ArticleJournal of thoracic disease2026
The impact of American Society of Anesthesiologists physical status on the feasibility and safety of non-intubated video-assisted thoracoscopic surgery: a retrospective analysis.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Non-intubated video-assisted thoracoscopic surgery (NIVATS) avoids the risks of general anesthesia, one-lung ventilation and tracheal intubation, and has traditionally been reserved for low-risk patients [American Society of Anesthesiologists (ASA) physical status I-II]. Its feasibility and safety in patients with higher ASA physical status remain insufficiently defined. We compared perioperative outcomes between low- and high-ASA patients undergoing NIVATS. Methods: This single-center retrospective cohort study included consecutive patients undergoing elective NIVATS for lung resection between September 2019 and December 2023. Patients were stratified into low-ASA (ASA I-II) and high-ASA (ASA III-IV) groups. Baseline characteristics and perioperative outcomes were compared using the Mann-Whitney U test, Chi-squared test or Fisher exact test. Multivariable Poisson regression adjusted for sex and operation type was used to estimate the independent association of high-ASA status with key outcomes, expressed as the incidence rate ratio (IRR). Results: A total of 663 patients were analyzed (low-ASA, n=517; high-ASA, n=146). High-ASA patients were older (median 66.9 Conclusions: NIVATS is technically feasible and intraoperatively well tolerated in high-ASA patients, with conversion and immediate complication rates comparable to those of low-ASA patients. However, high-ASA status independently predicts prolonged hospitalization and a substantially increased risk of mortality. These findings underscore the importance of careful patient selection and intensive, tailored postoperative care for high-risk patients undergoing NIVATS.
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