Predictor of conversion from video-assisted thoracoscopic surgery (VATS) to conventional open approach

Abstract

Video-assisted thoracoscopic surgery is increasingly used for thoracic procedures due to its advantages in reducing postoperative pain and hospital stay. This study aimed to identify predictors and underlying reasons for conversion from video-assisted thoracoscopic surgery to open approach and to assess the impact of such conversions on clinical outcomes, including hospital stay duration, morbidity, and mortality, which remain debated in current literature.

Patients and Methods

This retrospective observational study was conducted on 950 adult patients between May 2016 and March 2023 who underwent elective thoracic surgery. Demographic data, comorbidities, perioperative variables, and outcomes were documented and analyzed. Univariate logistic and multivariate regression analyses were conducted to identify independent predictors of conversion.

Results

A total of 638/950 patients scheduled for video-assisted thoracoscopic surgery are included in the analysis. The mean age of the cohort was 35.68 years, with 61.9% being male. Conversion to open thoracotomy was required in 3.13% (n = 20) of cases, primarily due to anatomical challenges (50%, n = 10), vascular injury (45%, n = 9), and technical difficulties (5%, n = 1). Significant predictors of conversion included diabetes mellitus (p = 0.049), hypertension (p = 0.031), and malignant pathology (p = 0.022). Penalized regression identified anatomical difficulty (OR: 62.4; p = 0.0085) and vascular injury (OR: 57.8; p = 0.0026) as independent predictors of conversion, whereas diabetes, hypertension, and malignant pathology did not retain statistical significance after adjustment.

Conclusion

Hypertension and malignancy were significant only in multivariate analysis, while anatomical challenges and vascular injuries remained significant in penalized regression.