Association between one-lung ventilation parameters and postoperative pulmonary infection after radical lung cancer surgery: A retrospective cohort study

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Abstract Objective To investigate the relationship between lung-protective parameters during one-lung ventilation (OLV) and the risk of postoperative pulmonary infection (PPI) after radical lung cancer (LC) surgery. Methods This retrospective study included 319 patients with non-small cell lung cancer who underwent radical LC surgery with OLV during January 1, 2022-December 31, 2025. Patients were divided into PPI (n = 35) and non-PPI (n = 284) groups based on whether PPI occurred during postoperative hospitalization. Baseline data, preoperative pulmonary function, and intraoperative OLV parameters were collected. Logistic regression analyses were performed to identify relevant factors. The discriminatory ability of the multivariate model was evaluated using the ROC curve. Results The incidence of PPI was 11.0%. Compared with the non-PPI group, the PPI group had older age, a higher proportion of hypertension, lower forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF), a higher proportion of open thoracic surgery, higher tidal volume (VT), higher inspiratory pressure, higher ventilation frequency, and higher fraction of inspired oxygen (FiO₂), but lower positive end-expiratory pressure (PEEP) (all P < 0.05). Multivariate logistic regression analysis showed that hypertension, lower FEV1, open thoracic surgery, higher inspiratory pressure, and higher FiO₂ were independently associated with PPI (all P < 0.05). The AUC of the model constructed based on these independent factors was 0.856 (95% CI: 0.782-0.906). Conclusion Lung-protective parameters during OLV are associated with PPI after radical LC surgery. Notably, higher inspiratory pressure and higher FiO₂ remain independently associated with PPI after adjusting for confounding factors.