This retrospective study enrolled elderly patients who underwent video-assisted thoracoscopic surgery(VATS) lung resection at the Department of Thoracic Surgery, Peking Union Medical College Hospital between April 2019 and July 2023. General clinical data, pulmonary function testing(PFT) parameters[including forced expiratory volume in 1 second(FEV₁%pred), forced vital capacity(FVC%pred), and peak expiratory flow(PEF%pred)], cardiopulmonary exercise testing(CPET) parameters[peak oxygen uptake(peak VO₂) and resting arterial oxygen saturation(SpO₂), etc.], and postoperative complications were collected. Univariate analysis and multivariate Logistic regression were performed to identify independent risk factors for postoperative complications.

Among 219 eligible patients, 44 developed postoperative complications(complication group), while 175 did not(non-complication group). Univariate analysis revealed that the complication group had higher body mass index(BMI), smoking rates, lobectomy rates, and prevalence of preexisting arrhythmias, along with lower FEV₁%pred, FVC%pred, PEF%pred, peak VO₂, and resting SpO₂(all P < 0.05). Multivariate Logistic regression identified lobectomy(OR=6.04, 95% CI: 2.55-14.33), history of arrhythmia(OR=3.13, 95% CI: 1.08-9.12), decreased FVC%pred(OR=1.04, 95% CI: 1.01-1.06), and reduced peak VO₂(OR=1.17, 95% CI: 1.03-1.32) as independent risk factors for postoperative complications.

Lobectomy, preexisting arrhythmias, decreased FVC%pred, and reduced peak VO₂ are significantly associated with an elevated risk of postoperative complications in elderly patients undergoing VATS lung resection. These findings underscore the importance of preoperative risk stratification and tailored prehabilitation strategies to optimize outcomes in this population.