Effects of non-intubated anesthesia on postoperative pulmonary complications after thoracoscopic segmentectomy: a propensity score-matched analysis

Background Minimal invasive thoracoscopic segmentectomy is being increasingly performed in patients with early lung tumor. A combination of non-intubated anesthesia and thoracoscopic segmentectomy could be a less invasive procedure due to the avoidance of the double-lumen endobronchial intubation and mechanical ventilation. This study was aimed to explore the relationship between non-intubated anesthesia and postoperative pulmonary complications (PPCs) in thoracoscopic segmentectomy.Patients and methods A retrospective propensity score matched study was conducted from November 2021 to July 2024 among patients who underwent non-intubated or intubated thoracoscopic segmentectomy from the same surgeon team. Propensity score matching was performed to establish 1:1 non-intubation versus intubation group matching to balance potential confounding factors. Primary outcome was the incidence of PPCs including respiratory infection, pneumothorax, atelectasis, pleural effusion, respiratory failure, bronchospasm, and aspiration pneumonitis, and was analysed by Chi-squared test (or Fisher exact test). PPCs severity grade was assessed as the second outcome, and analysed by Mann–Whitney U test.Results After 1:1 propensity score matched, a matched cohort with 122 (61:61) patients was generated. The incidence of PPCs was lower in non-intubation group as compared to intubation group (16.4% vs. 37.7%; p = 0.008), wherein the reduction of respiratory infections was most significant (9.8% vs. 29.5%; p = 0.006). The severity score of PPCs was reduced in non-intubation group (p = 0.030).Conclusion Non-intubated anesthesia was associated with lower PPCs incidence and milder severity grade in patients undergoing thoracoscopic segmentectomy.