Background The risk factors for postoperative complications in non-intubated video-assisted thoracoscopic surgery (VATS) has not been observed before. Here to develop a simple risk score to predict the risk of postoperative complications for patients who scheduling non-intubated VATS, which is beneficial to guide the clinical interventions. Methods 1837 patients who underwent non-intubated VATS were included from January 2011 to December 2018. A development data set and a validation data set were allocated according to an approximate 3:2 ratio of total cases. The stepwise logistic regression was used to establish a risk score model, and the methods of bootstrap and split-sample were used for validation. Results Multivariable analysis revealed that the forced expiratory volume in the first second in percent of predicted, the anesthesia method, blood loss, surgical time, and preoperative neutrophil ratio were risk factors for postoperative complications. The risk score was established with these 5 factors, varied from 0–53, with the corresponding predicted probability of postoperative complications occurrence ranged from 1%-92%, and was calibrated (Hosmer-Lemeshow χ2 = 6.261; P = 0.618). Good discrimination was acquired in the development and validation data sets (C-statistic 0.705 and 0.700). A positive correlation was between the risk score and postoperative complications (P for trend < 0.01). Three levels of low-risk (0–15 points], moderate-risk (15–30 points], and high-risk (> 30 points] were established based on the score distribution of postoperative complications. Conclusions This simple risk score model based on risk factors of postoperative complications can validly identify the high-risk patients with postoperative complications in the non-intubated VATS, and allow for early interventions.

Objective Subxiphoid approach for mediastinal tumor resection was reported to provide a better view and less postoperative pain. Non-intubated video-assisted thoracic surgery (NI-VATS) without muscle relaxant would decrease the possibility of postoperative airway collapse for anterior mediastinal mass operation. Herein, we sought to describe the use of NI-VATS through subxiphoid approach for anterior mediastinal tumor resection. Methods Patients that underwent subxiphoid VATS resection for anterior mediastinal tumor between December 2015 and September 2019 were retrospectively included for analysis. Patients were divided into two groups according to airway management: NI-VATS and intubated VATS (I-VATS). Intraoperative and postoperative variables were compared. Results A total of 40 patients were included. Among them, 21 patients received NI-VATS (52.5%) and 19 were treated with I-VATS (47.5%). In total, intraoperative (4/21 vs. 2/19; p = 0.446) and postoperative complications (5/21 vs. 7/19; p = 0.369) were similar between NI-VATS and I-VATS group. The anesthesia time (231.76 vs 244.71 min; p = 0.218), the operation time (152.35 vs 143.64 min; p = 0.980) and the length of stay (9.47 vs 10.57 day; p = 0.970) were similar between the two groups. Chest tube duration was shorter in NI-VATS groups (1.81 vs 1.84 day; p = 0.008), however, the total volume (351.95 vs 348.00 ml; p = 0.223) was similar. The post-operative pain scores (2.79 vs 2.93, P = 0.413) were comparable between two groups. Conclusions NI-VATS for mediastinal tumor resection via subxiphoid approach is a safe and technically feasible option. This technique leads to comparable perioperative clinical outcomes when compared with I-VATS via subxiphoid approach.