Impact of preoperative anemia on postoperative outcomes in patients undergoing video-assisted thoracoscopic surgery: a multi-institutional retrospective study

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) involves unique physiological challenges, including single-lung ventilation, that may amplify the effects of reduced oxygen-carrying capacity in anemic patients. Despite the minimally invasive nature of VATS, the specific impact of preoperative anemia on outcomes following these procedures remains inadequately characterized. METHODS: We conducted a multi-institutional retrospective cohort study using TriNetX research network data (2010-2024). Adults undergoing VATS with preoperative hemoglobin measurements were included. The anemia group (hemoglobin 8-12 g/dL) was compared to the control group (hemoglobin ≥12 g/dL) using 1:1 propensity score matching. RESULTS: After matching, 8,346 pairs of patients were analyzed. Patients with preoperative anemia had significantly higher 30-day mortality (odds ratio [OR] 3.20, 95% confidence interval [CI] 2.33-4.39, P