Postoperative Complications and Risk Factors Following Non-cardiac Thoracic Surgery: A Prospective Cohort Study from Nepal

Abstract Background Postoperative complications remain an important source of morbidity after thoracic surgery, contributing to prolonged hospitalization, increased healthcare utilization, and mortality. Evidence from low- and middle-income countries remains limited. Objectives To determine the incidence and severity of 30-day postoperative complications following non-cardiac thoracic surgery and identify independent predictors of postoperative complications in a tertiary thoracic surgical center in Nepal. Methods This prospective single-center observational cohort study included consecutive adults undergoing elective or emergency non-cardiac thoracic surgery under general anesthesia between January and December 2025. Postoperative complications were prospectively recorded and graded using the Clavien–Dindo classification. Multivariable logistic regression incorporated age, ASA physical status, preoperative hemoglobin, serum albumin, intraoperative blood loss, and operative duration. Firth penalized logistic regression was performed as a sensitivity analysis. Results Among 185 patients, mean age was 40.7 ± 18.3 years and 109 (58.9%) were male. Benign disease accounted for 168 (90.8%) cases, and 118 (63.8%) underwent open thoracotomy. Postoperative complications occurred in 73 patients (39.5%): 51 (27.6%) had minor complications (Clavien–Dindo I–II), 15 (8.1%) had major complications (III–IV), and 7 (3.8%) died within 30 days. ASA III–IV independently increased complication risk (adjusted odds ratio 3.27, 95% CI 1.57–6.96; p = 0.002), whereas higher serum albumin reduced risk (adjusted odds ratio 0.43 per 1 g/dL increase, 95% CI 0.19–0.90; p = 0.029). Conclusion Postoperative complications occurred in approximately two-fifths of patients. Higher ASA physical status and lower serum albumin independently predicted complications. Multicenter studies are needed for external validation.