Original Article| Volume 37, ISSUE 4, P547-554, April 2023

Regional Anesthesia for Lobectomy and Risk of Pulmonary Complications: A National Safety Quality Improvement Program Propensity-Matching Analysis

Published:December 11, 2022DOI:


      To determine whether general anesthesia (GA) in conjunction with regional anesthetic (RA) techniques are associated with favorable pulmonary outcomes versus GA alone among patients undergoing lobectomy by either video-assisted thoracoscopic surgery (VATS) or open thoracotomy.


      A retrospective cohort (2014-2017).


      The American College of Surgeons National Surgical Quality Improvement Program.


      Adult patients undergoing lobectomy by either VATS or open thoracotomy.


      Two groups of patients were identified based on the use of GA alone or GA in conjunction with RA (RA+GA) techniques (either neuraxial or peripheral nerve blocks). Both groups were propensity-matched based on pulmonary risk factors. The authors’ primary outcome was composite postoperative pulmonary complication (PPC), including pneumonia, reintubation, and failure to wean from the ventilator.

      Measurements and Main Results

      A total of 4,134 VATS (2,067 in GA and 2,067 in RA+GA) and 3,112 thoracotomies (1,556 in GA and 1,556 in RA+GA) were included in the final analysis. Regional anesthetic, as an adjuvant to GA, did not affect the incidence of PPC among patients undergoing lobectomy by VATS (odds ratio [OR] 1.07, 95% CI 0.81-1.43, p = 0.622), as well as in those undergoing lobectomy via thoracotomy (OR 1.19, 95% CI 0.93-1.51, p = 0.174). There was no statistically significant difference between groups in terms of readmission rates, length of stay, and mortality at 30 days.


      The RA techniques were not associated with a lower incidence of pulmonary complications in lobectomy surgery.

      Graphical Abstract

      Key Words

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        • Fingar K
        • Stocks C
        • Weiss A
        • et al.
        Most frequent operating room procedures performed in U.S. hospitals, 2003-2012.
        Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US), Rockville, MD2014
        • Reif MS
        • Socinski MA
        • Rivera MP.
        Evidence-based medicine in the treatment of non-small-cell lung cancer.
        Clin Chest Med. 2000; 21 (ix): 107-120
        • Kearney DJ
        • Lee TH
        • Reilly JJ
        • et al.
        Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function.
        Chest. 1994; 105: 753-759
        • Sengupta S.
        Post-operative pulmonary complications after thoracotomy.
        Indian J Anesth. 2015; 59: 618-626
        • Stephan F
        • Boucheseiche S
        • Hollande J
        • et al.
        Pulmonary complications following lung resection: A comprehensive analysis of incidence and possible risk factors.
        Chest. 2000; 118: 1263-1270
        • Beattie WS
        • Badner NH
        • Choi P.
        Epidural analgesia reduces postoperative myocardial infarction: A meta-analysis.
        Anesth Analg. 2001; 93: 853-858
        • Rodgers A
        • Walker N
        • Schug S
        • et al.
        Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials.
        BMJ. 2000; 321: 1493
        • Haager B
        • Schmid D
        • Eschbach J
        • et al.
        Regional versus systemic analgesia in video-assisted thoracoscopic lobectomy: A retrospective analysis.
        BMC Anesthesiol. 2019; 19: 183
        • Batchelor TJP
        • Rasburn NJ
        • Abdelnour-Berchtold E
        • et al.
        Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS(R)) Society and the European Society of Thoracic Surgeons (ESTS).
        Eur J Cardiothorac Surg. 2019; 55: 91-115
      1. American College of Surgeons. ACS NSQIP Participant Use Data File. Available at:∼/media/files/qualityprograms/nsqip/nsqip_puf_userguide_2014.ashx. Updated October 2015. Accessed May 1, 2020.

        • Cohen ME
        • Bilimoria KY
        • Ko CY
        • et al.
        Development of an American College of Surgeons National Surgery Quality Improvement Program: Morbidity and mortality risk calculator for colorectal surgery.
        J Am Coll Surg. 2009; 208: 1009-1016
        • Foster CA
        • Charles EJ
        • Turrentine FE
        • et al.
        Development and validation of procedure-specific risk score for predicting postoperative pulmonary complication: A NSQIP analysis.
        J Am Coll Surg. 2019; 229 (e3): 355-365
        • Janssen-Heijnen ML
        • Schipper RM
        • Razenberg PP
        • et al.
        Prevalence of co-morbidity in lung cancer patients and its relationship with treatment: A population-based study.
        Lung Cancer. 1998; 21: 105-113
        • Linden D
        • Linden K
        • Oparka J.
        In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection?.
        Interact Cardiovasc Thorac Surg. 2014; 19: 107-110
        • Schuchert MJ
        • Pettiford BL
        • Pennathur A
        • et al.
        Anatomic segmentectomy for stage I non-small-cell lung cancer: Comparison of video-assisted thoracic surgery versus open approach.
        J Thorac Cardiovasc Surg. 2009; 138 (e1): 1318-1325
        • McKenna Jr., RJ
        • Houck W
        • Fuller CB
        Video-assisted thoracic surgery lobectomy: Experience with 1,100 cases.
        Ann Thorac Surg. 2006; 81 (discussion 425-6): 421-425
        • Wu CL
        • Sapirstein A
        • Herbert R
        • et al.
        Effect of postoperative epidural analgesia on morbidity and mortality after lung resection in Medicare patients.
        J Clin Anesth. 2006; 18: 515-520
        • Freise H
        • Van Aken HK.
        Risks and benefits of thoracic epidural anaesthesia.
        Br J Anaesth. 2011; 107: 859-868
        • Popping DM
        • Elia N
        • Marret E
        • et al.
        Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: A meta-analysis.
        Arch Surg. 2008; 143 (discussion 1000): 990-999
        • Popping DM
        • Elia N
        • Van Aken HK
        • et al.
        Impact of epidural analgesia on mortality and morbidity after surgery: Systematic review and meta-analysis of randomized controlled trials.
        Ann Surg. 2014; 259: 1056-1067
        • Bauer C
        • Hentz JG
        • Ducrocq X
        • et al.
        Lung function after lobectomy: A randomized, double-blinded trial comparing thoracic epidural ropivacaine/sufentanil and intravenous morphine for patient-controlled analgesia.
        Anesth Analg. 2007; 105: 238-244
        • Liu SS
        • Block BM
        • Wu CL.
        Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: A meta-analysis.
        Anesthesiology. 2004; 101: 153-161
        • Warner DO.
        Preventing postoperative pulmonary complications: The role of the anesthesiologist.
        Anesthesiology. 2000; 92: 1467-1472
        • Block BM
        • Liu SS
        • Rowlingson AJ
        • et al.
        Efficacy of postoperative epidural analgesia: A meta-analysis.
        JAMA. 2003; 290: 2455-2463
        • Wu CL
        • Cohen SR
        • Richman JM
        • et al.
        Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: A meta-analysis.
        Anesthesiology. 2005; 103 (quiz 1109-10): 1079-1088
        • Kheterpal S
        • Tremper KK
        • Heung M
        • et al.
        Development and validation of an acute kidney injury risk index for patients undergoing general surgery: Results from a national data set.
        Anesthesiology. 2009; 110: 505-515
        • Klaibert B
        • Lohser J
        • Tang R
        • et al.
        Efficacy of ultrasound-guided single-injection erector spinae plane block for thoracoscopic wedge resection: A prospective randomized control trial.
        Reg Anesth Pain Med. 2022; 47: 749-754
        • Ranganath YS
        • Ramanujam V
        • Onodera Y
        • et al.
        Impact of paravertebral blocks on analgesic and non-analgesic outcomes after video-assisted thoracoscopic surgery: A propensity matched cohort study.
        PLoS One. 2021; 16e0252059