Complications of Video-Assisted Thoracic Surgery (VATS)

Intraoperative and Postoperative Complications

Conversion rates range from 0-12% and should not be considered a failure but rather a safety resource, according to the European Respiratory Society, 1
Wound infection occurs in approximately 6% of cases and represents the most common early morbidity, 1
Prolonged air leak is the most common postoperative complication, occurring in 7-35% of patients, 2, 3
Pleural space infection (empyema) occurs in 7-24% of cases depending on the indication and complexity, 1, 2, 3
Bronchopleural fistula is reported in 7-35% of surgical series, particularly after extensive resections, 2, 3

VATS demonstrates significantly lower rates of overall perioperative morbidity compared to thoracotomy, according to the European Society of Cardiology, 4
Postoperative cardiac complications are reduced in elderly patients undergoing VATS versus open procedures, 5
Atrial arrhythmias occur at significantly lower rates with VATS versus open procedures, 4

The 60-day mortality ranges from 0-11% across various indications, 1
Postoperative mortality in elderly patients (>80 years) is remarkably low at <2% for VATS compared to higher rates with open thoracotomy, 5, 6
Pneumonectomy carries higher mortality risk and should be avoided when possible, particularly in elderly patients, 5, 6

Comorbidities—particularly cardiac and pulmonary disease—represent the most significant predictors of postoperative complications, more so than chronological age alone, according to the American College of Cardiology, 5, 6
Poor functional capacity (<4 METs) predicts increased mortality after thoracic surgery (relative risk 18.7), 4
Extent of resection impacts outcomes, with pneumonectomy carrying higher risk than lobectomy or limited resection, 5, 6
Immunocompromised patients and those with persistent resistant organisms have worse outcomes, 1