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Updated: Sep 13, 2025

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
The Prognostic Nutritional Index predicts poor postoperative outcomes in patients undergoing video-assisted thoracic
Jesús J Rosales-de la Rosa1, José B López-Martínez1, Andrea Escamilla-López1
1Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Background:
The Prognostic Nutritional Index (PNI) as a prognostic tool for the postoperative outcomes in patients undergoing thoracic surgery due to an infectious etiology remains unexplored.
Objective:
To evaluate the PNI as predictor of poor postoperative outcomes in patients undergoing surgery for a thoracic infection.
Material And Methods:
A retrospective analysis in patients undergoing VATS during January 2019 to December 2023, including 61 patients. We performed a ROC curve analysis to identify the optimal PNI cut-off value to classify the patients into groups: A high (HR) and low-risk (LR) group. Chi-square, Fisher exact, and Mann-Whitney tests were used to compare them. A multivariate analysis with Cox regression was also performed.
Results:
The optimal PNI cut-off value was 28.69, with AUC 0.860 (p = 0.001), sensitivity 88.9%, specificity 78.8%. 42 patients were low-risk, while 19 high-risk. There was a significant difference in 30-day mortality between groups (HR 42% vs LR 2%, p < 0.001) as well as in 30-day major complications (HR 68% vs LR 16%, p < 0.001). A multivariate analysis revealed that PNI-based risk group was an independent predictor of mortality (p = 0.008) and major complications (p < 0.001).
Conclusions:
The PNI is a valid predictor of poor postoperative outcomes in patients undergoing VATS for a thoracic infection.
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