{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T19:17:12Z","timestamp":1777576632621,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Asian Cardiovasc Thorac Ann"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Video-assisted thoracoscopic surgery is increasingly used for thoracic procedures due to its advantages in reducing postoperative pain and hospital stay. This study aimed to identify predictors and underlying reasons for conversion from video-assisted thoracoscopic surgery to open approach and to assess the impact of such conversions on clinical outcomes, including hospital stay duration, morbidity, and mortality, which remain debated in current literature.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This retrospective observational study was conducted on 950 adult patients between May 2016 and March 2023 who underwent elective thoracic surgery. Demographic data, comorbidities, perioperative variables, and outcomes were documented and analyzed. Univariate logistic and multivariate regression analyses were conducted to identify independent predictors of conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 638\/950 patients scheduled for video-assisted thoracoscopic surgery are included in the analysis. The mean age of the cohort was 35.68 years, with 61.9% being male. Conversion to open thoracotomy was required in 3.13% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200920) of cases, primarily due to anatomical challenges (50%,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200910), vascular injury (45%,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20099), and technical difficulties (5%,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20091). Significant predictors of conversion included diabetes mellitus (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.049), hypertension (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.031), and malignant pathology (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.022). Penalized regression identified anatomical difficulty (OR: 62.4;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0085) and vascular injury (OR: 57.8;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0026) as independent predictors of conversion, whereas diabetes, hypertension, and malignant pathology did not retain statistical significance after adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hypertension and malignancy were significant only in multivariate analysis, while anatomical challenges and vascular injuries remained significant in penalized regression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02184923251407839","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T18:54:56Z","timestamp":1766170496000},"page":"43-52","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictor of conversion from video-assisted thoracoscopic surgery (VATS) to conventional open approach"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8013-2815","authenticated-orcid":false,"given":"Mohamed","family":"Elshalkamy","sequence":"first","affiliation":[{"name":"Mansoura University Hospitals"},{"name":"Current affiliation: Cardiothoracic Surgery Department, Royal Brompton and Harefield Hospitals, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2829-4437","authenticated-orcid":false,"given":"Sameh Ibrahim","family":"Elsayed","sequence":"additional","affiliation":[{"name":"Mansoura University Hospitals"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3861-8132","authenticated-orcid":false,"given":"Amr","family":"Abdellateef","sequence":"additional","affiliation":[{"name":"Mansoura University Hospitals"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5559-661X","authenticated-orcid":false,"given":"Mohamed Ahmed","family":"Gabr","sequence":"additional","affiliation":[{"name":"Mansoura University Hospitals"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2250-8203","authenticated-orcid":false,"given":"Mohammed","family":"Keshta","sequence":"additional","affiliation":[{"name":"Mansoura University Hospitals"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"495","article-title":"Video-assisted thoracoscopic surgery versus open thymectomy for thymoma: a systematic review","volume":"4","author":"Xie A","year":"2015","unstructured":"Xie A, Tjahjono R, Phan K, et al. Video-assisted thoracoscopic surgery versus open thymectomy for thymoma: a systematic review. Ann Cardiothorac Surg 2015; 4: 495.","journal-title":"Ann Cardiothorac Surg"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.09.98"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.5090\/jcs.23.140"},{"key":"e_1_3_2_5_2","article-title":"Thoracotomy versus video-assisted thoracoscopic resection of lung cancer: a protocol for a systematic review and meta-analysis","volume":"98","author":"Chai T","year":"2019","unstructured":"Chai T, Lin Y, Kang M, et al. Thoracotomy versus video-assisted thoracoscopic resection of lung cancer: a protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98: e14646.","journal-title":"Medicine (Baltimore)"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12962-021-00307-2"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2100016"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.21037\/shc.2017.08.03"},{"key":"e_1_3_2_9_2","first-page":"764","article-title":"Video-assisted thoracoscopic pneumonectomy","volume":"7","author":"Chen H-W","year":"2015","unstructured":"Chen H-W, Du M. Video-assisted thoracoscopic pneumonectomy. J Thorac Dis 2015; 7: 764.","journal-title":"J Thorac Dis"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezac304"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15020410"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-20-2950"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezac249"},{"key":"e_1_3_2_14_2","article-title":"Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open","volume":"5","author":"Hanna JM","year":"2013","unstructured":"Hanna JM, Berry MF, D'Amico TA. Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis 2013; 5: S182\u2013S189.","journal-title":"J Thorac Dis"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.07.40"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/1556984519849037"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.04.032"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-015-4492-3"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.12.009"},{"key":"e_1_3_2_20_2","article-title":"Operative bleeding during thoracoscopic thymectomy: Causes and management strategies","author":"Abdellateef A","year":"2020","unstructured":"Abdellateef A, Keshta M, Saleh ME, et al. Operative bleeding during thoracoscopic thymectomy: Causes and management strategies. Multimed Man Cardiothorac Surg 2020.","journal-title":"Multimed Man Cardiothorac Surg"}],"container-title":["Asian Cardiovascular and Thoracic Annals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02184923251407839","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02184923251407839","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02184923251407839","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T19:29:01Z","timestamp":1777404541000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02184923251407839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/02184923251407839"],"URL":"https:\/\/doi.org\/10.1177\/02184923251407839","relation":{},"ISSN":["0218-4923","1816-5370"],"issn-type":[{"value":"0218-4923","type":"print"},{"value":"1816-5370","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]}}}