Intraoperative Anesthetic Complications in Pediatric Patients with Mediastinal Mass: A Retrospective Cohort Study.

Background: With advances in diagnostic techniques and therapeutic approaches, updated data on the incidence of intraoperative anesthetic complications in pediatric thoracoscopic mediastinal mass resection are needed. This study aimed to investigate the current incidence, identify potential risk factors, and assess the impact of such complications on postoperative clinical outcomes. Methods: We retrospectively reviewed the medical records of all 778 pediatric patients who underwent elective thoracoscopic mediastinal mass resection at our center from January 2023 to December 2025. Results: After exclusion of ineligible cases, the incidence of intraoperative anesthetic complications was 28.8% (188/653). Initial clinical symptoms (p = 0.007) and one-lung ventilation time (p < 0.001) were independently associated with the occurrence of anesthetic complications. Patients who developed intraoperative anesthetic complications had a significantly higher incidence of postoperative pulmonary complications, longer postoperative hospital stay, and longer Intensive Care Unit (ICU) stay compared with those without complications. Conclusions: Intraoperative anesthetic complications warrant greater clinical attention because of their high incidence, the difficulty in predicting them from preoperative data alone, and their potential association with adverse postoperative outcomes.