J Int Med Res. 2026 Jul;54(7):3000605261469830. doi: 10.1177/03000605261469830. Epub 2026 Jul 20.
ABSTRACT
ObjectivePostoperative pulmonary complications are a leading determinant of perioperative mortality and adverse prognosis in thoracic surgery. This study aimed to explore the association between nonintubated video-assisted thoracoscopic surgery versus intubated video-assisted thoracoscopic surgery and the incidence of postoperative pulmonary complications as well as perioperative anesthesia-related adverse events in patients undergoing video-assisted thoracoscopic surgery lung resection.MethodsA single-center retrospective cohort study was conducted in consecutive patients undergoing elective video-assisted thoracoscopic surgery lung resection (January 2023 to September 2025, Chongqing General Hospital). The primary outcome was the incidence of postoperative pulmonary complications (Melbourne Group Scale), and the secondary outcomes included recovery and adverse events. Multivariate logistic regression using the enter method was performed to identify independent factors associated with postoperative pulmonary complications, and inverse probability of treatment weighting was used to balance baseline covariates between the groups.ResultsA total of 486 patients were included (290 intubated video-assisted thoracoscopic surgery and 196 nonintubated video-assisted thoracoscopic surgery). The nonintubated video-assisted thoracoscopic surgery group had a lower overall in-hospital incidence of postoperative pulmonary complications (4.59% vs. 23.45%; unadjusted odds ratio = 0.157, 95% confidence interval: 0.078-0.318; adjusted odds ratio = 0.243, 95% confidence interval: 0.107-0.550; inverse probability of treatment weighting-adjusted odds ratio = 0.215, 95% confidence interval: 0.092-0.503; all p < 0.001). The nonintubated video-assisted thoracoscopic surgery group had a higher incidence of intraoperative hypercapnia (59.69% vs. 4.83%) but lower incidences of postoperative hypoxemia (2.04% vs. 12.07%) and postoperative nausea and vomiting (PONV) (2.04% vs. 10.34%; all p < 0.001) along with a shorter recovery time and lower sufentanil consumption and chest drainage volume (all p < 0.001). The conversion rate from nonintubated video-assisted thoracoscopic surgery to intubated video-assisted thoracoscopic surgery was 2.04% (4/196), with no neurological or cardiovascular adverse events related to intraoperative hypercapnia.ConclusionsIn this retrospective cohort study, nonintubated video-assisted thoracoscopic surgery was associated with fewer postoperative pulmonary complications, faster recovery, and lower opioid use, providing clinical evidence for anesthesia optimization. However, large-scale prospective trials are needed to establish causal relationships.
PMID:42478082 | DOI:10.1177/03000605261469830