Impact of Postoperative Pulmonary Complications in Non-intubated and Intubated Video-assisted Thoracoscopic Lung resection: A Retrospective Cohort Study

Background The primary objective of this study was to evaluate the incidence of postoperative pulmonary complications (PPCs) and the risk of perioperative anesthesia-related complications in patients undergoing intubated video-assisted thoracoscopic surgery (IVATS) and non-intubated video-assisted thoracoscopic surgery (NIVATS). Methods We conducted a retrospective cohort study of patients who underwent video-assisted thoracoscopic pneumonectomy from January 1, 2023 to September 1, 2025. The main outcome was the incidence of PPCs based on Melbourne Group Scale (MGS), and the secondary outcomes included extubation/laryngeal mask airway time, cumulative sufentanil total dose, postoperative 24-hour NRS score, cumulative drainage volume, drainage tube removal time, postoperative hospitalization duration and total hospitalization duration, and perioperative period. Further, the enter model is used for multi-factor logic analysis and subgroup analysis, and the potential confounding factors are excluded, and the general odds ratio (OR) is used for quantification. Results A total of 486 patients were collected in this study, including 290 patients in IVATS group and 196 patients in NIVATS group. During hospitalization, the incidence of PPCs in NIVATS group was significantly lower than that in IVATS group (4.59% vs 23.45%, OR = 0.157, 95%CI,0.078–0.318, P < 0.001). In NIVATS group, the incidence of hypercapnia during operation was higher (59.69% vs 4.83%, OR = 0.034, 95%CI,0.019–0.063, P < 0.001), and the postoperative hypoxia index (2.04% vs 12.07%, OR = 6.588, 95%CI,2.303–18.851, P < 0.001) and the incidence of nausea and vomiting (2.04% vs 10.34%, OR = 5.538, 95%CI, 1.919–15.983, P < 0.001) were lower. The extubation/laryngeal mask airway time, postoperative hospital stay, total hospital stay and indwelling time of thoracic drainage tube in NIVATS group were shorter than those in IVATS group (P < 0.001), and the cumulative dosage and postoperative drainage volume of sufentanil were less (P < 0.001). Conclusions NIVATS can significantly reduce the incidence of PPCs in patients undergoing video-assisted thoracoscopic lung resection, shorten the recovery time, reduce the dosage of analgesic drugs and postoperative drainage, but it needs further verification in prospective randomized controlled trials.