Related Experiment Video
Updated: Aug 5, 2026
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Postoperative outcomes following anatomical lung resections in relation to intraoperative ventilation practices: a
Timon Marvin Schnabel1, Mark Schieren2, Jerome Defosse2
1Department of Anaesthesiology, University Witten/Herdecke, Cologne-Holweide Hospital, Cologne, Germany.
Background:
Patients undergoing anatomical resection during thoracic surgery are exposed to an elevated risk of postoperative complications, particularly when one lung ventilation (OLV) is applied. The objective of this study is to evaluate the association between intraoperative ventilation parameters during OLV in anatomical resections and outcomes in this cohort.
Methods:
A retrospective multicenter cohort study was conducted using data from the German Thoracic Registry. Between 2015 and 2021 1128 patients underwent anatomical resection. Intraoperative parameters analyzed included driving pressure (DP), peak airway pressure (Pmax), positive end-expiratory pressure (PEEP), and tidal volume per predicted body weight (TV/PBW). The primary outcomes of the study were postoperative complications, respiratory complications, and in-hospital mortality.
Results:
The analysis included 1128 patients undergoing anatomical lung resections, with a postoperative complication rate of 28.7% and respiratory complications in 16.3%. Elevated DP >20 mbar (p = .008), Pmax >25 mbar (p = .003), and TV >5 mL/kg PBW (p = .013) were significantly associated with increased complication rates. Respiratory complications were significantly associated with DP >20 mbar (p = .006), Pmax >25 mbar (p = .001), and PEEP >8 mbar (p = .017). In-hospital mortality was 1.2% (n = 14). Given the low number of events, mortality analyses were considered exploratory; unadjusted analyses showed higher mortality with prolonged OLV and longer surgery duration (both p < .001).
Conclusion:
In this registry-based cohort, univariable threshold analyses indicated higher postoperative and respiratory complication rates when intraoperative airway pressures and tidal volumes exceeded commonly used protective ranges. However, these findings should be interpreted as observational and hypothesis-generating, as adjusted models and sensitivity analyses suggest potential confounding by patient risk and procedural complexity. Prospective studies with standardized complication severity grading and detailed preoperative pulmonary characterization are needed.
