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

Impact of Postoperative Pulmonary Complications in Non-intubated and Intubated Video-assisted Thoracoscopic Lung resection: A Retrospective Cohort Study | 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 Postoperative Pulmonary Complications in Non-intubated and Intubated Video-assisted Thoracoscopic Lung resection: A Retrospective Cohort Study Rui Xu, Li Yang, Peng Kong, Wei Yang, Ying Zhu, Yun Xue, Fuxia Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8219046/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Non-intubated Video-assisted Thoracoscopic Intubated Video-assisted Thoracoscopic Postoperative Pulmonary Complications Anesthesiology Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction In thoracic surgery, postoperative pulmonary complications (PPCs) are still the main cause of postoperative mortality and have a great impact on the prognosis of patients.( 1 – 4 ) It is estimated that the incidence of PPCs after thoracic surgery is 30%-50%, which is the main reason for postoperative morbidity, mortality and prolonged hospitalization.( 5 ) Although minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) have made progress, PPCs is still very high (26.8%-29.9%).( 6 ) Among them, there are surgical and non-surgical risk factors. From the point of view of surgery, the minimally invasive technology through video-assisted thoracoscope is an important reason for the decrease of PPCs incidence.( 7 ) As the same time, among the risk factors related to anesthesia, the factors causing PPCs may be related to acute postoperative pain, decreased minute ventilation (MV), secretion retention, atelectasis, lung injury, pneumonia and so on.( 8 , 9 ) At present, the reported intervention measures to reduce PPCs include enhanced recovery after surgery (ERAS), lung protective ventilation strategy (LPVS), preventive use of mucolytic agents, respiratory physiotherapy, epidural analgesia, goal-oriented hemodynamic therapy and the use of esketamine.( 10 – 13 ) The traditional anesthesia method of video-assisted thoracoscopic surgery is intubated video-assisted thoracoscopic surgery (IVATS), which often adopts double-lumen tube (DLT) to control breathing under general anesthesia, and one-lung ventilation (OLV) on the healthy side during the operation.( 14 ) One-lung ventilation is related to transient pulmonary hypoperfusion caused by hypoxic pulmonary vasoconstriction, which can lead to local tissue ischemia. Restoring perfusion during lung re-expansion may cause some degree of ischemia-reperfusion injury.( 15 ) In addition, DLT may induce various complications related to tracheal intubation, such as lung infection, lung injury, bronchospasm, cardiac function damage, arrhythmia, postoperative sore throat, cough, irritability and so on, ( 16 )thus increasing the incidence of PPCs. In order to improve the prognosis of patients, non-intubated video-assisted thoracoscopic surgery (NIVATS) is gradually carried out.( 17 ) This technique has been proved to be suitable for many different types of video-assisted thoracoscopic surgery, such as wedge resection, segmental resection, lobectomy, lung volume reduction and mediastinal tumor surgery. NIVATS now often uses laryngeal mask anesthesia (LMA) combined with regional block anesthesia. As a supraglottic ventilation device, laryngeal mask airway has the advantages of simple performance, short time, few complications, quick recovery and low cost.( 18 ) Therefore, the use of LAM combined with nerve block as the respiratory tract management mode of NIVATS is more and more widely used in thoracic surgery.( 19 ) Although NIVATS can improve the prognosis of patients in theory, it is still controversial. At present, there is little research on the relationship between IVATS, NIVATS and PPCs. This study is a retrospective cohort study, aiming to explore the effects of IVATS and NIVATS on PPCs and prognosis of patients, so as to provide guidance for anesthesia methods of video-assisted thoracoscopic surgery. Methods Study design and patient selection In this study, patients who underwent elective video-assisted thoracoscopic lung resection from January 1, 2023 to September 1, 2025 were collected. Inclusion criteria: age 18–75 years, American Association of Anesthesiologists (ASA) physical condition classification I-III. Exclusion criteria include previous chest surgery history or chest trauma, patients who need to be transferred to intensive care unit (ICU) for further treatment after surgery, patients with missing main data, and patients who underwent secondary surgery during hospitalization. Anesthesia and surgical procedures They were divided into two groups according to anesthesia methods. IVATS group: DLT was used, and the breathing was controlled after the fiberoptic bronchoscope was aligned. Lung protective ventilation strategy was adopted during operation. During the operation, respiratory parameters were adjusted according to the end-expiratory partial pressure of carbon dioxide (PetCO2) and blood gas analysis results, and sputum aspiration and lung inflation were fully performed before the end of the operation. NIVATS group: LAM combined with regional block anesthesia was used, and paraspinal nerve block was performed on the corresponding intercostal segment of the surgical incision under the guidance of ultrasound. After the effect of regional block anesthesia was satisfactory, anesthesia induction was carried out and laryngeal mask was placed. The ventilator adopts SIMV mode to assist breathing. After the operation, the surgeon performed thoracic superficial anesthesia and vagus nerve block on the operating side under thoracoscope. When the patient has hypercapnia or the surgeon's satisfaction is poor, the parameters of ventilator should be adjusted after giving a small dose of micuronium bromide.( 20 ) Change the intubation anesthesia when the following situations occur. The effects of respiratory function include hypoxemia: SpO2 < 85% or hypercapnia PaCO2 ≥ 80 mmHg. Although SIMV is tried, it still has no improvement. Tracheal secretions and bloody secretions increased significantly, leading to dyspnea and airway obstruction. Hemodynamics and internal environment instability: HR > 100 bpm or systolic blood pressure change > 30% compared with the baseline value. Arrhythmia caused by non-surgical stimulation (such as frequent atrial or ventricular premature beats ≥ 6 beats/min); The pH value of two arterial blood gas analyses is less than 7.15 (conducted at an interval of 15 minutes or more). ( 3 ) The operation is difficult, the operating field is too large, and the operation is difficult. There was no improvement after drug treatment, lasting more than 5 minutes; Despite visceral pleural surface anesthesia and vagus nerve block, he continued to cough (> 2 times per minute). Patients in both groups maintained stable circulation during operation, and when necessary, vasoactive drugs were pumped or injected intravenously to keep the fluctuation of HR and MAP within 30% of the basic value. All drug infusion was stopped 5 minutes before the end of the operation, and palonosetron 0.5mg and sufentanil 5ug were injected intravenously. When the patient is fully awake, pull out the endotracheal tube or laryngeal mask, and connect PCIA at the same time (sufentanil 1ug/ml, background infusion 1-2ml/h, bolus does 0.5-1ml). When Steward's awakening score is greater than 4 and his vital signs are stable, he will be transferred back to the ward, and then the thoracic surgeon will decide the time to pull out the thoracic drainage tube and the time to leave the hospital according to the patient's specific situation. Outcomes The main result of this study is the incidence of PPCs. The existence of PPCs is defined by Melbourne Group Scale (MGS),( 21 , 22 ) which includes eight criteria: body temperature > 38°C, white cell count > 11.2×10 9 /L, purulent sputum, chest X-ray findings of atelectasis or consolidation, signs of infection on sputum moicrobiology, clinical diagnosis of pneumonia, oxygen saturation < 90% on room air, and prolonged high dependency unit stay for respiratory complications. Patients who meet four or more of the eight criteria will be diagnosed as PPCs. The secondary indicators were the time of extubation of tracheal tube or laryngeal mask, arterial blood gas analysis indexes (PH, PCO2, PF ratio) after extubation, NRS score after extubation, cumulative total dose of sufentanil, NRS score 24 hours after operation, cumulative drainage volume, time of extubation, postoperative hospital stay and total hospital stay. At the same time, adverse events were recorded, including airway spasm, choking, body movement, hypercapnia, reflux aspiration, malignant arrhythmia, unplanned tracheal intubation and so on. Postoperative adverse events include shivering, restlessness, delirium, hypoxemia (SpO2 < 90% or PF radio < 300), sore throat and postoperative nausea and vomiting (PONV). Statistical Analysis Use SPSS software (version 26.0; SPSS (Chicago, Illinois, USA) follows the principle of intention therapy. Bilateral P < 0.05 was considered statistically significant. Use SPSS software (version 26.0; SPSS (Chicago, Illinois, USA) follows the principle of intention therapy. Bilateral P < 0.05 was considered statistically significant. Continuous variables expressed as mean ± standard deviation or median (quartile range) depend on the distribution of data. Qualitative variables are represented by numbers and percentages. Chi-square test was used to compare the incidence of qualitative variables, such as PPCs, between IVATS group and NIVATS group. Independent t test is used to compare the continuous normal distribution data between IVATS group and NIVATS group, while Mann-Whitney U test is used to compare the non-normal distribution data. Calculate the odds ratio (OR) and the average difference of 95% confidence interval (95%CI) of the research results. Enter model was used for logical analysis, and the influence of NIVATS on the incidence of PPCs was further verified by including potential related factors (≥ 60 years old or < 60 years old, gender, ASA, COPD, asthma, smoking status and operation type). Kaplan-Meier analysis was used to compare the cumulative incidence of PPCs with the length of operation between different groups. In addition, subgroup analysis was further used to verify the influence of NIVATS on the incidence of PPCs in different surgical types. Result Through inclusion criteria and exclusion criteria, the data of 486 patients were collected in this study, including 290 patients in IVATS group and 196 patients in NIVATS group, as shown in Fig. 1 . The demographic parameters and baseline data of each group of patients are listed in Table 1 . Table 1 Baseline IVATS group (n = 290) NIVATS group (n = 196) Age (years) 61.26 ± 9.40 55.32 ± 11.38 Sex (male/female), n(%) 126(43.45%)/164(56.55%) 68(34.69%)/128(65.31%) BMI (kg/m2) 23.87 ± 2.89 23.40 ± 2.67 ASA classification I, n (%) 0 (0) 0 (0) II, n (%) 51 (17.59%) 84 (42.86%) III, n (%) 239 (82.41%) 112 (57.14%) Smoker, n (%) 100 (34.48%) 43 (21.94%) Asthma, n (%) 7 (2.41%) 2 (1.02%) COPD, n (%) 13 (4.48%) 3 (1.53%) Preoperative Arterial Blood Gas PH 7.41 ± 0.17 7.42 ± 0.03 PCO2 (mmHg) 38.23 ± 3.47 38.37 ± 4.24 PF ratio 409.79 ± 62.85 421.36 ± 49.01 Surgery duration (min) 139.13 ± 66.13 90.05 ± 48.15 Lobectomy, n (%) 113 (38.97%) 140 (71.43%) Wedge resection, n (%) 58 (20.00%) 22 (11.22%) Segmentectomy, n (%) 119 (41.03%) 34 (17.35%) Hypertension, n (%) 47 (16.21%) 28 (14.29%) Diabetes, n (%) 34 (11.73%) 21 (10.71%) Coronary artery disease, n (%) 14 (4.83%) 8 (4.08%) BMI, body mass index; ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease; PF ratio, PaO2/FiO2 ratio; IVATS, Image-guided video-assisted thoracoscopic surgery; NIVATS, Non-Intubated video-assisted thoracoscopic surgery. 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 38°C ( P = 0.025), postoperative purulent sputum ( P < 0.001), positive rate of microbial infection in sputum culture ( P = 0.018), incidence of clinical diagnosis of pneumonia ( P 0.05. The results showed that lobectomy (OR = 2.732, 95%CI,1.212–6.157, P = 0.015) was the risk factor of PPCs, and NIVATS group (OR = 20.243, 95%CI, 0.107–0.550, P = 0.01) and operation duration ≤ 2 h (OR = 0.419, 95%CI, 0.212–0.827, P = 0.012) were the protective factors. By further calculation of Kaplan-Meier analysis, it was found that there was no statistically significant difference between the two groups in the cumulative incidence of PPCs as shown in Fig. 3 with the length of operation ( P = 0.081). In subgroup analysis, the incidence of PPCs in NIVATS group was significantly lower than that in IVATS group (27.45% vs 1.56%, OR = 0.177, 95%CI, 0.055–0.551, P = 0.003) when the surgical type was lobectomy (Fig. 4 A), and in Fig. 4 B, NIVATS group also performed well when the surgical type was non-lobectomy (7.81% vs 1.50%, OR = 0.875, 95%CI, 0.809–0.933, P 60 years) 0.616 1.257(0.710–2.225) 0.432 Sex (Male vs. Female) 0.023 0.935(0.390–2.240) 0.880 ASA classification (II vs. III) 1.678 1.698(0.762–3.784) 0.195 COPD (Yes vs. No) 0.010 0.932(0.235-3.700) 0.920 Asthma (Yes vs. No) 0.741 2.668(0.286–24.912) 0.389 Smoker (Yes vs. No) 2.094 0.521(0.215–1.260) 0.148 Surgery duration (≤ 2 h vs.>2 h) 6.284 0.419(0.212–0.827) 0.012 Surgery type Segmentectomy vs. Wedge resection 1.273 1.517(0.736–3.128) 0.259 Lobectomy vs. Wedge resection 5.879 2.732(1.212–6.157) 0.015 Anesthesia mode (NIVATS vs IVATS) 11.513 0.243(0.107–0.550) 0.010 ASA, American society of anesthesiologists; COPD, chronic obstructive pulmonary disease; IVATS, Image-guided video-assisted thoracoscopic surgery; NIVATS, Non-Intubated video-assisted thoracoscopic surgery. Table 3 compares the incidence of adverse events between the two groups. The incidence of hypercapnia in NIVATS group was significantly higher than that in IVATS group (OR = 0.034, 95%CI, 0.019–0.063, P < 0.001). The incidence of postoperative hypoxia index in NIVATS group was significantly lower than that in IVATS group (OR = 6.588, 95%CI, 2.303–18.851, P < 0.001), and the incidence of PONV in NIVATS group was significantly lower than that in IVATS group (OR = 5.538, 95%CI, 1.919–15.983, P < 0.001), and there was no significant difference in other adverse event indexes. Table 3 Adverse events between two groups IVATS group (n = 290) NIVATS group (n = 196) OR (95%CI) P Intraoperative Airway spasm, n(%) 2(0.70%) 0(0) 1.681(1.561–1.809) 0.658 Body movement or Cough, n(%) 1(0.34%) 0(0) 1.678(1.560–1.806) 1.000 Regurgitating aspiration, n(%) 0(0) 0(0) 1.000 Hypercapnia, n(%) 14 (4.83%) 117(59.69%) 0.034 (0.019–0.063) < 0.001 Malignant arrhythmia, n(%) 2 (0.70%) 0 (0) 1.681(1.561–1.809) 0.658 Unplanned ETT, n(%) 0 (0) 4 (2.04%) 2.510 (2.250–2.802) 0.053 Postoperative Low PF ratio, n(%) 35 (12.07%) 4 (2.04) 6.588 (2.303–18.851) < 0.001 Shiver, n(%) 1 (0.34%) 0 (0) 1.678(1.560–1.806) 1.000 Restless, n(%) 8 (2.76%) 1 (0.51%) 5.532 (0.686–44.585) 0.144 Delirium, n(%) 0(0) 0(0) 1.000 PONV, n(%) 30(10.34%) 4(2.04%) 5.538 (1.919–15.983) 60mmHg or EtCO 2 > 60mmHg. Low PF ratio, PaO2/FiO2, PF ratio < 300;ETT, Endotracheal tube; PONV, Postoperative nausea and vomiting. As shown in Table 4 , among other indicators, the time for pulling out the drainage tube in NIVATS group was shorter than that in IVATS group ( Z =-8.261, P < 0.001).The total amount of sufentanil in NIVATS group was less than that in IVATS group ( Z =-3.525, P < 0.001).The postoperative cumulative drainage in NIVATS group was significantly lower than that in IVATS group ( Z =-11.096, P < 0.001).The duration of tracheal extubation, postoperative hospitalization and total hospitalization in NIVATS group were significantly shorter than those in IVATS group, with Z of -0.095, -9.321 and − 10.306, respectively, and All P < 0.001. Table 4 Other index between two groups IVATS group (n = 290) NIVATS group (n = 196) Z-value P Extubation time (min) 33.96 ± 4.05 16.39 ± 0.81 -8.261 < 0.001 Postoperative PF ratio 397.78 ± 5.67 409.00 ± 4.46 -2.432 0.115 NRS scale after operation 1(0) 1(0) -0.409 0.683 Cumulative sufentanil dosage after operation (µg) 148.93 ± 3.86 124.26 ± 3.27 -3.525 < 0.001 NRS score 24 hours after operation. 3(0) 3( 1 ) -1.981 0.527 Cumulative discharge (ml) 670.25 ± 30.00 285.06 ± 24.79 -11.096 < 0.001 Thoracic drainage time (day) 5.22 ± 0.28 3.17 ± 0.20 -9.095 < 0.001 Postoperative hospital stays (day) 7.32 ± 0.32 4.81 ± 0.20 -9.321 < 0.001 Cumulative hospital stays (day) 12.43 ± 0.40 8.27 ± 0.26 -10.306 < 0.001 PF ratio, PaO2/FiO2 ratio; NRS, Numerical rating scale. Discussion The choice of anesthesia mode in video-assisted thoracoscopic surgery has a key influence on the postoperative recovery of patients and the risk of PPCs. At present, the comparison of clinical efficacy between IVATS and NIVATS still needs more evidence. This study focuses on the influence of two anesthesia methods on PPCs and other recovery indexes of patients undergoing elective video-assisted thoracoscopic surgery, aiming at providing reference for the optimization of anesthesia scheme for video-assisted thoracoscopic surgery. The results of this study showed that the incidence of PPCs in the NIVATS group was significantly lower than that in the IVATS group, regardless of the type of operation, whether it was video-assisted thoracoscopic lobectomy or non-lobectomy, but the duration of operation had no significant correlation with the incidence of PPCs in the two groups. Mechanical ventilation can lead to ventilator-associated lung injury (VALI),( 23 ) which mainly includes volume injury, barometric injury, tension injury, biological injury and shear injury. Lung protective ventilation strategy (LPVS) is a new mechanical ventilation strategy developed for VALI in recent years.( 24 ) Its purpose is to protect lung tissue as much as possible and reduce mechanical ventilation damage. LPVS mainly includes small tidal volume, optimal positive end-expiratory pressure, lung recruitment, etc.( 1 ) The implementation of LPVS can improve lung compliance and gas exchange in alveoli, reduce the occurrence of pulmonary edema and infection, and reduce the incidence of PPCs.( 25 ) In this study, the NIVATS group used LAM combined with regional block anesthesia, which further avoided VALI caused by mechanical ventilation, thus reducing the incidence of PPCs. According to MGS standard, the decrease of PPCs in NIVTAS group observed in our study can be attributed to postoperative body temperature > 38°C, purulent sputum, signs of infection on sputum microbiology, clinical diagnosis of pneumonia, and prolonged high dependency unit stay for respiratory complications. The reason why the incidence of PPCs decreased after NIVATS operation may be that compared with IVATS, it avoided the injuries related to DLY, OLV, mechanical ventilation and residual effects of muscle relaxants, and affected the recovery of patients' respiratory function and sputum excretion function after operation.( 26 – 28 ) It is worth noting that there is no difference in the incidence of obvious atelectasis or consolidation between the two groups in chest X-ray examination, but there is a significant difference in the incidence of clinical diagnosis of pneumonia, which may be due to the subjectivity of clinical diagnosis of pneumonia. The clinical diagnosis of pneumonia is based on the comprehensive judgment of signs, symptoms and the results of diagnostic tests, and the differences in diagnostic guidelines or clinical practice experience followed by different doctors in charge may lead to subtle differences in diagnostic standards.( 29 ) In terms of postoperative recovery index, the time of removing drainage tube, tracheal catheter, postoperative hospital stay and total hospital stay in NIVATS group were shorter than those in IVATS group. The cumulative total amount of sufentanil and the cumulative drainage after operation in NIVATS group were less than those in IVATS group. In terms of safety index, the incidence of hypercapnia in NIVATS group was significantly higher than that in IVATS group, and the incidence of hypoxia index and postoperative nausea and vomiting in NIVATS group were significantly lower. We believe that the advantages come from the protection of patients' respiratory function by non-intubation technology and the overall inhibition of patients by the reduction of the total amount of general anesthesia drugs. Consistent with previous research results, the incidence of hypercapnia in NIVATS group was significantly higher than that in IVATS group.( 30 ) The main reason is the phenomenon of "contradictory breathing" caused by lung collapse on the unventilated side during NIVATS operation and the relatively low ventilation efficiency.( 31 ) At present, the influence of hypercapnia on brain metabolism and function is controversial. Studies have shown that hypercapnia can increase intracranial pressure, reduce cerebral perfusion and accelerate cerebral ischemia.( 32 , 33 ) However, some studies believe that hypercapnia has neuroprotective effect.( 34 ) But, hypercapnia during NIVATS operation is mostly temporary, which can be quickly relieved and returned to normal after the operation. Even in PACU and NIVATS patients, the PCO 2 is lower than that in IVATS group, and this "permissive hypercapnia" has almost no adverse effect on the long-term prognosis of patients after operation.( 35 ) The results of this study further confirm this view. The incidence of postoperative hypoxia in NIVATS group may be related to the significant decrease of PPCs in NIVATS group. In addition, the incidence of postoperative nausea and vomiting in NIVATS group is low, which may be because the routine use of muscle relaxants in IVATS group can significantly increase PONV by reducing the high incidence of postoperative gastrointestinal reactions caused by intestinal perfusion and oxygen delivery.( 36 ) However, it should be pointed out in particular that NIVTAS also has contraindications at present. Among the anesthetic factors, patients with known or suspected intubation difficulty (Mallampati III-IV), BMI > 30 kg/m 2 , persistent cough, type II respiratory failure (PO 2 50 mmHg), abnormal coagulation (IRF > 1.5) and contralateral transverse nerve paralysis are not included.( 37 ) Among the surgical factors, severe adhesion, massive hemorrhage and severe mediastinal and diaphragmatic movements should also be excluded from the application scope of NIVATS.( 38 ) However, we believe that with the maturity of NIVATS technology and the increase of anesthesiologists' experience, contraindications will gradually decrease. Limitations This study has several limitations. First, the study did not include the evaluation index of the satisfaction of the surgeon, and the doctor's satisfaction with the operation conditions may affect the operation duration and even increase the risk of unplanned tracheal intubation, which may lead to some potential confounding factors being uncontrolled. Secondly, the same group of surgeons are not fixed in this study, and there are individual differences in the judgment of different doctors on the timing of drainage tube removal and the discharge standard of patients, which may interfere with the secondary outcome indicators such as postoperative drainage tube indwelling time and hospital stay. Based on the above limitations, further prospective randomized controlled trials should be conducted to further verify the clinical efficacy and safety of NIVATS. Conclusion The results of this study show that NIVATS can effectively reduce the incidence of postoperative pulmonary complications in patients undergoing thoracoscopic lung resection, and it is a promising choice of anesthesia methods for thoracoscopic elective surgery. However, further prospective randomized controlled clinical studies are needed to confirm its efficacy. Abbreviations VATS : Video-assisted thoracoscopic surgery IVATS : Intubated VATS NIVATS : Non-intubated VATS PPCs : Postoperative pulmonary complications MGS : Melbourne Group Scale ETCO2: End-tidal carbon dioxide Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki. The research plan was approved by the Ethics Committee of Chongqing General Hospital (approval number: S2025-038-01). Given the retrospective nature of this study and the use of de-identified data, the requirement for written informed consent was waived by the Chongqing General Hospital. Clinical trial number: Not applicable. Consent for publication Not applicable. Availability of data and materials Anonymized data may be made available from the corresponding author (ZZ) upon reasonable request and with approval from the Chongqing General Hospital. Competing interests The authors declare no competing interests. Funding Not applicable. Authors' contributions R.X. made substantial contributions to the conception of the study, the acquisition of data, analysis, and interpretation of data, and drafted the manuscript. L.Y. contributed to the acquisition of data, analysis, and interpretation of data. P.K. made substantial contributions to the conception of the study.W.Y. made substantial contributions to the acquisition of data of the study.Y.Z. contributed significantly to the conception and design of the work. Y.X. made substantial contributions to the conception of the study. F.X.W and Z.Z. contributed significantly to the conception and design of the work, and substantively revised the manuscript. All authors have approved the submitted version of the manuscript, agreed to be personally accountable for their own contributions, and ensured that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 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Comparison of postoperative pulmonary complications and intraoperative safety in thoracoscopic surgery under non-intubated versus intubated anesthesia: a randomized, controlled, double-blind non-inferiority trial. Updates Surg. 2024;76(8):2863–73. Marshall O, Chawla S, Lu H, Pape L, Ge Y. Cerebral blood flow modulation insufficiency in brain networks in multiple sclerosis: A hypercapnia MRI study. J Cereb Blood Flow Metab. 2016;36(12):2087–95. Zhou Q, Cao B, Niu L, Cui X, Yu H, Liu J, et al. Effects of permissive hypercapnia on transient global cerebral ischemia-reperfusion injury in rats. Anesthesiology. 2010;112(2):288–97. Cheng Q, Li L, Lin D, Li R, Yue Y, Wei H, et al. Effects of acute hypercapnia on cognitive function in patients undergoing bronchoscope intervention. J Thorac Dis. 2019;11(3):1065–71. Cheng Q, Zhang J, Wang H, Zhang R, Yue Y, Li L. Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications among Patients Receiving Bronchoscopic Interventions under General Anesthesia. PLoS ONE. 2015;10(7):e0130771. Yi MS, Kang H, Kim MK, Choi GJ, Park YH, Baek CW, et al. Relationship between the incidence and risk factors of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia. Asian J Surg. 2018;41(4):301–6. Pompeo E. Non-intubated thoracic surgery: nostalgic or reasonable? Ann Transl Med. 2015;3(8):99. Chiang XH, Lin MW. Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention. Front Surg. 2021;8:769850. Additional Declarations No competing interests reported. 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08:43:51","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":118017,"visible":true,"origin":"","legend":"","description":"","filename":"0696b8cf2be64354aae996bb825fb1931structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8219046/v1/fb5f3e8449b99b976e7e81a8.xml"},{"id":100560186,"identity":"a24eef1d-11f8-4fa5-becb-dbd54a8317f0","added_by":"auto","created_at":"2026-01-19 08:43:39","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128944,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8219046/v1/6b733c9d2b924cfbfe78b162.html"},{"id":100560498,"identity":"c96b5ac1-f9cd-4dfe-aa7f-ec84773f6a4b","added_by":"auto","created_at":"2026-01-19 08:43:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":343772,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe presence of PPCs was defined by using the Melbourne Group Scale (MGS).\u003c/strong\u003e(A) Incidence of PPCs in NIVATS group and IVATS group. (B) Detailed comparisons of MGS criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e: NIVATS: non-intubated video-assisted thoracoscopic surgery; IVTAS: intubated video-assisted thoracoscopic surgery; PPCs, postoperative pulmonary complications.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8219046/v1/682d2d24dd604599f59767cc.png"},{"id":100560965,"identity":"d11610d8-780a-492f-9b36-630c12156273","added_by":"auto","created_at":"2026-01-19 08:43:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":373725,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the study.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8219046/v1/28181b19ae74192336d45d12.png"},{"id":100560651,"identity":"4d3d28e4-959a-4834-9c33-43ec7018bf77","added_by":"auto","created_at":"2026-01-19 08:43:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":458154,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe cumulative incidence of PPCs with operation duration by using Kaplan-Meier analysis.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e: NIVATS: non-intubated video-assisted thoracoscopic surgery; IVTAS: intubated video-assisted thoracoscopic surgery; PPCs, postoperative pulmonary complications.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8219046/v1/e740772cdc1e59578f63e3f0.png"},{"id":100560406,"identity":"d4b0a745-93a8-4532-b81f-0669d1a76bd5","added_by":"auto","created_at":"2026-01-19 08:43:40","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":150127,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA subgroup analysis to compare the incidence of PPCs in patients undergoing lobectomy (A) and non-lobectomy (B).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e: NIVATS: non-intubated video-assisted thoracoscopic surgery; IVTAS: intubated video-assisted thoracoscopic surgery; PPCs, postoperative pulmonary complications.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8219046/v1/4d78ffe9940965876bea710c.png"},{"id":104035713,"identity":"1515b20c-418f-44eb-b1c9-6de0f3c20594","added_by":"auto","created_at":"2026-03-06 02:40:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2257658,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8219046/v1/319d5764-547a-4d9e-aaae-ac030b36a289.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of Postoperative Pulmonary Complications in Non-intubated and Intubated Video-assisted Thoracoscopic Lung resection: A Retrospective Cohort Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn thoracic surgery, postoperative pulmonary complications (PPCs) are still the main cause of postoperative mortality and have a great impact on the prognosis of patients.(\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) It is estimated that the incidence of PPCs after thoracic surgery is 30%-50%, which is the main reason for postoperative morbidity, mortality and prolonged hospitalization.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Although minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) have made progress, PPCs is still very high (26.8%-29.9%).(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Among them, there are surgical and non-surgical risk factors. From the point of view of surgery, the minimally invasive technology through video-assisted thoracoscope is an important reason for the decrease of PPCs incidence.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) As the same time, among the risk factors related to anesthesia, the factors causing PPCs may be related to acute postoperative pain, decreased minute ventilation (MV), secretion retention, atelectasis, lung injury, pneumonia and so on.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) At present, the reported intervention measures to reduce PPCs include enhanced recovery after surgery (ERAS), lung protective ventilation strategy (LPVS), preventive use of mucolytic agents, respiratory physiotherapy, epidural analgesia, goal-oriented hemodynamic therapy and the use of esketamine.(\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe traditional anesthesia method of video-assisted thoracoscopic surgery is intubated video-assisted thoracoscopic surgery (IVATS), which often adopts double-lumen tube (DLT) to control breathing under general anesthesia, and one-lung ventilation (OLV) on the healthy side during the operation.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) One-lung ventilation is related to transient pulmonary hypoperfusion caused by hypoxic pulmonary vasoconstriction, which can lead to local tissue ischemia. Restoring perfusion during lung re-expansion may cause some degree of ischemia-reperfusion injury.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) In addition, DLT may induce various complications related to tracheal intubation, such as lung infection, lung injury, bronchospasm, cardiac function damage, arrhythmia, postoperative sore throat, cough, irritability and so on, (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)thus increasing the incidence of PPCs.\u003c/p\u003e \u003cp\u003eIn order to improve the prognosis of patients, non-intubated video-assisted thoracoscopic surgery (NIVATS) is gradually carried out.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) This technique has been proved to be suitable for many different types of video-assisted thoracoscopic surgery, such as wedge resection, segmental resection, lobectomy, lung volume reduction and mediastinal tumor surgery. NIVATS now often uses laryngeal mask anesthesia (LMA) combined with regional block anesthesia. As a supraglottic ventilation device, laryngeal mask airway has the advantages of simple performance, short time, few complications, quick recovery and low cost.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Therefore, the use of LAM combined with nerve block as the respiratory tract management mode of NIVATS is more and more widely used in thoracic surgery.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAlthough NIVATS can improve the prognosis of patients in theory, it is still controversial. At present, there is little research on the relationship between IVATS, NIVATS and PPCs. This study is a retrospective cohort study, aiming to explore the effects of IVATS and NIVATS on PPCs and prognosis of patients, so as to provide guidance for anesthesia methods of video-assisted thoracoscopic surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and patient selection\u003c/h2\u003e \u003cp\u003eIn this study, patients who underwent elective video-assisted thoracoscopic lung resection from January 1, 2023 to September 1, 2025 were collected. Inclusion criteria: age 18\u0026ndash;75 years, American Association of Anesthesiologists (ASA) physical condition classification I-III. Exclusion criteria include previous chest surgery history or chest trauma, patients who need to be transferred to intensive care unit (ICU) for further treatment after surgery, patients with missing main data, and patients who underwent secondary surgery during hospitalization.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnesthesia and surgical procedures\u003c/h3\u003e\n\u003cp\u003eThey were divided into two groups according to anesthesia methods. IVATS group: DLT was used, and the breathing was controlled after the fiberoptic bronchoscope was aligned. Lung protective ventilation strategy was adopted during operation. During the operation, respiratory parameters were adjusted according to the end-expiratory partial pressure of carbon dioxide (PetCO2) and blood gas analysis results, and sputum aspiration and lung inflation were fully performed before the end of the operation. NIVATS group: LAM combined with regional block anesthesia was used, and paraspinal nerve block was performed on the corresponding intercostal segment of the surgical incision under the guidance of ultrasound. After the effect of regional block anesthesia was satisfactory, anesthesia induction was carried out and laryngeal mask was placed. The ventilator adopts SIMV mode to assist breathing. After the operation, the surgeon performed thoracic superficial anesthesia and vagus nerve block on the operating side under thoracoscope. When the patient has hypercapnia or the surgeon's satisfaction is poor, the parameters of ventilator should be adjusted after giving a small dose of micuronium bromide.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eChange the intubation anesthesia when the following situations occur. The effects of respiratory function include hypoxemia: SpO2\u0026thinsp;\u0026lt;\u0026thinsp;85% or hypercapnia PaCO2\u0026thinsp;\u0026ge;\u0026thinsp;80 mmHg. Although SIMV is tried, it still has no improvement. Tracheal secretions and bloody secretions increased significantly, leading to dyspnea and airway obstruction. Hemodynamics and internal environment instability: HR\u0026thinsp;\u0026gt;\u0026thinsp;100 bpm or systolic blood pressure change\u0026thinsp;\u0026gt;\u0026thinsp;30% compared with the baseline value. Arrhythmia caused by non-surgical stimulation (such as frequent atrial or ventricular premature beats\u0026thinsp;\u0026ge;\u0026thinsp;6 beats/min); The pH value of two arterial blood gas analyses is less than 7.15 (conducted at an interval of 15 minutes or more). (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The operation is difficult, the operating field is too large, and the operation is difficult. There was no improvement after drug treatment, lasting more than 5 minutes; Despite visceral pleural surface anesthesia and vagus nerve block, he continued to cough (\u0026gt;\u0026thinsp;2 times per minute).\u003c/p\u003e \u003cp\u003ePatients in both groups maintained stable circulation during operation, and when necessary, vasoactive drugs were pumped or injected intravenously to keep the fluctuation of HR and MAP within 30% of the basic value. All drug infusion was stopped 5 minutes before the end of the operation, and palonosetron 0.5mg and sufentanil 5ug were injected intravenously. When the patient is fully awake, pull out the endotracheal tube or laryngeal mask, and connect PCIA at the same time (sufentanil 1ug/ml, background infusion 1-2ml/h, bolus does 0.5-1ml). When Steward's awakening score is greater than 4 and his vital signs are stable, he will be transferred back to the ward, and then the thoracic surgeon will decide the time to pull out the thoracic drainage tube and the time to leave the hospital according to the patient's specific situation.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe main result of this study is the incidence of PPCs. The existence of PPCs is defined by Melbourne Group Scale (MGS),(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) which includes eight criteria: body temperature\u0026thinsp;\u0026gt;\u0026thinsp;38\u0026deg;C, white cell count\u0026thinsp;\u0026gt;\u0026thinsp;11.2\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L, purulent sputum, chest X-ray findings of atelectasis or consolidation, signs of infection on sputum moicrobiology, clinical diagnosis of pneumonia, oxygen saturation\u0026thinsp;\u0026lt;\u0026thinsp;90% on room air, and prolonged high dependency unit stay for respiratory complications. Patients who meet four or more of the eight criteria will be diagnosed as PPCs. The secondary indicators were the time of extubation of tracheal tube or laryngeal mask, arterial blood gas analysis indexes (PH, PCO2, PF ratio) after extubation, NRS score after extubation, cumulative total dose of sufentanil, NRS score 24 hours after operation, cumulative drainage volume, time of extubation, postoperative hospital stay and total hospital stay. At the same time, adverse events were recorded, including airway spasm, choking, body movement, hypercapnia, reflux aspiration, malignant arrhythmia, unplanned tracheal intubation and so on. Postoperative adverse events include shivering, restlessness, delirium, hypoxemia (SpO2\u0026thinsp;\u0026lt;\u0026thinsp;90% or PF radio\u0026thinsp;\u0026lt;\u0026thinsp;300), sore throat and postoperative nausea and vomiting (PONV).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eUse SPSS software (version 26.0; SPSS (Chicago, Illinois, USA) follows the principle of intention therapy. Bilateral \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Use SPSS software (version 26.0; SPSS (Chicago, Illinois, USA) follows the principle of intention therapy. Bilateral \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Continuous variables expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (quartile range) depend on the distribution of data. Qualitative variables are represented by numbers and percentages. Chi-square test was used to compare the incidence of qualitative variables, such as PPCs, between IVATS group and NIVATS group. Independent t test is used to compare the continuous normal distribution data between IVATS group and NIVATS group, while Mann-Whitney U test is used to compare the non-normal distribution data. Calculate the odds ratio (OR) and the average difference of 95% confidence interval (95%CI) of the research results. Enter model was used for logical analysis, and the influence of NIVATS on the incidence of PPCs was further verified by including potential related factors (\u0026ge;\u0026thinsp;60 years old or \u0026lt;\u0026thinsp;60 years old, gender, ASA, COPD, asthma, smoking status and operation type). Kaplan-Meier analysis was used to compare the cumulative incidence of PPCs with the length of operation between different groups. In addition, subgroup analysis was further used to verify the influence of NIVATS on the incidence of PPCs in different surgical types.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eThrough inclusion criteria and exclusion criteria, the data of 486 patients were collected in this study, including 290 patients in IVATS group and 196 patients in NIVATS group, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The demographic parameters and baseline data of each group of patients are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\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\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIVATS group (n\u0026thinsp;=\u0026thinsp;290)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNIVATS group (n\u0026thinsp;=\u0026thinsp;196)\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\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.26\u0026thinsp;\u0026plusmn;\u0026thinsp;9.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.32\u0026thinsp;\u0026plusmn;\u0026thinsp;11.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex (male/female), n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126(43.45%)/164(56.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(34.69%)/128(65.31%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI (kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eASA classification\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (17.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (42.86%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239 (82.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112 (57.14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSmoker, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (34.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (21.94%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAsthma, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.02%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCOPD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (4.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.53%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePreoperative Arterial Blood Gas\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCO2 (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePF ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e409.79\u0026thinsp;\u0026plusmn;\u0026thinsp;62.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e421.36\u0026thinsp;\u0026plusmn;\u0026thinsp;49.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSurgery duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139.13\u0026thinsp;\u0026plusmn;\u0026thinsp;66.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.05\u0026thinsp;\u0026plusmn;\u0026thinsp;48.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLobectomy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (38.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140 (71.43%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWedge resection, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (20.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (11.22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSegmentectomy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (41.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (17.35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (16.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (14.29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiabetes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (11.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (10.71%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCoronary artery disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (4.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (4.08%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI, body mass index; ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease; PF ratio, PaO2/FiO2 ratio; IVATS, Image-guided video-assisted thoracoscopic surgery; NIVATS, Non-Intubated video-assisted thoracoscopic surgery.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDuring hospitalization, the incidence of PPCs in NIVATS group was significantly lower than that in IVATS group (4.59% vs 23.45%, OR\u0026thinsp;=\u0026thinsp;0.157, 95%CI,0.078\u0026ndash;0.318, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA. In Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB, among the eight evaluation criteria of MGS, the incidence of postoperative body temperature\u0026thinsp;\u0026gt;\u0026thinsp;38\u0026deg;C (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025), postoperative purulent sputum (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), positive rate of microbial infection in sputum culture (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018), incidence of clinical diagnosis of pneumonia (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and respiratory failure in NIVATS group.\u003c/p\u003e \u003cp\u003eEnter the multivariate logistic regression analysis model that affects PPCs is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and the model P\u0026thinsp;\u0026gt;\u0026thinsp;0.05. The results showed that lobectomy (OR\u0026thinsp;=\u0026thinsp;2.732, 95%CI,1.212\u0026ndash;6.157, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015) was the risk factor of PPCs, and NIVATS group (OR\u0026thinsp;=\u0026thinsp;20.243, 95%CI, 0.107\u0026ndash;0.550, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01) and operation duration\u0026thinsp;\u0026le;\u0026thinsp;2 h (OR\u0026thinsp;=\u0026thinsp;0.419, 95%CI, 0.212\u0026ndash;0.827, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012) were the protective factors. By further calculation of Kaplan-Meier analysis, it was found that there was no statistically significant difference between the two groups in the cumulative incidence of PPCs as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e with the length of operation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.081). In subgroup analysis, the incidence of PPCs in NIVATS group was significantly lower than that in IVATS group (27.45% vs 1.56%, OR\u0026thinsp;=\u0026thinsp;0.177, 95%CI, 0.055\u0026ndash;0.551, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) when the surgical type was lobectomy (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA), and in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB, NIVATS group also performed well when the surgical type was non-lobectomy (7.81% vs 1.50%, OR\u0026thinsp;=\u0026thinsp;0.875, 95%CI, 0.809\u0026ndash;0.933, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\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\u003eEnter the multivariate logistic regression analysis model that affects postoperative pulmonary complications (PPCs).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWald \u003cem\u003ex\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\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 \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (\u0026le;\u0026thinsp;60 years vs. \u0026gt;60 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.257(0.710\u0026ndash;2.225)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Male vs. Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.935(0.390\u0026ndash;2.240)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA classification (II vs. III)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.698(0.762\u0026ndash;3.784)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD (Yes vs. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.932(0.235-3.700)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthma (Yes vs. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.668(0.286\u0026ndash;24.912)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoker (Yes vs. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.521(0.215\u0026ndash;1.260)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery duration (\u0026le;\u0026thinsp;2 h vs.\u0026gt;2 h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.419(0.212\u0026ndash;0.827)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery type\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSegmentectomy vs. Wedge resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.517(0.736\u0026ndash;3.128)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLobectomy vs. Wedge resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.732(1.212\u0026ndash;6.157)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia mode (NIVATS vs IVATS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.243(0.107\u0026ndash;0.550)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eASA, American society of anesthesiologists; COPD, chronic obstructive pulmonary disease; IVATS, Image-guided video-assisted thoracoscopic surgery; NIVATS, Non-Intubated video-assisted thoracoscopic surgery.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e compares the incidence of adverse events between the two groups. The incidence of hypercapnia in NIVATS group was significantly higher than that in IVATS group (OR\u0026thinsp;=\u0026thinsp;0.034, 95%CI, 0.019\u0026ndash;0.063, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The incidence of postoperative hypoxia index in NIVATS group was significantly lower than that in IVATS group (OR\u0026thinsp;=\u0026thinsp;6.588, 95%CI, 2.303\u0026ndash;18.851, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the incidence of PONV in NIVATS group was significantly lower than that in IVATS group (OR\u0026thinsp;=\u0026thinsp;5.538, 95%CI, 1.919\u0026ndash;15.983, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and there was no significant difference in other adverse event indexes.\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\u003eAdverse events between two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIVATS group (n\u0026thinsp;=\u0026thinsp;290)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNIVATS group (n\u0026thinsp;=\u0026thinsp;196)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntraoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAirway spasm, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(0.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.681(1.561\u0026ndash;1.809)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody\u0026nbsp;movement or Cough, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.678(1.560\u0026ndash;1.806)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegurgitating aspiration, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypercapnia, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (4.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117(59.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.034 (0.019\u0026ndash;0.063)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignant arrhythmia, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.681(1.561\u0026ndash;1.809)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned ETT, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.510 (2.250\u0026ndash;2.802)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow PF ratio, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (12.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.588 (2.303\u0026ndash;18.851)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShiver, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.678(1.560\u0026ndash;1.806)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRestless, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (2.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.532 (0.686\u0026ndash;44.585)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelirium, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePONV, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(10.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(2.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.538 (1.919\u0026ndash;15.983)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSore throat, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(2.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.120 (0.492\u0026ndash;34.488)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eHypercapnia, Arterial Blood Gas PaCO₂ \u0026gt; 60mmHg or EtCO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026gt;\u0026thinsp;60mmHg. Low PF ratio, PaO2/FiO2, PF ratio\u0026thinsp;\u0026lt;\u0026thinsp;300;ETT, Endotracheal tube; PONV, Postoperative nausea and vomiting.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, among other indicators, the time for pulling out the drainage tube in NIVATS group was shorter than that in IVATS group (\u003cem\u003eZ\u003c/em\u003e=-8.261, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).The total amount of sufentanil in NIVATS group was less than that in IVATS group (\u003cem\u003eZ\u003c/em\u003e=-3.525, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).The postoperative cumulative drainage in NIVATS group was significantly lower than that in IVATS group (\u003cem\u003eZ\u003c/em\u003e=-11.096, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).The duration of tracheal extubation, postoperative hospitalization and total hospitalization in NIVATS group were significantly shorter than those in IVATS group, with \u003cem\u003eZ\u003c/em\u003e of -0.095, -9.321 and \u0026minus;\u0026thinsp;10.306, respectively, and All \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOther index between two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIVATS group (n\u0026thinsp;=\u0026thinsp;290)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNIVATS group (n\u0026thinsp;=\u0026thinsp;196)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\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\u003eExtubation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-8.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePostoperative PF ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e397.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e409.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNRS scale after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCumulative sufentanil dosage after operation (\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e124.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNRS score 24 hours after operation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCumulative discharge (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e670.25\u0026thinsp;\u0026plusmn;\u0026thinsp;30.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e285.06\u0026thinsp;\u0026plusmn;\u0026thinsp;24.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-11.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThoracic drainage time (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-9.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePostoperative hospital stays (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-9.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCumulative hospital stays (day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-10.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ePF ratio, PaO2/FiO2 ratio; NRS, Numerical rating scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe choice of anesthesia mode in video-assisted thoracoscopic surgery has a key influence on the postoperative recovery of patients and the risk of PPCs. At present, the comparison of clinical efficacy between IVATS and NIVATS still needs more evidence. This study focuses on the influence of two anesthesia methods on PPCs and other recovery indexes of patients undergoing elective video-assisted thoracoscopic surgery, aiming at providing reference for the optimization of anesthesia scheme for video-assisted thoracoscopic surgery.\u003c/p\u003e \u003cp\u003eThe results of this study showed that the incidence of PPCs in the NIVATS group was significantly lower than that in the IVATS group, regardless of the type of operation, whether it was video-assisted thoracoscopic lobectomy or non-lobectomy, but the duration of operation had no significant correlation with the incidence of PPCs in the two groups. Mechanical ventilation can lead to ventilator-associated lung injury (VALI),(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) which mainly includes volume injury, barometric injury, tension injury, biological injury and shear injury. Lung protective ventilation strategy (LPVS) is a new mechanical ventilation strategy developed for VALI in recent years.(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) Its purpose is to protect lung tissue as much as possible and reduce mechanical ventilation damage. LPVS mainly includes small tidal volume, optimal positive end-expiratory pressure, lung recruitment, etc.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The implementation of LPVS can improve lung compliance and gas exchange in alveoli, reduce the occurrence of pulmonary edema and infection, and reduce the incidence of PPCs.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) In this study, the NIVATS group used LAM combined with regional block anesthesia, which further avoided VALI caused by mechanical ventilation, thus reducing the incidence of PPCs.\u003c/p\u003e \u003cp\u003eAccording to MGS standard, the decrease of PPCs in NIVTAS group observed in our study can be attributed to postoperative body temperature\u0026thinsp;\u0026gt;\u0026thinsp;38\u0026deg;C, purulent sputum, signs of infection on sputum microbiology, clinical diagnosis of pneumonia, and prolonged high dependency unit stay for respiratory complications. The reason why the incidence of PPCs decreased after NIVATS operation may be that compared with IVATS, it avoided the injuries related to DLY, OLV, mechanical ventilation and residual effects of muscle relaxants, and affected the recovery of patients' respiratory function and sputum excretion function after operation.(\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) It is worth noting that there is no difference in the incidence of obvious atelectasis or consolidation between the two groups in chest X-ray examination, but there is a significant difference in the incidence of clinical diagnosis of pneumonia, which may be due to the subjectivity of clinical diagnosis of pneumonia. The clinical diagnosis of pneumonia is based on the comprehensive judgment of signs, symptoms and the results of diagnostic tests, and the differences in diagnostic guidelines or clinical practice experience followed by different doctors in charge may lead to subtle differences in diagnostic standards.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn terms of postoperative recovery index, the time of removing drainage tube, tracheal catheter, postoperative hospital stay and total hospital stay in NIVATS group were shorter than those in IVATS group. The cumulative total amount of sufentanil and the cumulative drainage after operation in NIVATS group were less than those in IVATS group. In terms of safety index, the incidence of hypercapnia in NIVATS group was significantly higher than that in IVATS group, and the incidence of hypoxia index and postoperative nausea and vomiting in NIVATS group were significantly lower. We believe that the advantages come from the protection of patients' respiratory function by non-intubation technology and the overall inhibition of patients by the reduction of the total amount of general anesthesia drugs. Consistent with previous research results, the incidence of hypercapnia in NIVATS group was significantly higher than that in IVATS group.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) The main reason is the phenomenon of \"contradictory breathing\" caused by lung collapse on the unventilated side during NIVATS operation and the relatively low ventilation efficiency.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) At present, the influence of hypercapnia on brain metabolism and function is controversial. Studies have shown that hypercapnia can increase intracranial pressure, reduce cerebral perfusion and accelerate cerebral ischemia.(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) However, some studies believe that hypercapnia has neuroprotective effect.(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) But, hypercapnia during NIVATS operation is mostly temporary, which can be quickly relieved and returned to normal after the operation. Even in PACU and NIVATS patients, the PCO\u003csub\u003e2\u003c/sub\u003e is lower than that in IVATS group, and this \"permissive hypercapnia\" has almost no adverse effect on the long-term prognosis of patients after operation.(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) The results of this study further confirm this view. The incidence of postoperative hypoxia in NIVATS group may be related to the significant decrease of PPCs in NIVATS group. In addition, the incidence of postoperative nausea and vomiting in NIVATS group is low, which may be because the routine use of muscle relaxants in IVATS group can significantly increase PONV by reducing the high incidence of postoperative gastrointestinal reactions caused by intestinal perfusion and oxygen delivery.(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHowever, it should be pointed out in particular that NIVTAS also has contraindications at present. Among the anesthetic factors, patients with known or suspected intubation difficulty (Mallampati III-IV), BMI\u0026thinsp;\u0026gt;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e, persistent cough, type II respiratory failure (PO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;60 mmHg and PCO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026gt;\u0026thinsp;50 mmHg), abnormal coagulation (IRF\u0026thinsp;\u0026gt;\u0026thinsp;1.5) and contralateral transverse nerve paralysis are not included.(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) Among the surgical factors, severe adhesion, massive hemorrhage and severe mediastinal and diaphragmatic movements should also be excluded from the application scope of NIVATS.(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) However, we believe that with the maturity of NIVATS technology and the increase of anesthesiologists' experience, contraindications will gradually decrease.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study has several limitations. First, the study did not include the evaluation index of the satisfaction of the surgeon, and the doctor's satisfaction with the operation conditions may affect the operation duration and even increase the risk of unplanned tracheal intubation, which may lead to some potential confounding factors being uncontrolled. Secondly, the same group of surgeons are not fixed in this study, and there are individual differences in the judgment of different doctors on the timing of drainage tube removal and the discharge standard of patients, which may interfere with the secondary outcome indicators such as postoperative drainage tube indwelling time and hospital stay. Based on the above limitations, further prospective randomized controlled trials should be conducted to further verify the clinical efficacy and safety of NIVATS.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study show that NIVATS can effectively reduce the incidence of postoperative pulmonary complications in patients undergoing thoracoscopic lung resection, and it is a promising choice of anesthesia methods for thoracoscopic elective surgery. However, further prospective randomized controlled clinical studies are needed to confirm its efficacy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eVATS\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eVideo-assisted thoracoscopic surgery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIVATS\u003c/em\u003e\u003c/strong\u003e: Intubated VATS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNIVATS\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNon-intubated VATS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePPCs\u003c/em\u003e\u003c/strong\u003e: Postoperative pulmonary complications\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMGS\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eMelbourne Group Scale\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eETCO2:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eEnd-tidal carbon dioxide\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki. The research plan was approved by the Ethics Committee of Chongqing General Hospital (approval number: S2025-038-01). Given the retrospective nature of this study and the use of de-identified data, the requirement for written informed consent was waived by the Chongqing General Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnonymized data may be made available from the corresponding author (ZZ) upon reasonable request and with approval from the Chongqing General Hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.X. made substantial contributions to the conception of the study, the acquisition of data, analysis, and interpretation of data, and drafted the manuscript. L.Y. contributed to the acquisition of data, analysis, and interpretation of data. P.K. made substantial contributions to the conception of the study.W.Y. made substantial contributions to the acquisition of data of the study.Y.Z. contributed significantly to the conception and design of the work. Y.X. made substantial contributions to the conception of the study. F.X.W and Z.Z. contributed significantly to the conception and design of the work, and substantively revised the manuscript. All authors have approved the submitted version of the manuscript, agreed to be personally accountable for their own contributions, and ensured that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the doctors in the thoracic surgery department of Chongqing General Hospital for their selfless contributions to this work.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFerrando C, Carrami\u0026ntilde;ana A, Pi\u0026ntilde;eiro P, Mirabella L, Spadaro S, Librero J, et al. Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial. 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Transl Lung Cancer Res. 2021;10(8):3503\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathews DM, Oberding MJ, Simmons EL, O'Donnell SE, Abnet KR, MacDonald K. Improving patient safety during procedural sedation via respiratory volume monitoring: A randomized controlled trial. J Clin Anesth. 2018;46:118\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams GW 2nd, George CA, Harvey BC, Freeman JE. A Comparison of Measurements of Change in Respiratory Status in Spontaneously Breathing Volunteers by the ExSpiron Noninvasive Respiratory Volume Monitor Versus the Capnostream Capnometer. Anesth Analg. 2017;124(1):120\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAk AK, Anjum F. Ventilator-Induced Lung Injury (VILI). StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Fatima Anjum declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright \u0026copy; 2025. StatPearls Publishing LLC.; 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahetya SK. Searching for the optimal positive end-expiratory pressure for lung protective ventilation. Curr Opin Crit Care. 2020;26(1):53\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarley RA, Simon K. Lung-Protective Ventilation. Annu Rev Nurs Res. 2017;35(1):37\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePompeo E. State of the art and perspectives in non-intubated thoracic surgery. Ann Transl Med. 2014;2(11):106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg. 2016;49(3):721\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang H, Liu J, Wu S, Zhang Y, Liu H, Yang H, et al. Nonintubated Spontaneous Ventilation Offers Better Short-term Outcome for Mediastinal Tumor Surgery. Ann Thorac Surg. 2019;108(4):1045\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMetlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA. 1997;278(17):1440\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu CY, Chen JS, Lin YS, Tsai TM, Hung MH, Chan KC, et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg. 2013;95(2):405\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang L, Wang D, Zhang Y. Comparison of postoperative pulmonary complications and intraoperative safety in thoracoscopic surgery under non-intubated versus intubated anesthesia: a randomized, controlled, double-blind non-inferiority trial. Updates Surg. 2024;76(8):2863\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarshall O, Chawla S, Lu H, Pape L, Ge Y. Cerebral blood flow modulation insufficiency in brain networks in multiple sclerosis: A hypercapnia MRI study. J Cereb Blood Flow Metab. 2016;36(12):2087\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou Q, Cao B, Niu L, Cui X, Yu H, Liu J, et al. Effects of permissive hypercapnia on transient global cerebral ischemia-reperfusion injury in rats. Anesthesiology. 2010;112(2):288\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng Q, Li L, Lin D, Li R, Yue Y, Wei H, et al. Effects of acute hypercapnia on cognitive function in patients undergoing bronchoscope intervention. J Thorac Dis. 2019;11(3):1065\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng Q, Zhang J, Wang H, Zhang R, Yue Y, Li L. Effect of Acute Hypercapnia on Outcomes and Predictive Risk Factors for Complications among Patients Receiving Bronchoscopic Interventions under General Anesthesia. PLoS ONE. 2015;10(7):e0130771.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYi MS, Kang H, Kim MK, Choi GJ, Park YH, Baek CW, et al. Relationship between the incidence and risk factors of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia. Asian J Surg. 2018;41(4):301\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePompeo E. Non-intubated thoracic surgery: nostalgic or reasonable? Ann Transl Med. 2015;3(8):99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiang XH, Lin MW. Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention. Front Surg. 2021;8:769850.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Non-intubated Video-assisted Thoracoscopic, Intubated Video-assisted Thoracoscopic, Postoperative Pulmonary Complications, Anesthesiology","lastPublishedDoi":"10.21203/rs.3.rs-8219046/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8219046/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe 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).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA 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\u0026thinsp;=\u0026thinsp;0.157, 95%CI,0.078\u0026ndash;0.318, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In NIVATS group, the incidence of hypercapnia during operation was higher (59.69% vs 4.83%, OR\u0026thinsp;=\u0026thinsp;0.034, 95%CI,0.019\u0026ndash;0.063, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the postoperative hypoxia index (2.04% vs 12.07%, OR\u0026thinsp;=\u0026thinsp;6.588, 95%CI,2.303\u0026ndash;18.851, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the incidence of nausea and vomiting (2.04% vs 10.34%, OR\u0026thinsp;=\u0026thinsp;5.538, 95%CI, 1.919\u0026ndash;15.983, P\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the cumulative dosage and postoperative drainage volume of sufentanil were less (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNIVATS 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.\u003c/p\u003e","manuscriptTitle":"Impact of Postoperative Pulmonary Complications in Non-intubated and Intubated Video-assisted Thoracoscopic Lung resection: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 08:26:31","doi":"10.21203/rs.3.rs-8219046/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce7fc5e3-1f66-4285-9923-25924738c2c7","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-06T02:39:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 08:26:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8219046","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8219046","identity":"rs-8219046","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}