Risk Factors for the Development of Intraoperative Hypoxia in Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery: A Retrospective Study from a Single Center

Abstract

Background Nonintubated video-assisted thoracic surgery (NIVATS) has been demonstrated to be safe and effective in patients. However, the risk factors for intraoperative hypoxia are unclear. This retrospective study aimed to identify the risk factors for the development of intraoperative hypoxia in patients undergoing NIVATS. Material/Methods The study included patients who underwent NIVATS between January 2011 and December 2018. Intraoperative hypoxia was defined as SpO 2 ≤93%. Risk factors for hypoxia were identified by binary logistic regression analysis, and the characteristic distribution of patients with and without hypoxia was elaborated. Results Of 2742 included patients, age, anesthesia method, the technical level of surgeons, stair-climbing ability, and type of thoracic procedure were associated with intraoperative hypoxia ( P <0.05). The characteristics of patients with hypoxia were older age ( P =0.011), higher body mass index and revised cardiac risk index level ( P =0.033 and P =0.031), and lower composition of stair-climbing ≥22 m ( P <0.001). These patients also had more anatomical lung surgery and mediastinal mass resection ( P =0.033) and more epidural anesthesia ( P =0.005). The surgeries were more likely to be performed by surgeons with less than 10 years of VATS training ( P =0.009) and to have increased intraoperative maximum end-expiratory carbon dioxide partial pressure ( P <0.001). These patients had a longer Intensive Care Unit stay ( P <0.001), duration of chest-tube drainage ( P =0.019), and postoperative hospitalization ( P =0.003). Conclusions The current study suggests that old age and stair-climbing ability of patients, anesthesia method, thoracic procedures, and surgeon experience are risk factors for intraoperative hypoxia in patients undergoing NIVATS.

Preoperative Nomogram and Risk Calculator for Postoperative Hypoxemia and Related Clinical Outcomes Following Stanford Type A Acute Aortic Dissection Surgery

“…Older age has been reported to be associated with the development of hypoxemia in various surgeries ( 7 , 12 – 14 ), which was consistent with the results of this study. Shi et al investigated the incidence and risk factors for early postoperative hypoxemia in patients undergoing on-pump coronary artery bypass grafting ( 7 ).…”

Incidence, Risk Factors, and Outcomes of Severe Hypoxemia After Cardiac Surgery

“…Additionally, several other predictors for postoperative hypoxemia have also been reported previously in the literature but were not found to be significant when analyzed by the multivariate analysis in the current study, such as advanced age, hypertension, smoking history, renal insufficiency, female sex, poor cardiac function, and diabetes ( 1 , 23 , 24 , 43 , 44 ). Some postoperative factors have also been reported to be related to the occurrence of postoperative hypoxemia, but we did not include postoperative factors into our analysis due to these factors were not available early.…”

“…To improve the weaknesses and deficiencies of traditional CPB, minimal invasive extracorporeal circulation has been introduced these years and the concept of “more physiologic” cardiac surgery has been proposed ( 21 , 22 ). In addition, longer surgical time and surgeon experience have also been reported to be independently associated with the development of postoperative hypoxemia in the literature ( 23 , 24 ). Therefore, more training and improved surgical skills of surgeons may benefit patients significantly.…”

Effects of Non-intubated Video-Assisted Thoracic Surgery on Patients With Pulmonary Dysfunction

“…Some of the patients included in this study were ASA grade 3, which implied that NIVATS could also be extended to patients higher than ASA II. But this requires that, firstly, Anesthesiologists need to have much experience of NIVATS, for the reason that it may have to convert to endotracheal intubation due to unpredictable conditions, such as bleeding or pleural adhesion ( 21 ); secondly, the surgeon should have rich experience in thoracoscopy, preferably more than 5 years, and can complete various types of thoracoscopic procedures ( 22 ); thirdly, the operation time should not be too long and the surgical procedure is not too difficult. Since long-term spontaneous breathing during NIVATS may lead to hypoxia and hypercapnia.…”