between groups, whereas operative time remained longer in the morning group. Perioperative complication rates were similar between groups. Subgroup analyses demonstrated a consistent pattern across procedures, surgeon experience, and surgical approaches, with operative time shorter in the afternoon group. Conclusions Surgical start time was associated with operative duration, with morning procedures taking longer than those in the afternoon. However, surgical start time was not associated with perioperative complications or overall survival. These findings suggest surgical start time may influence operative efficiency but has limited impact on clinical outcomes. Urologic surgery propensity score matching operative time surgical start time time of day Figures Figure 1 Figure 2 INTRODUCTION Urologic surgery represents a substantial component of modern surgical practice. Based on data from the Japanese National Clinical Database, more than 42,000 major urologic cancer surgeries, including partial nephrectomy, radical nephrectomy, radical cystectomy, and radical prostatectomy, are performed in 2021 [ 1 ]. Adrenalectomy is widely performed as a standard urologic procedure in several countries, particularly for functional adrenal tumors, and is increasingly performed using minimally invasive approaches [ 2 , 3 ]. Surgical procedures are often scheduled as multiple consecutive cases within a single operating day, making workflow and scheduling critical determinants of perioperative efficiency and outcomes [ 4 ]. Time-of-day variation has been recognized as a determinant of human performance, with fatigue, sleep deprivation, and circadian rhythm disruption adversely affecting cognitive and technical abilities. These factors have been implicated in performance variability and an increased risk of adverse events in healthcare settings [ 5 – 7 ]. In surgical practice, several studies have suggested that later surgical start times are associated with worse clinical outcomes, including higher rates of complications, mortality, and adverse events. These effects have been attributed to surgeon fatigue, cumulative workload, and transitions in care delivery [ 5 , 8 – 10 ]. Furthermore, later procedures have been linked to reduced efficiency, such as prolonged hospital stay and increased resource utilization [ 11 , 12 ]. However, the evidence remains inconsistent. Some studies have demonstrated no significant association between surgical start time and perioperative outcomes, operative duration, or costs, suggesting that the impact of surgical timing may be context-dependent [ 13 – 15 ]. Despite increasing interest in time-related effects, evidence specific to urologic oncology surgeries remains limited. Therefore, we aimed to evaluate the impact of surgical start time (morning vs afternoon) on clinical outcomes. METHODS Inclusion and exclusion criteria We collected data from patients who underwent radical prostatectomy, nephrectomy, partial nephrectomy, nephroureterectomy, cystectomy, or adrenalectomy at Hiroshima University Hospital from January 2010 to October 2025. Surgical start times were collected, and patients were categorized into morning (8:00–12:00) and afternoon (after 12:00) groups. Radical cystectomy was excluded from the analysis because only two cases were performed in the afternoon. After excluding cases with missing surgical start time data, 2,627 patients were included in the final analysis. Patient characteristics, including demographic factors, comorbidities, medication use, preoperative laboratory data, and tumor- and surgery-related variables (including surgical procedure, clinical T stage, surgical approach, and surgeon experience), were collected. Perioperative outcomes, including operative time, pneumoperitoneum time, console time, estimated blood loss, perioperative complications, and overall survival (OS), were evaluated. A total of 46 surgeons performed at least one procedure. Surgeons with ≥ 20 years of experience as urologists at the time of surgery were defined as experienced surgeons, whereas those with < 20 years of experience were defined as less experienced surgeons. Adrenal tumors were not assigned a preoperative clinical TNM classification; therefore, T, N, and M were recorded as N/A (not applicable). Propensity score matching To adjust for baseline differences between the morning and afternoon groups, propensity score matching (PSM) was performed. Propensity scores were estimated using a nominal logistic regression model in which surgical start time (morning vs afternoon) was included as the dependent variable. The following covariates were included in the model: age, sex, body mass index, comorbidities, medication use, tumor-related variables, and surgery-related factors, including surgical procedure, clinical T stage, N stage, M stage, surgical approach, and surgeon experience. Based on the estimated propensity scores, 1:1 nearest-neighbor matching without replacement was performed. Patients in the morning and afternoon groups were matched according to their propensity scores to minimize baseline differences. Forest plot construction To evaluate the association between surgical start time and operative duration, linear regression analyses were performed using operative time as the dependent variable and surgical start time (afternoon vs morning) as the independent variable. Regression coefficients (β) and their standard errors were obtained from the models, and 95% confidence intervals (CIs) were derived from these estimates. Subgroup analyses were conducted according to surgical procedure, surgeon experience, and surgical approach. For visualization, a forest plot was constructed using the β coefficients and corresponding 95% CIs. The point estimates (β) were represented by circles, and the 95% CIs were depicted as horizontal lines. The size of each circle was scaled proportionally to the sample size (N) of each subgroup, allowing for visual weighting of estimates. Statistics Continuous variables were compared using nonparametric tests, including the Wilcoxon rank-sum test or the Kruskal–Wallis test, as appropriate. Categorical variables were compared using the χ² test. A two-sided P value < 0.05 was considered statistically significant. Kaplan–Meier analysis was used to estimate overall survival (OS), and differences between groups were compared using the log-rank test. Survival curves were generated using Prism 8 software (GraphPad Software Inc., Boston, MA, USA; RRID: SCR_002798). All statistical analyses were performed using JMP software (SAS Institute Inc., Cary, NC, USA; RRID: SCR_008567). RESULTS Baseline characteristics 2,827 patients were included (1,614 in the morning and 1,013 in the afternoon; Table 1 , left). Before PSM, several baseline, tumor-related, and surgical factors differed between the groups. Patients in the morning group were older, had more comorbidities (including ischemic heart disease and prior malignancy), and were more likely to receive antiplatelet or anticoagulant therapy. Tumor and surgical characteristics also differed (Table 2 , left), with adrenalectomy more frequent in the afternoon group and nephroureterectomy and advanced T stage more common in the morning group. Benign pathology was more frequently observed in the afternoon group. Surgical approach and surgeon experience were comparable. Table 1 Baseline characteristics before and after PSM Variable Before PSM After PSM AM (n = 1614) PM (n = 1013) P value AM (n = 954) PM (n = 954) P value Follow-up duration, months 46.2 (15.4–73.8) 42.1 (20.7–76.3) 0.698 40.3 (12.3–72.9) 42.7 (14.6–76.9) 0.146 Age, years 68 (60–73) 66 (57–72) < 0.001 66 (58–72) 66 (57–72) 0.527 Sex Female 284 (17.5) 178 (17.5) 0.998 172 (18.0) 162 (17.0) 0.547 Male 1343 (82.4) 842 (82.6) 782 (82.0) 792 (83.0) BMI, kg/m² 23.2 (21.2–25.4) 23.6 (21.6–26.0) 0.002 23.4 (21.4–25.8) 23.6 (21.7–26.0) 0.182 Comorbidities Hypertension 782 (48.5) 491 (48.5) 0.992 485 (50.8) 452 (47.4) 0.131 Diabetes mellitus 294 (18.2) 175 (17.3) 0.54 158 (16.6) 162 (17.0) 0.806 Asthma 58 (3.6) 44 (4.3) 0.333 33 (3.5) 41 (4.3) 0.342 COPD 30 (1.9) 17 (1.7) 0.894 16 (1.7) 14 (1.5) 0.935 CKD G1-2 1134 (70.3) 746 (73.6) 0.164 716 (50.4) 706 (49.7) 0.871 CKD G3 423 (26.2) 233 (23.0) 208 (48.9) 217 (51.1) CKD G4-5 57 (3.5) 34 (3.4) 30 (49.2) 31 (50.8) Ischemic heart disease 76 (4.7) 29 (2.9) 0.045 28 (2.9) 27 (2.8) 0.891 Arrhythmia 93 (5.8) 48 (4.7) 0.257 48 (5.0) 46 (4.8) 0.832 Cerebrovascular disease 94 (5.9) 60 (6.0) 0.932 9 (0.9) 11 (1.2) 0.532 Prior malignancy 250 (15.5) 120 (11.9) 0.009 105 (11.0) 112 (11.7) 0.614 Oral medication Antiplatelet agents or anticoagulants 204 (12.6) 95 (9.4) 0.01 86 (9.0) 89 (9.3) 0.812 Prior abdominal surgery 456 (28.3) 255 (25.2) 0.084 227 (23.8) 242 (25.4) 0.425 Prior any radiation therapy 21 (1.3) 5 (0.5) 0.042 7 (0.7) 4 (0.4) 0.361 ASA PS 1 162 (10.0) 100 (9.9) 0.879 104 (10.9) 98 (10.3) 0.905 2 1366 (84.6) 858 (84.7) 801 (84.0) 807 (84.6) 3 85 (5.3) 55 (5.4) 49 (5.1) 49 (5.1) 4 1 (0.1) 0 (0.0) 0 (0.0) 0 (0.0) Preoperative blood test Hemoglobin, g/dL 14.2 (13.1–15.1) 14.3 (13.3–15.2) 0.015 14.3 (13.2–15.1) 14.4 (13.4–15.2) 0.343 eGFR, mL/min/1.73 m² 66 (55–77) 68 (57–78) 0.02 68 (58–79) 68 (57–78) 0.787 Serum albumin, g/dL 4.3 (4.1–4.5) 4.3 (4.1–4.5) 0.033 4.3 (4.1–4.5) 4.3 (4.1–4.5) 0.613 AM, morning group; PM, afternoon group; BMI, body mass index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; ASA PS: American Society of Anesthesiologists Physical Status; eGFR, estimated glomerular filtration rate. Table 2 Surgical and tumor characteristics before and after PSM Before PSM After PSM AM (n = 1614) PM (n = 1013) P value AM (n = 954) PM (n = 954) P value Surgical approach Open 90 (5.5) 42 (4.1) 0.207 41 (4.3) 41 (4.3) 0.872 Laparoscopic 380 (23.4) 254 (24.9) 258 (26.0) 248 (26.0) Robot-assisted 1157 (71.1) 724 (71.0) 655 (68.7) 665 (69.7) Surgeon Experienced surgeon 1103 (68.3) 661 (65.3) 0.101 657 (68.9) 643 (67.4) 0.492 Less experienced surgeon 511 (31.7) 352 (34.8) 297 (31.1) 311 (32.0) Surgical procedure Adrenalectomy 188 (11.6) 179 (17.6) < 0.001 163 (17.1) 160 (16.8) 0.885 Prostatectomy 783 (48.1) 480 (47.1) 454 (47.6) 465 (48.7) Nephrectomy 184 (11.3) 112 (11.0) 95 (10.0) 103 (10.8) Partial nephrectomy 307 (18.9) 201 (19.7) 198 (20.8) 182 (19.1) Nephroureterectomy 165 (10.1) 48 (4.7) 44 (4.6) 44 (4.6) Clinical T stage N/A or less than T3 1463 (90.6) 954 (93.9) 0.003 906 (95.0) 896 (93.9) 0.317 T3 or T4 151 (9.4) 62 (6.1) 48 (5.0) 58 (6.1) Clinical N stage N/A or N0 1576 (97.7) 1000 (98.7) 0.053 946 (99.2) 941 (98.6) 0.278 ≥N1 38 (2.4) 13 (1.3) 8 (0.8) 13 (1.4) Clinical M stage N/A or M0 1577 (97.7) 997 (98.4) 0.206 939 (98.4) 943 (98.9) 0.43 M1 37 (2.3) 16 (1.6) 15 (1.6) 11 (1.2) Pathological diagnosis Benign 183 (11.3) 175 (17.3) < 0.001 161 (16.9) 156 (16.4) 0.758 Malignant 1431 (88.7) 838 (82.7) 793 (83.1) 798 (83.6) AM, morning group; PM, afternoon group After PSM using variables that showed statistical significance or clinical relevance in the pre-matched cohort, 954 patients were included in each group (Table 1 , right). Following matching, patient characteristics, comorbidities, medication use, prior treatments, and preoperative laboratory findings were well balanced between the groups, with no significant differences observed. Tumor-related and surgical factors were also similar between the two groups after matching (Table 2 , right). Surgical approach and surgeon experience remained comparable after matching. Perioperative outcomes Before PSM, operative time, pneumoperitoneum time, and console time were significantly longer in the morning group (Table 3 ). Estimated blood loss was higher in the morning group, whereas complication rates were comparable. Table 3 Perioperative outcomes before and after PSM Before PSM After PSM AM (n = 1614) PM (n = 1013) P value AM (n = 954) PM (n = 954) P value Operative time 223 (181–275) 208 (169–256) < 0.001 217 (175–269) 207 (168–256) 0.001 Pneumoperitoneum time (n = 1537) 175 (138–221) (n = 978) 165 (132–204) < 0.001 (n = 913) 170 (131–217) (n = 913) 165 (131–204) 0.038 Console time (n = 1157) 151 (117–195) (n = 724) 146 (112–184) 0.004 (n = 655) 151 (117–196) (n = 665) 146 (112–183.8) 0.013 Estimated blood loss, mL 100 (42–222) 88 (33–200) 0.003 100 (38–220) 90 (35–200) 0.382 Blood infusion 39 (2.4) 19 (1.9) 0.219 17 (1.8) 19 (2.0) 0.737 Intraoperative complications None 1545 (95.7) 967 (95.5) 0.864 905 (94.9) 909 (95.3) 0.604 Grade Ⅰ or Ⅱ 58 (3.6) 40 (3.9) 39 (4.1) 39 (4.1) Grade Ⅲ 11 (0.7) 6 (0.6) 10 (1.1) 6 (0.6) Postoperative complications None 1460 (90.5) 919 (90.7) 0.765 868 (91.0) 871 (91.3) 0.592 Grade Ⅰ or Ⅱ 106 (6.6) 69 (6.8) 55 (5.8) 59 (6.2) Grade Ⅲ 43 (2.7) 24 (2.7) 27 (1.8) 23 (2.4) Grade Ⅳ 2 (0.1) 0 (0.0) 2 (0.2) 0 (0.0) Grade Ⅴ 3 (0.2) 1 (0.1) 2 (0.2) 1 (0.1) AM, morning group; PM, afternoon group After PSM, operative time remained significantly longer in the morning group (217 vs 207 min; P = 0.001). Pneumoperitoneum and console times were longer in the morning group, whereas estimated blood loss and transfusion rates were similar between groups. Perioperative complications, including severe complications, did not differ between groups. Overall survival Before PSM, Kaplan–Meier analysis showed no statistically significant difference in OS between the morning and afternoon groups in patients with benign pathology (Fig. 1 A). In contrast, among patients with malignant disease, OS was significantly worse in the morning group compared with the afternoon group (Fig. 1 B). After PSM, no significant differences in OS were observed between the morning and afternoon groups in either the benign or malignant cohorts (Fig. 1 C and 1 D). Overall and stratified analyses of operative time In the PS–matched cohort, subgroup analyses were performed to assess the association between surgical start time and operative duration (Fig. 2 ). Overall, operative time was approximately 7 minutes shorter in the afternoon group than in the morning group. In procedure-specific analyses, adrenalectomy and prostatectomy showed significantly shorter operative time in the afternoon group, whereas other procedures demonstrated similar trends that did not reach statistical significance. Stratified analyses by surgeon experience and surgical approach showed consistent findings, with operative time generally shorter in the afternoon group across all subgroups. DISCUSSION This study evaluated the impact of surgical start time on perioperative outcomes across major urologic procedures. Before propensity score matching, patients in the morning group had less favorable baseline characteristics, including more comorbidities and fewer benign tumors, which likely contributed to longer operative time, greater blood loss, and worse overall survival. Despite these differences, intraoperative and postoperative complication rates were comparable between groups. After adjustment with propensity score matching, estimated blood loss and overall survival rates were similar between groups, and complication rates remained unchanged. In contrast, operative time, including pneumoperitoneum and console time, remained significantly longer in the morning group. Subgroup analyses showed a consistent pattern across procedures, surgeon experience levels, and surgical approaches, with operative time generally shorter in the afternoon group. To our knowledge, this study is the first to demonstrate differences in clinical outcomes between morning and afternoon start times across multiple urologic procedures. Previous cross-specialty reports have frequently indicated that starting elective surgery in the afternoon is associated with inferior perioperative outcomes, such as prolonged hospital stay, higher incidence of composite complications, increased mortality rates, or reduced productivity [ 6 , 9 – 11 ]. Studies comparing elective morning and afternoon cancer surgeries across specialties have yielded inconsistent results. In neurosurgery, later start times and longer operative durations have been associated with worse outcomes, whereas lung cancer surgery has shown no significant differences in operative time, complications, or other clinical outcomes [ 8 , 13 ]. In colorectal cancer, survival outcomes were similar despite differences in certain complications, and operative time was longer in morning procedures [ 14 ]. Similarly, in robot-assisted radical prostatectomy, afternoon surgeries tended to have shorter operative times and less blood loss, with comparable complication rates, although hospital stays were longer [ 16 ]. In contrast to cancer surgeries, several reports indicate that outcomes for procedures such as kidney transplantation, lung transplantation, and coronary artery bypass grafting are not dependent on the starting time [ 17 – 19 ]. In our study, before PSM, patients in the morning group had less favorable baseline characteristics, including a higher burden of comorbidities and a lower proportion of benign tumors. This pattern suggests that more complex or higher-risk cases may have been preferentially scheduled earlier, reflecting real-world clinical practice. Consistent with findings in colorectal and prostate cancer, operative time remained longer in the morning group after propensity score matching. There are several possible explanations for these findings. The relative lack of time constraints during morning sessions compared with afternoon sessions may result in extended operative times [ 14 ]. Decreased operative time with successive cases within a single day may indicate that a surgeon or surgical team is “warming up” and improving performance, irrespective of the learning curve [ 16 ]. The specific background of university hospitals may complicate the interpretation of these findings. For instance, at our institution, residents are more heavily involved in morning surgeries. Furthermore, surgical team composition varies for each procedure. In surgical procedures performed at university hospitals, involvement of residents is likely to lead to prolonged operative times [ 20 , 21 ]. Highly consistent surgical care teams in urologic surgery have been associated with improved surgical efficiency and patient outcomes [ 22 ]. However, because data on these factors were not collected in this study, the causal relationship with our findings remains unclear. Future prospective studies incorporating data on surgeon experience and team stability are warranted to further clarify these issues. The lack of difference in complication rates between the morning and afternoon groups may be attributed to the highly standardized nature of elective urologic surgeries. In this context, perioperative outcomes are primarily determined by patient- and procedure-related factors rather than external factors such as surgical start time [ 23 , 24 ]. This study has several limitations. First, this was a retrospective, single-center study, which may limit the generalizability of our findings. Second, although propensity score matching was performed to adjust for baseline differences, residual confounding from unmeasured variables cannot be excluded. Finally, detailed information regarding intraoperative factors, such as surgical team composition, degree of resident involvement, and team consistency, was not available. These factors may influence operative efficiency and may partially explain the observed differences in operative time. In conclusion, surgical start time was associated with operative duration in major urologic surgeries, with morning procedures taking longer than those in the afternoon. This pattern was consistent across procedures and subgroups, even after adjustment. However, surgical start time was not associated with perioperative complications or overall survival, suggesting limited impact on clinical outcomes. Surgeons should be aware that operative time in major oncologic surgeries and adrenalectomy procedures may be longer in the morning. Abbreviations CI confidence interval OS overall survival PSM propensity score matching Declarations ACKNOWLEDGMENTS We would like to thank Editage (www.editage.jp) for English language editing. This retrospective study was conducted as part of the Hiroshima Cancer Registry Project (H-CARP), including Hiroshima University Hospital and its affiliated institutions. We also thank the members of H-CARP for their cooperation in developing the registration system using the Research Electronic Data Capture (REDCap) system, hosted at Hiroshima University. Author contributions KK, KG, and NH designed this study. KG managed the REDCap database. YK, MN, SM, YS, HK, and KH provided clinical information. KK and KG performed the statistical analyses. KK and KG interpreted the data. KK edited the manuscript and generated tables and figures. All authors agreed to be accountable for the contents of the study. Conflicts of interest None declared Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of the Institutional Review Board of Hiroshima University Hospital (approval no. 2022-0003) and conformed to the provisions of the Declaration of Helsinki. Funding sources This study did not receive any specific grants from funding agencies in the public, commercial, or nonprofit sectors. References Kikuchi E, Yamamoto H, Yasui T et al (2024) The first detailed annual record on the National Clinical Database Urology Division in Japan: A report on five surgical procedures. Int J Urol 31(12):1344–1355. https://doi.org/10.1111/iju.15561 Agarwal K, Gupta M, Ramachandran R, Tandon N, Kumar R (2026) Surgical and functional outcomes of adrenalectomy by urologists: A 17-year cohort review. Indian J Urol 42(1):24–29. https://doi.org/10.4103/iju.iju_350_25 Naito M, Shikuma H, Hatayama T et al (2025) Treatment outcomes of robotic adrenalectomy compared to laparoscopic adrenalectomy: A propensity score matching study. Asian J Endosc Surg 18(1):e70062. https://doi.org/10.1111/ases.70062 Vladu A, Ghitea TC, Daina LG, Țîrț DP, Daina MD (2024) Enhancing operating room efficiency: The impact of computational algorithms on surgical scheduling and team dynamics. Healthc (Basel) 12(19). https://doi.org/10.3390/healthcare12191906 Wright MC, Phillips-Bute B, Mark JB et al (2006) Time of day effects on the incidence of anesthetic adverse events. Qual Saf Health Care 15(4):258–263. https://doi.org/10.1136/qshc.2005.017566 Kelz RR, Freeman KM, Hosokawa PW et al (2008) Time of day is associated with postoperative morbidity: An analysis of the national surgical quality improvement program data. Ann Surg 247(3):544–552. https://doi.org/10.1097/SLA.0b013e31815d7434 Meewisse AJG, Gribnau A, Thiessen SE, Stenvers DJ, Hermanides J, van Zuylen ML (2024) Effect of time of day on outcomes in elective surgery: A systematic review. Anaesthesia 79(12):1325–1334. https://doi.org/10.1111/anae.16395 Mao Z, Zhang J, Wang P, Zuo W (2025) The association between the duration of surgery and risks of mortality and unplanned reoperation is modulated by the surgical start time. Sci Rep 15(1):28057. https://doi.org/10.1038/s41598-025-12265-3 Nakata Y, Watanabe Y, Ozaki A (2024) Association between surgical productivity and start time. Perioper Care Oper Room Manag 34. https://doi.org/10.1016/j.pcorm.2024.100371 Sim JH, Park YS, Park B et al (2025) Impact of daily, weekly, and seasonal surgical timing on postoperative outcomes in high-risk patients undergoing elective non-cardiac surgery: A retrospective, single-center study. J Clin Anesth 105:111879. https://doi.org/10.1016/j.jclinane.2025.111879 Cifarelli CP, McMichael JP, Forman AG et al (2021) Surgical start time impact on hospital length of stay for elective inpatient procedures. Cureus 13(7):e16259. https://doi.org/10.7759/cureus.16259 Nason GJ, O’Connor EM, O’Neill C, Izzeldin O, Considine SW, O’Brien MF (2016) The impact of day of surgery on the length of stay for major urological procedures. Can Urol Assoc J 10(11–12):E367–E371. https://doi.org/10.5489/cuaj.3777 Hu GHAL, Xu JR ZJ, et al (2022) Whether the start time of elective lung surgery impacts perioperative outcomes and cost? Front Surg 9:922198. https://doi.org/10.3389/fsurg.2022.922198 Ishiyama Y, Ishida F, Ooae S et al (2019) Surgical starting time in the morning versus the afternoon: Propensity score matched analysis of operative outcomes following laparoscopic colectomy for colorectal cancer. Surg Endosc 33(6):1769–1776. https://doi.org/10.1007/s00464-018-6449-9 Sim JH, Park B, Choi Y (2026) Association between surgical start time and postoperative mortality, morbidity and healthcare utilisation in elective non-cardiac surgeries: A retrospective, single-centre study using propensity score matching. Anaesthesia 81(1):72–82. https://doi.org/10.1111/anae.16788 Thomas AA, Kim B, Derboghossians A et al (2014) Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy. Urol Ann 6(2):142–146. https://doi.org/10.4103/0974-7796.130645 Seow YY, Alkari B, Dyer P, Riad H (2004) Cold ischemia time, surgeon, time of day, and surgical complications. Transplantation 77(9):1386–1389. https://doi.org/10.1097/01.TP.0000122230.46091.E2 Tan PJ, Xu M, Sessler DI, Bashour CA (2009) Operation timing does not affect outcome after coronary artery bypass graft surgery. Anesthesiology 111(4):785–789. https://doi.org/10.1097/ALN.0b013e3181b6a50c George TJ, Arnaoutakis GJ, Merlo CA et al (2011) Association of operative time of day with outcomes after thoracic organ transplant. JAMA 305(21):2193–2199. https://doi.org/10.1001/jama.2011.726 Mack J, Turner C, Carter D et al (2020) The effect of resident participation on appendectomy operative times. J Surg Educ 77(6):e196–e200. https://doi.org/10.1016/j.jsurg.2020.06.022 Benissan-Messan DZ, Tamer R, Pieper H, Meara M, Chen XP (2023) What factors impact surgical operative time when teaching a resident in the operating room. Heliyon 9(6):e16554. https://doi.org/10.1016/j.heliyon.2023.e16554 Linder BJ, Anderson SS, Boorjian SA, Tollefson MK, Habermann EB (2023) Effect of surgical care team consistency during urologic procedures on surgical efficiency and perioperative outcomes. Urology 175:84–89. https://doi.org/10.1016/j.urology.2023.02.004 Minervini A, Di Maida F, Mari A et al (2021) Perioperative outcomes of patients undergoing urological elective surgery during the COVID-19 pandemic: A national overview across 28 Italian institutions. Cent Eur J Urol 74(2):259–268. https://doi.org/10.5173/ceju.2021.0374 Soliman C, Wuethrich PY, Walz J et al (2025) Development of the CAMUS intra- and postoperative risk and difficulty estimation indices risk prediction tool for estimating peri- and postoperative outcomes, including surgical difficulty, in major urological surgery-A protocol for a Delphi Study. Eur Urol Open Sci 76:23–37. https://doi.org/10.1016/j.euros.2025.04.002 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Apr, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviewers invited by journal 20 Apr, 2026 Editor assigned by journal 02 Apr, 2026 Submission checks completed at journal 02 Apr, 2026 First submitted to journal 30 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9268541","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626939546,"identity":"9b955f4c-a1d7-494a-a008-98e7dfa99ab0","order_by":0,"name":"Kohei Kobatake","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Kohei","middleName":"","lastName":"Kobatake","suffix":""},{"id":626939547,"identity":"8699ed46-e7a0-426c-9f32-d509ed406321","order_by":1,"name":"Keisuke Goto","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYBACCQbGBhAtZ8AMJBkbJOAyzPi1JDAYk6IFBBIYEjcwgLUQ4TDJ9ubmFx9/2KRvZ+d9+PDnDoto/gYeA4YfNQzs5ji0SPMcbLOckZCWu7OZ3diY94xE7owDPAaMPccYmC1xWCknkdhmzJNwOHfDYTY2acY2idyG+28MGHgbGJgNDuDQIv8QrCXdAKhF8idQy3yQLX/xaJGWYGx+DNSSANIiwQvUsgGohRmfLZI9iW2MM9LSDIEOYzYGadl4gK3gsMwxCZx+kTh+/PGHDzY28gbnjzE+/NlWlzvvAPPGh29qbJJxhRgQsElgCAGdJJFsgFsL8weswnZ4tIyCUTAKRsHIAgBrQFUuhBWrhwAAAABJRU5ErkJggg==","orcid":"","institution":"Hiroshima University","correspondingAuthor":true,"prefix":"","firstName":"Keisuke","middleName":"","lastName":"Goto","suffix":""},{"id":626939548,"identity":"9491c486-3802-4e9c-9740-c3f6650667f1","order_by":2,"name":"Yuki Kohada","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Yuki","middleName":"","lastName":"Kohada","suffix":""},{"id":626939549,"identity":"503fd149-1186-44a0-8c42-5c0f61bbe058","order_by":3,"name":"Miki Naito","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Miki","middleName":"","lastName":"Naito","suffix":""},{"id":626939550,"identity":"ce385b4a-732a-4cc2-9a65-097be5bb716d","order_by":4,"name":"Shunsuke Miyamoto","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Shunsuke","middleName":"","lastName":"Miyamoto","suffix":""},{"id":626939551,"identity":"ae7916dc-1e78-4b5a-bdff-87becbd0561d","order_by":5,"name":"Yohei Sekino","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Yohei","middleName":"","lastName":"Sekino","suffix":""},{"id":626939552,"identity":"2e548151-8efb-4019-bd45-96ec74c98cdf","order_by":6,"name":"Hiroyuki Kitano","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Hiroyuki","middleName":"","lastName":"Kitano","suffix":""},{"id":626939553,"identity":"b18b1b2d-5dd4-4070-b6aa-ac2a829f77fc","order_by":7,"name":"Keisuke Hieda","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Keisuke","middleName":"","lastName":"Hieda","suffix":""},{"id":626939554,"identity":"7e48e433-a934-407b-929d-8c50148b65e5","order_by":8,"name":"Nobuyuki Hinata","email":"","orcid":"","institution":"Hiroshima University","correspondingAuthor":false,"prefix":"","firstName":"Nobuyuki","middleName":"","lastName":"Hinata","suffix":""}],"badges":[],"createdAt":"2026-03-30 14:40:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9268541/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9268541/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108011342,"identity":"34ee2fa4-393e-409a-a5ca-3ed2377aae37","added_by":"auto","created_at":"2026-04-28 13:14:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":216956,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan–Meier curves of overall survival according to surgical start time.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKaplan–Meier curves comparing overall survival between the morning and afternoon groups. (A) overall survival (OS) in patients with benign pathology before propensity score matching (PSM). (B) OS of patients with malignant pathology before PSM. (C) OS in patients with benign pathology after PSM. (D) OS in patients with malignant pathology after PSM. AM, morning group; PM, afternoon group.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9268541/v1/ee2c92cb5518b7dfdb44262d.png"},{"id":108011238,"identity":"d83724fc-17c5-4d93-b075-e63e052ab8b6","added_by":"auto","created_at":"2026-04-28 13:14:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":406190,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOverall and stratified analyses of operative time according to surgical start time.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe forest plot shows the association between surgical start time (afternoon vs morning) and operative duration based on linear regression analyses. Regression coefficients (β) represent the difference in operative time (minutes) between the afternoon and morning groups, with negative values indicating shorter operative time in the afternoon group. Horizontal lines indicate 95% confidence intervals (CIs), and circle sizes are proportional to the sample size (N) of each subgroup.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9268541/v1/31cc0a4f3c5cf28843cff58a.png"},{"id":108012921,"identity":"df63e35c-9984-48bc-9474-ecc780d8a9be","added_by":"auto","created_at":"2026-04-28 13:16:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1211737,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9268541/v1/0698aa06-a9c9-45b7-95e0-b3f395244253.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Surgical Start Time on Clinical Outcomes in Urologic Surgery: A Single-Center Study of Major Oncologic surgeries and Adrenalectomy","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eUrologic surgery represents a substantial component of modern surgical practice. Based on data from the Japanese National Clinical Database, more than 42,000 major urologic cancer surgeries, including partial nephrectomy, radical nephrectomy, radical cystectomy, and radical prostatectomy, are performed in 2021 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Adrenalectomy is widely performed as a standard urologic procedure in several countries, particularly for functional adrenal tumors, and is increasingly performed using minimally invasive approaches [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Surgical procedures are often scheduled as multiple consecutive cases within a single operating day, making workflow and scheduling critical determinants of perioperative efficiency and outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTime-of-day variation has been recognized as a determinant of human performance, with fatigue, sleep deprivation, and circadian rhythm disruption adversely affecting cognitive and technical abilities. These factors have been implicated in performance variability and an increased risk of adverse events in healthcare settings [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn surgical practice, several studies have suggested that later surgical start times are associated with worse clinical outcomes, including higher rates of complications, mortality, and adverse events. These effects have been attributed to surgeon fatigue, cumulative workload, and transitions in care delivery [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, later procedures have been linked to reduced efficiency, such as prolonged hospital stay and increased resource utilization [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the evidence remains inconsistent. Some studies have demonstrated no significant association between surgical start time and perioperative outcomes, operative duration, or costs, suggesting that the impact of surgical timing may be context-dependent [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite increasing interest in time-related effects, evidence specific to urologic oncology surgeries remains limited. Therefore, we aimed to evaluate the impact of surgical start time (morning vs afternoon) on clinical outcomes.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eWe collected data from patients who underwent radical prostatectomy, nephrectomy, partial nephrectomy, nephroureterectomy, cystectomy, or adrenalectomy at Hiroshima University Hospital from January 2010 to October 2025. Surgical start times were collected, and patients were categorized into morning (8:00\u0026ndash;12:00) and afternoon (after 12:00) groups. Radical cystectomy was excluded from the analysis because only two cases were performed in the afternoon. After excluding cases with missing surgical start time data, 2,627 patients were included in the final analysis.\u003c/p\u003e \u003cp\u003ePatient characteristics, including demographic factors, comorbidities, medication use, preoperative laboratory data, and tumor- and surgery-related variables (including surgical procedure, clinical T stage, surgical approach, and surgeon experience), were collected. Perioperative outcomes, including operative time, pneumoperitoneum time, console time, estimated blood loss, perioperative complications, and overall survival (OS), were evaluated.\u003c/p\u003e \u003cp\u003eA total of 46 surgeons performed at least one procedure. Surgeons with \u0026ge;\u0026thinsp;20 years of experience as urologists at the time of surgery were defined as experienced surgeons, whereas those with \u0026lt;\u0026thinsp;20 years of experience were defined as less experienced surgeons.\u003c/p\u003e \u003cp\u003eAdrenal tumors were not assigned a preoperative clinical TNM classification; therefore, T, N, and M were recorded as N/A (not applicable).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePropensity score matching\u003c/h3\u003e\n\u003cp\u003eTo adjust for baseline differences between the morning and afternoon groups, propensity score matching (PSM) was performed. Propensity scores were estimated using a nominal logistic regression model in which surgical start time (morning vs afternoon) was included as the dependent variable. The following covariates were included in the model: age, sex, body mass index, comorbidities, medication use, tumor-related variables, and surgery-related factors, including surgical procedure, clinical T stage, N stage, M stage, surgical approach, and surgeon experience.\u003c/p\u003e \u003cp\u003eBased on the estimated propensity scores, 1:1 nearest-neighbor matching without replacement was performed. Patients in the morning and afternoon groups were matched according to their propensity scores to minimize baseline differences.\u003c/p\u003e\n\u003ch3\u003eForest plot construction\u003c/h3\u003e\n\u003cp\u003eTo evaluate the association between surgical start time and operative duration, linear regression analyses were performed using operative time as the dependent variable and surgical start time (afternoon vs morning) as the independent variable. Regression coefficients (β) and their standard errors were obtained from the models, and 95% confidence intervals (CIs) were derived from these estimates. Subgroup analyses were conducted according to surgical procedure, surgeon experience, and surgical approach. For visualization, a forest plot was constructed using the β coefficients and corresponding 95% CIs. The point estimates (β) were represented by circles, and the 95% CIs were depicted as horizontal lines. The size of each circle was scaled proportionally to the sample size (N) of each subgroup, allowing for visual weighting of estimates.\u003c/p\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eContinuous variables were compared using nonparametric tests, including the Wilcoxon rank-sum test or the Kruskal\u0026ndash;Wallis test, as appropriate. Categorical variables were compared using the χ\u0026sup2; test. A two-sided P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Kaplan\u0026ndash;Meier analysis was used to estimate overall survival (OS), and differences between groups were compared using the log-rank test. Survival curves were generated using Prism 8 software (GraphPad Software Inc., Boston, MA, USA; RRID: SCR_002798). All statistical analyses were performed using JMP software (SAS Institute Inc., Cary, NC, USA; RRID: SCR_008567).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003e2,827 patients were included (1,614 in the morning and 1,013 in the afternoon; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, left). Before PSM, several baseline, tumor-related, and surgical factors differed between the groups. Patients in the morning group were older, had more comorbidities (including ischemic heart disease and prior malignancy), and were more likely to receive antiplatelet or anticoagulant therapy. Tumor and surgical characteristics also differed (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, left), with adrenalectomy more frequent in the afternoon group and nephroureterectomy and advanced T stage more common in the morning group. Benign pathology was more frequently observed in the afternoon group. Surgical approach and surgeon experience were comparable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics before and after PSM\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1614)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1013)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;954)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;954)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFollow-up duration, months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.2\u003c/p\u003e \u003cp\u003e(15.4\u0026ndash;73.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.1\u003c/p\u003e \u003cp\u003e(20.7\u0026ndash;76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40.3\u003c/p\u003e \u003cp\u003e(12.3\u0026ndash;72.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003cp\u003e(14.6\u0026ndash;76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (60\u0026ndash;73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (57\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e66 (58\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e66 (57\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e284 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e178 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e172 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e162 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1343 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e842 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e782 (82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e792 (83.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003cp\u003e(21.2\u0026ndash;25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003cp\u003e(21.6\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003cp\u003e(21.4\u0026ndash;25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003cp\u003e(21.7\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e782 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e491 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e485 (50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e452 (47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e294 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e158 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e162 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCKD G1-2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1134 (70.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e746 (73.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e716 (50.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e706 (49.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCKD G3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e423 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e233 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e208 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e217 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCKD G4-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30 (49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e31 (50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIschemic heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArrhythmia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e46 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrior malignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e250 (15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120 (11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e112 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOral medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAntiplatelet agents or anticoagulants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e86 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e89 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.812\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrior abdominal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e456 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e255 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e227 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e242 (25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrior any radiation therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA PS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e98 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1366 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e858 (84.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e801 (84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e807 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative blood test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHemoglobin, g/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003cp\u003e(13.1\u0026ndash;15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003cp\u003e(13.3\u0026ndash;15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003cp\u003e(13.2\u0026ndash;15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003cp\u003e(13.4\u0026ndash;15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eeGFR, mL/min/1.73 m\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (55\u0026ndash;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (57\u0026ndash;78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e68 (58\u0026ndash;79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e68 (57\u0026ndash;78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSerum albumin, g/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3 (4.1\u0026ndash;4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3 (4.1\u0026ndash;4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.3 (4.1\u0026ndash;4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.3 (4.1\u0026ndash;4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAM, morning group; PM, afternoon group; BMI, body mass index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; ASA PS: American Society of Anesthesiologists Physical Status; eGFR, estimated glomerular filtration rate.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical and tumor characteristics before and after PSM\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1614)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1013)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;954)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;954)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSurgical approach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparoscopic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e254 (24.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e258 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e248 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobot-assisted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1157 (71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e724 (71.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e655 (68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e665 (69.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperienced surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1103 (68.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e661 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e657 (68.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e643 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.492\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess experienced surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e511 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e352 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e297 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e311 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSurgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdrenalectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e179 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e163 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e160 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProstatectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e783 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e480 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e454 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e465 (48.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e103 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartial nephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e307 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e201 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e198 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e182 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNephroureterectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical T stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A or less than T3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1463 (90.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e954 (93.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e906 (95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e896 (93.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT3 or T4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical N stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A or N0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1576 (97.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1000 (98.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e946 (99.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e941 (98.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;N1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical M stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A or M0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1577 (97.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e997 (98.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e939 (98.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e943 (98.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePathological diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBenign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e161 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e156 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalignant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1431 (88.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e838 (82.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e793 (83.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e798 (83.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAM, morning group; PM, afternoon group\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter PSM using variables that showed statistical significance or clinical relevance in the pre-matched cohort, 954 patients were included in each group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, right). Following matching, patient characteristics, comorbidities, medication use, prior treatments, and preoperative laboratory findings were well balanced between the groups, with no significant differences observed. Tumor-related and surgical factors were also similar between the two groups after matching (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, right). Surgical approach and surgeon experience remained comparable after matching.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePerioperative outcomes\u003c/h3\u003e\n\u003cp\u003eBefore PSM, operative time, pneumoperitoneum time, and console time were significantly longer in the morning group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Estimated blood loss was higher in the morning group, whereas complication rates were comparable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003ePerioperative outcomes before and after PSM\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1614)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1013)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;954)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePM\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;954)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223\u003c/p\u003e \u003cp\u003e(181\u0026ndash;275)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e208\u003c/p\u003e \u003cp\u003e(169\u0026ndash;256)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e217\u003c/p\u003e \u003cp\u003e(175\u0026ndash;269)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e207\u003c/p\u003e \u003cp\u003e(168\u0026ndash;256)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePneumoperitoneum time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1537)\u003c/p\u003e \u003cp\u003e175 (138\u0026ndash;221)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;978)\u003c/p\u003e \u003cp\u003e165 (132\u0026ndash;204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;913)\u003c/p\u003e \u003cp\u003e170 (131\u0026ndash;217)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;913)\u003c/p\u003e \u003cp\u003e165 (131\u0026ndash;204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsole time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1157)\u003c/p\u003e \u003cp\u003e151 (117\u0026ndash;195)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;724)\u003c/p\u003e \u003cp\u003e146 (112\u0026ndash;184)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;655)\u003c/p\u003e \u003cp\u003e151 (117\u0026ndash;196)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;665)\u003c/p\u003e \u003cp\u003e146 (112\u0026ndash;183.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEstimated blood loss, mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003cp\u003e(42\u0026ndash;222)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003cp\u003e(33\u0026ndash;200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003cp\u003e(38\u0026ndash;220)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e90\u003c/p\u003e \u003cp\u003e(35\u0026ndash;200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBlood infusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.737\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntraoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1545 (95.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e967 (95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e905 (94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e909 (95.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade Ⅰ or Ⅱ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade Ⅲ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePostoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1460 (90.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e919 (90.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e868 (91.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e871 (91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade Ⅰ or Ⅱ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e59 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade Ⅲ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade Ⅴ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAM, morning group; PM, afternoon group\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter PSM, operative time remained significantly longer in the morning group (217 vs 207 min; P\u0026thinsp;=\u0026thinsp;0.001). Pneumoperitoneum and console times were longer in the morning group, whereas estimated blood loss and transfusion rates were similar between groups. Perioperative complications, including severe complications, did not differ between groups.\u003c/p\u003e\n\u003ch3\u003eOverall survival\u003c/h3\u003e\n\u003cp\u003eBefore PSM, Kaplan\u0026ndash;Meier analysis showed no statistically significant difference in OS between the morning and afternoon groups in patients with benign pathology (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). In contrast, among patients with malignant disease, OS was significantly worse in the morning group compared with the afternoon group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). After PSM, no significant differences in OS were observed between the morning and afternoon groups in either the benign or malignant cohorts (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOverall and stratified analyses of operative time\u003c/h2\u003e \u003cp\u003eIn the PS\u0026ndash;matched cohort, subgroup analyses were performed to assess the association between surgical start time and operative duration (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Overall, operative time was approximately 7 minutes shorter in the afternoon group than in the morning group. In procedure-specific analyses, adrenalectomy and prostatectomy showed significantly shorter operative time in the afternoon group, whereas other procedures demonstrated similar trends that did not reach statistical significance. Stratified analyses by surgeon experience and surgical approach showed consistent findings, with operative time generally shorter in the afternoon group across all subgroups.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study evaluated the impact of surgical start time on perioperative outcomes across major urologic procedures. Before propensity score matching, patients in the morning group had less favorable baseline characteristics, including more comorbidities and fewer benign tumors, which likely contributed to longer operative time, greater blood loss, and worse overall survival. Despite these differences, intraoperative and postoperative complication rates were comparable between groups.\u003c/p\u003e \u003cp\u003eAfter adjustment with propensity score matching, estimated blood loss and overall survival rates were similar between groups, and complication rates remained unchanged. In contrast, operative time, including pneumoperitoneum and console time, remained significantly longer in the morning group. Subgroup analyses showed a consistent pattern across procedures, surgeon experience levels, and surgical approaches, with operative time generally shorter in the afternoon group.\u003c/p\u003e \u003cp\u003eTo our knowledge, this study is the first to demonstrate differences in clinical outcomes between morning and afternoon start times across multiple urologic procedures. Previous cross-specialty reports have frequently indicated that starting elective surgery in the afternoon is associated with inferior perioperative outcomes, such as prolonged hospital stay, higher incidence of composite complications, increased mortality rates, or reduced productivity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies comparing elective morning and afternoon cancer surgeries across specialties have yielded inconsistent results. In neurosurgery, later start times and longer operative durations have been associated with worse outcomes, whereas lung cancer surgery has shown no significant differences in operative time, complications, or other clinical outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In colorectal cancer, survival outcomes were similar despite differences in certain complications, and operative time was longer in morning procedures [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, in robot-assisted radical prostatectomy, afternoon surgeries tended to have shorter operative times and less blood loss, with comparable complication rates, although hospital stays were longer [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast to cancer surgeries, several reports indicate that outcomes for procedures such as kidney transplantation, lung transplantation, and coronary artery bypass grafting are not dependent on the starting time [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, before PSM, patients in the morning group had less favorable baseline characteristics, including a higher burden of comorbidities and a lower proportion of benign tumors. This pattern suggests that more complex or higher-risk cases may have been preferentially scheduled earlier, reflecting real-world clinical practice.\u003c/p\u003e \u003cp\u003eConsistent with findings in colorectal and prostate cancer, operative time remained longer in the morning group after propensity score matching.\u003c/p\u003e \u003cp\u003eThere are several possible explanations for these findings. The relative lack of time constraints during morning sessions compared with afternoon sessions may result in extended operative times [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Decreased operative time with successive cases within a single day may indicate that a surgeon or surgical team is \u0026ldquo;warming up\u0026rdquo; and improving performance, irrespective of the learning curve [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe specific background of university hospitals may complicate the interpretation of these findings. For instance, at our institution, residents are more heavily involved in morning surgeries. Furthermore, surgical team composition varies for each procedure. In surgical procedures performed at university hospitals, involvement of residents is likely to lead to prolonged operative times [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Highly consistent surgical care teams in urologic surgery have been associated with improved surgical efficiency and patient outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, because data on these factors were not collected in this study, the causal relationship with our findings remains unclear. Future prospective studies incorporating data on surgeon experience and team stability are warranted to further clarify these issues.\u003c/p\u003e \u003cp\u003eThe lack of difference in complication rates between the morning and afternoon groups may be attributed to the highly standardized nature of elective urologic surgeries. In this context, perioperative outcomes are primarily determined by patient- and procedure-related factors rather than external factors such as surgical start time [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, this was a retrospective, single-center study, which may limit the generalizability of our findings. Second, although propensity score matching was performed to adjust for baseline differences, residual confounding from unmeasured variables cannot be excluded. Finally, detailed information regarding intraoperative factors, such as surgical team composition, degree of resident involvement, and team consistency, was not available. These factors may influence operative efficiency and may partially explain the observed differences in operative time.\u003c/p\u003e \u003cp\u003eIn conclusion, surgical start time was associated with operative duration in major urologic surgeries, with morning procedures taking longer than those in the afternoon. This pattern was consistent across procedures and subgroups, even after adjustment. However, surgical start time was not associated with perioperative complications or overall survival, suggesting limited impact on clinical outcomes. Surgeons should be aware that operative time in major oncologic surgeries and adrenalectomy procedures may be longer in the morning.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eoverall survival\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epropensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.jp) for English language editing. This retrospective study was conducted as part of the Hiroshima Cancer Registry Project (H-CARP), including Hiroshima University Hospital and its affiliated institutions. We also thank the members of H-CARP for their cooperation in developing the registration system using the Research Electronic Data Capture (REDCap) system, hosted at Hiroshima University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKK, KG, and NH designed this study. KG managed the REDCap database. YK, MN, SM, YS, HK, and KH provided clinical information. KK and KG performed the statistical analyses. KK and KG interpreted the data. KK edited the manuscript and generated tables and figures. All authors agreed to be accountable for the contents of the study.\u0026nbsp;\u003c/p\u003e\n\n\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of the Institutional Review Board of Hiroshima University Hospital (approval no. 2022-0003) and conformed to the provisions of the Declaration of Helsinki.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific grants from funding agencies in the public, commercial, or nonprofit sectors.\u003c/p\u003e\n\n\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKikuchi E, Yamamoto H, Yasui T et al (2024) The first detailed annual record on the National Clinical Database Urology Division in Japan: A report on five surgical procedures. Int J Urol 31(12):1344\u0026ndash;1355. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/iju.15561\u003c/span\u003e\u003cspan address=\"10.1111/iju.15561\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal K, Gupta M, Ramachandran R, Tandon N, Kumar R (2026) Surgical and functional outcomes of adrenalectomy by urologists: A 17-year cohort review. Indian J Urol 42(1):24\u0026ndash;29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/iju.iju_350_25\u003c/span\u003e\u003cspan address=\"10.4103/iju.iju_350_25\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaito M, Shikuma H, Hatayama T et al (2025) Treatment outcomes of robotic adrenalectomy compared to laparoscopic adrenalectomy: A propensity score matching study. Asian J Endosc Surg 18(1):e70062. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ases.70062\u003c/span\u003e\u003cspan address=\"10.1111/ases.70062\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVladu A, Ghitea TC, Daina LG, Ț\u0026icirc;rț DP, Daina MD (2024) Enhancing operating room efficiency: The impact of computational algorithms on surgical scheduling and team dynamics. Healthc (Basel) 12(19). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/healthcare12191906\u003c/span\u003e\u003cspan address=\"10.3390/healthcare12191906\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWright MC, Phillips-Bute B, Mark JB et al (2006) Time of day effects on the incidence of anesthetic adverse events. Qual Saf Health Care 15(4):258\u0026ndash;263. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/qshc.2005.017566\u003c/span\u003e\u003cspan address=\"10.1136/qshc.2005.017566\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelz RR, Freeman KM, Hosokawa PW et al (2008) Time of day is associated with postoperative morbidity: An analysis of the national surgical quality improvement program data. Ann Surg 247(3):544\u0026ndash;552. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/SLA.0b013e31815d7434\u003c/span\u003e\u003cspan address=\"10.1097/SLA.0b013e31815d7434\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeewisse AJG, Gribnau A, Thiessen SE, Stenvers DJ, Hermanides J, van Zuylen ML (2024) Effect of time of day on outcomes in elective surgery: A systematic review. Anaesthesia 79(12):1325\u0026ndash;1334. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/anae.16395\u003c/span\u003e\u003cspan address=\"10.1111/anae.16395\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMao Z, Zhang J, Wang P, Zuo W (2025) The association between the duration of surgery and risks of mortality and unplanned reoperation is modulated by the surgical start time. Sci Rep 15(1):28057. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-025-12265-3\u003c/span\u003e\u003cspan address=\"10.1038/s41598-025-12265-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakata Y, Watanabe Y, Ozaki A (2024) Association between surgical productivity and start time. Perioper Care Oper Room Manag 34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pcorm.2024.100371\u003c/span\u003e\u003cspan address=\"10.1016/j.pcorm.2024.100371\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSim JH, Park YS, Park B et al (2025) Impact of daily, weekly, and seasonal surgical timing on postoperative outcomes in high-risk patients undergoing elective non-cardiac surgery: A retrospective, single-center study. J Clin Anesth 105:111879. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jclinane.2025.111879\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinane.2025.111879\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCifarelli CP, McMichael JP, Forman AG et al (2021) Surgical start time impact on hospital length of stay for elective inpatient procedures. Cureus 13(7):e16259. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.16259\u003c/span\u003e\u003cspan address=\"10.7759/cureus.16259\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNason GJ, O\u0026rsquo;Connor EM, O\u0026rsquo;Neill C, Izzeldin O, Considine SW, O\u0026rsquo;Brien MF (2016) The impact of day of surgery on the length of stay for major urological procedures. Can Urol Assoc J 10(11\u0026ndash;12):E367\u0026ndash;E371. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5489/cuaj.3777\u003c/span\u003e\u003cspan address=\"10.5489/cuaj.3777\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu GHAL, Xu JR ZJ, et al (2022) Whether the start time of elective lung surgery impacts perioperative outcomes and cost? Front Surg 9:922198. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fsurg.2022.922198\u003c/span\u003e\u003cspan address=\"10.3389/fsurg.2022.922198\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshiyama Y, Ishida F, Ooae S et al (2019) Surgical starting time in the morning versus the afternoon: Propensity score matched analysis of operative outcomes following laparoscopic colectomy for colorectal cancer. Surg Endosc 33(6):1769\u0026ndash;1776. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00464-018-6449-9\u003c/span\u003e\u003cspan address=\"10.1007/s00464-018-6449-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSim JH, Park B, Choi Y (2026) Association between surgical start time and postoperative mortality, morbidity and healthcare utilisation in elective non-cardiac surgeries: A retrospective, single-centre study using propensity score matching. Anaesthesia 81(1):72\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/anae.16788\u003c/span\u003e\u003cspan address=\"10.1111/anae.16788\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas AA, Kim B, Derboghossians A et al (2014) Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy. Urol Ann 6(2):142\u0026ndash;146. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/0974-7796.130645\u003c/span\u003e\u003cspan address=\"10.4103/0974-7796.130645\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeow YY, Alkari B, Dyer P, Riad H (2004) Cold ischemia time, surgeon, time of day, and surgical complications. Transplantation 77(9):1386\u0026ndash;1389. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/01.TP.0000122230.46091.E2\u003c/span\u003e\u003cspan address=\"10.1097/01.TP.0000122230.46091.E2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan PJ, Xu M, Sessler DI, Bashour CA (2009) Operation timing does not affect outcome after coronary artery bypass graft surgery. Anesthesiology 111(4):785\u0026ndash;789. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/ALN.0b013e3181b6a50c\u003c/span\u003e\u003cspan address=\"10.1097/ALN.0b013e3181b6a50c\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeorge TJ, Arnaoutakis GJ, Merlo CA et al (2011) Association of operative time of day with outcomes after thoracic organ transplant. JAMA 305(21):2193\u0026ndash;2199. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2011.726\u003c/span\u003e\u003cspan address=\"10.1001/jama.2011.726\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMack J, Turner C, Carter D et al (2020) The effect of resident participation on appendectomy operative times. J Surg Educ 77(6):e196\u0026ndash;e200. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jsurg.2020.06.022\u003c/span\u003e\u003cspan address=\"10.1016/j.jsurg.2020.06.022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenissan-Messan DZ, Tamer R, Pieper H, Meara M, Chen XP (2023) What factors impact surgical operative time when teaching a resident in the operating room. Heliyon 9(6):e16554. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.heliyon.2023.e16554\u003c/span\u003e\u003cspan address=\"10.1016/j.heliyon.2023.e16554\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLinder BJ, Anderson SS, Boorjian SA, Tollefson MK, Habermann EB (2023) Effect of surgical care team consistency during urologic procedures on surgical efficiency and perioperative outcomes. Urology 175:84\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.urology.2023.02.004\u003c/span\u003e\u003cspan address=\"10.1016/j.urology.2023.02.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinervini A, Di Maida F, Mari A et al (2021) Perioperative outcomes of patients undergoing urological elective surgery during the COVID-19 pandemic: A national overview across 28 Italian institutions. Cent Eur J Urol 74(2):259\u0026ndash;268. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5173/ceju.2021.0374\u003c/span\u003e\u003cspan address=\"10.5173/ceju.2021.0374\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoliman C, Wuethrich PY, Walz J et al (2025) Development of the CAMUS intra- and postoperative risk and difficulty estimation indices risk prediction tool for estimating peri- and postoperative outcomes, including surgical difficulty, in major urological surgery-A protocol for a Delphi Study. Eur Urol Open Sci 76:23\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.euros.2025.04.002\u003c/span\u003e\u003cspan address=\"10.1016/j.euros.2025.04.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Urologic surgery, propensity score matching, operative time, surgical start time, time of day","lastPublishedDoi":"10.21203/rs.3.rs-9268541/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9268541/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe impact of surgical start time on perioperative outcomes remains controversial, and evidence in urologic oncology is limited. We aimed to evaluate the association between surgical start time and clinical outcomes across major urologic procedures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analyzed 2,827 patients who underwent major urologic surgeries at a single institution from 2010 to 2025. Patients were categorized into morning (8:00\u0026ndash;12:00) and afternoon (after 12:00) groups. Propensity score matching (PSM) was performed to adjust for baseline differences. Perioperative outcomes, including operative time, estimated blood loss, complications, and overall survival, were compared. Linear regression analyses were used to assess the association between surgical start time and operative duration.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBefore PSM, the morning group included patients with higher perioperative risk, and operative time, estimated blood loss, and overall survival were significantly worse than in the afternoon group. After PSM, 954 patients with balanced baseline characteristics were included in each group. In the matched cohort, estimated blood loss and overall survival were comparable between groups, whereas operative time remained longer in the morning group. Perioperative complication rates were similar between groups. Subgroup analyses demonstrated a consistent pattern across procedures, surgeon experience, and surgical approaches, with operative time shorter in the afternoon group.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSurgical start time was associated with operative duration, with morning procedures taking longer than those in the afternoon. However, surgical start time was not associated with perioperative complications or overall survival. These findings suggest surgical start time may influence operative efficiency but has limited impact on clinical outcomes.\u003c/p\u003e","manuscriptTitle":"Impact of Surgical Start Time on Clinical Outcomes in Urologic Surgery: A Single-Center Study of Major Oncologic surgeries and Adrenalectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-28 13:05:39","doi":"10.21203/rs.3.rs-9268541/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-30T17:15:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121541701582511055393609915672091091382","date":"2026-04-21T09:55:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-20T09:40:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T15:51:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T13:05:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2026-03-30T14:34:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dda0cb69-3841-4563-be82-22bc2c9fd41c","owner":[],"postedDate":"April 28th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-30T17:15:51+00:00","index":11,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T13:05:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-28 13:05:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9268541","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9268541","identity":"rs-9268541","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}