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Updated: Mar 29, 2026
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Outcome after video-assisted thoracoscopic surgery and open pulmonary lobectomy in patients with low VO2 max: a
Shah Sheikh Sofina Begum1, Kostas Papagiannopoulos1, Pierre Emmanuel Falcoz2
1Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
Objectives:
The aim was to verify the association of low VO2 max with postoperative morbidity and mortality after video-assisted thoracoscopic surgery (VATS) or open pulmonary lobectomy using the European Society of Thoracic Surgeons (ESTS) database.
Methods:
A retrospective analysis of data collected from the ESTS database was conducted. A total of 1684 lobectomy patients with available VO2 max values were included (2007-14). Patients operated through VATS (281 patients) or thoracotomy (1403 patients) were separately analysed. Propensity score analyses were performed to match patients with high (≥15 ml/kg/min) and low VO2 max (<15 ml/kg/min) for each approach. The following variables were used to construct the score: age, body mass index, predicted postoperative forced expiratory volume in 1 s (%), coronary artery disease, American Society of Anaesthesiology grade and Eastern Cooperative Oncology Group performance score. Cardiopulmonary morbidity and 30-day mortality were compared between the matched groups.
Results:
Mean VO2 max was 17.4 ml/kg/min. A total of 471 patients (28%) had low VO2 max. Overall postoperative cardiopulmonary morbidity and mortality rates were 30% (505 patients) and 4.1% (70 patients), respectively. Morbidity and mortality rates in low VO2 max patients were 33% (156 patients) and 6% (28 patients), respectively. After VATS, cardiopulmonary morbidity and mortality rates were 2-fold (13 of 72, 18% vs 143 of 399, 36%, P = 0.003) and 5-fold (1 of 72, 1.4% vs 27 of 399, 6.7%, P = 0.09) lower compared with thoracotomy. Matched comparison after thoracotomy (399 pairs): Mortality was significantly higher in patients with low VO2 max (27 patients, 6.7%) compared with those with high VO2 max (11 patients, 2.8%, P = 0.008). Complication rates were similar between the two groups (low VO2 max: 143 patients, 36% vs high VO2 max: 133 patients, 33%, respectively, P = 0.5). Matched comparison after vats (72 pairs): Morbidity and mortality rates of patients with low VO2 max were similar to those of patients with high VO2 max (morbidity: 13 patients, 18% vs 17 patients, 24%, P = 0.4; mortality: 1 patient, 1.4% vs 4 patients, 5.5%, P = 0.4).
Conclusions:
Low VO2 max was not associated with an increased surgical risk after VAT lobectomy, which challenges the traditional operability criteria when this technique is used.
