Minimally invasive thoracoscopic segmentectomy is increasingly used for early-stage lung tumors. Combining thoracoscopic segmentectomy with non-intubated anesthesia avoids double-lumen endobronchial intubation and mechanical ventilation, which may reduce invasiveness. This study aimed to evaluate the relationship between non-intubated anesthesia and the occurrence and severity of postoperative pulmonary complications (PPCs) after thoracoscopic segmentectomy.
The report presents a retrospective cohort study of patients who underwent thoracoscopic segmentectomy performed by the same surgeon team between November 2021 and July 2024. Patients received either non-intubated or conventional intubated anesthesia. The abstract does not list detailed inclusion or exclusion criteria, nor does it provide the total number of eligible patients before matching; those details were not reported in the abstract and would require consultation of the full text.
To reduce confounding, the investigators performed 1:1 propensity score matching to create comparable non-intubation and intubation groups. After matching, the study cohort comprised 122 patients, with 61 in each group. The primary outcome, the incidence of PPCs, was analyzed using Chi-squared test or Fisher exact test as appropriate. The secondary outcome, severity grade of PPCs, was compared using the Mann-Whitney U test. The abstract does not specify which covariates were included in the propensity model, nor does it present balance diagnostics; those elements were not reported in the abstract.
The predefined primary outcome was the incidence of postoperative pulmonary complications (PPCs). PPCs were defined to include respiratory infection, pneumothorax, atelectasis, pleural effusion, respiratory failure, bronchospasm, and aspiration pneumonitis. The secondary outcome was the severity grade of PPCs.
After propensity score matching (61 non-intubated versus 61 intubated), the overall incidence of PPCs was significantly lower in the non-intubation group compared with the intubation group: 16.4% versus 37.7% (p = 0.008). Among the individual components of PPCs, the reduction in respiratory infection was the most pronounced: 9.8% in the non-intubated group versus 29.5% in the intubated group (p = 0.006). The aggregate severity score for PPCs was also lower in the non-intubation group (p = 0.030), indicating not only fewer events but milder postoperative pulmonary morbidity in that group.
The abstract mentions additional clinical observations in a plain-language summary, noting shorter length of hospital stay and lower postoperative white blood cell counts in the non-intubation group, but the abstract does not provide numeric values, measures of dispersion, or p values for those secondary observations.
The authors summarized that non-intubated anesthesia can be a feasible and safe alternative to intubated anesthesia for selected patients undergoing thoracoscopic segmentectomy. They report associations between non-intubated anesthesia and decreased incidence and severity of PPCs, as well as shorter hospital stay and lower postoperative white blood cell levels. The abstract does not provide the detailed methods for selecting “selected patients,” nor does it quantify the reductions in length of stay or white blood cell counts; those specifics were not reported in the abstract.
Based on the matched cohort analysis, the authors conclude that non-intubated anesthesia was associated with a lower incidence of PPCs and a milder severity grade of pulmonary complications in patients undergoing thoracoscopic segmentectomy.
The abstract does not report certain important methodological and contextual details that are relevant for interpretation and applicability: the full list of covariates used for propensity score matching and balance statistics; detailed inclusion and exclusion criteria; raw counts for individual PPC categories beyond those highlighted; perioperative anesthesia protocols and monitoring; intraoperative events and conversion rates; and full numerical data for secondary observations such as length of stay and white blood cell changes. These items are not included in the abstract and would require examination of the full published article for confirmation.