Postoperative pulmonary complications in awake video-assisted thoracoscopic surgery: Our 10-year experience

The aim of this study was to evaluate the effect of awake video-assisted thoracoscopic surgery on postoperative pulmonary complications among patients with different risk scores using the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT).

Between January 2011 and August 2021, a total of 246 patients (158 males, 88 females; mean age: 59.1±13.6 years; range, 25 to 84 years) who underwent awake video-assisted thoracoscopic surgery were retrospectively analyzed. According to the ARISCAT scores, the patients with low and intermediate scores were included in Group L (n=173), while those with high scores (n=73) were included in Group H. Sedation protocol consisted of the combination of midazolam and fentanyl with propofol infusion, if necessary. Oxygen was delivered via face mask or nasal canula (2 to 5 L/min) maintaining an oxygen saturation of >95%, and analgesia was achieved with intercostal nerve block. Demographics, operative, and postoperative data of the patients, and pulmonary complications were evaluated.

Demographics, operative, and postoperative data were similar between the groups. Postoperative pulmonary complications were observed in 20 (27%) patients in Group H and 29 (17%) patients in Group L without statistically significant difference (p=0.056). Surgical approaches consisted of pleural procedures (n=194) and pulmonary resection (n=52). The incidence of pulmonary complications was significantly higher in the pulmonary resection compared to non-pulmonary procedures (p=0.027).

Awake video-assisted thoracoscopic surgery seems to be beneficial in reducing the incidence of postoperative pulmonary complications in high-risk patients as assessed with the ARISCAT.