Identifying High‐Risk Patients for Trainee Residents in Thoracoscopic Anatomical Lung Resection: Enhancing Safe Surgery and Effective Training

INTRODUCTION: This study aimed to identify risk factors for postoperative complications in early-stage thoracic surgery trainee residents with 50 or less cases of thoracic surgery experience performing thoracoscopic anatomical lung resections for non-small cell lung cancer. METHODS: A retrospective analysis of 101 patients operated on by trainee residents with ≤ 50 thoracic surgery cases were conducted across two institutions from January 2015 to December 2023. Patient characteristics and surgical factors were compared between those with and without complications. Logistic regression analysis was used to evaluate the association of various factors with postoperative complications. RESULTS: Complications occurred in 27.7% of patients, predominantly prolonged air leaks. In a univariable logistic regression analysis to analyze the risk of postoperative complications, the age ≥ 76 years old (odds ratio [OR] 4.000, 95% confidence interval [CI] 1.540-10.40; p = 0.004), heavy smoking (Brinkman index ≥ 600) (OR 2.630, 95% CI 1.080-6.440; p = 0.034), extensive adhesions (OR 12.00, 95% CI 1.280-112; p = 0.030), longer operative time (≥ 238 min) (OR 2.760, 95% CI 1.050-7.300; p = 0.004), and use of six or more staplers (OR 4.820, 95% CI 1.820-12.80; p = 0.002) were found to have statistically significant differences. While these factors showed significance in univariable analysis, the age ≥ 76 years old (OR 3.690, 95% CI 1.270-10.70; p = 0.017) and the use of ≥ 6 staplers (OR 3.720, 95% CI 1.260-11.00; p = 0.017) remained consistent significant risk factors in multivariable analysis. No complications were observed when operative time was < 180 min (p = 0.059). CONCLUSIONS: These findings emphasize the need for meticulous patient selection for trainee residents. Avoiding high-risk cases defined by the identified factors can improve training outcomes and enhance patient safety in thoracic surgery.