Effect of intraoperative ventilation strategy on postoperative pulmonary complications in thoracic surgery under general anesthesia: a meta-analysis

BACKGROUND: Thoracic surgery is essential for treating various chest diseases. The ventilation strategies used during surgery can affect the risk of postoperative pulmonary complications (PPCs). OBJECTIVE: This meta-analysis assesses how lung-protective ventilation strategies (LPVS) affect PPCs compared with conventional strategies in adult patients undergoing thoracic surgery under general anesthesia through a meta-analysis. METHODS: A systematic literature search was conducted across PubMed, Embase, Cochrane, and Web of Science databases. Heterogeneity among studies was analyzed using the Q test and I² statistic Pooled results were presented as relative risk (RR) with 95% confidence intervals (CIs). RESULTS: A total of 11 randomized controlled trials, encompassing 1915 participants, were analyzed. LPVS significantly reduced the incidence of PPCs (RR = 0.82, 95%CI = 0.71–0.95). Subgroup analyses revealed significant effects in Asian countries (RR = 0.59, 95%CI = 0.39–0.87) and patients ≥ 60 years old both in control (RR = 0.84, 95% CI = 0.72–0.98) and research group (RR = 0.82, 95% CI = 0.70–0.9). Significant effects were also found in control group with tidal volume ≥ 8 ml/kg (RR = 0.67, 95% CI = 0.51–0.89) and research group with tidal volume ≤ 5 ml/kg (RR = 0.84, 95% CI = 0.73–0.98). CONCLUSION: LPVS effectively reduce PPCs in thoracic surgery, particularly among older patients. Future research should standardize protocols and explore long-term outcomes.