Association between preoperative pan-immune-inflammation value and postoperative atrial fibrillation after scheduled video-assisted thoracoscopic lobectomy.

OBJECTIVE(S): This study aimed to evaluate the association between preoperative pan-immune-inflammation value (PIV) and postoperative atrial fibrillation (POAF) after scheduled video-assisted thoracoscopic surgery (VATS) lobectomy. In addition, we assessed other complete blood count (CBC)-derived inflammatory indices and performed sensitivity analyses according to the interval between laboratory testing and surgery. METHODS: This retrospective cohort study included adult patients scheduled for VATS lobectomy between January 2015 and November 2025. Patients with preexisting atrial fibrillation or other arrhythmias, active infection, hematologic or immunologic disease, intraoperative change in the extent of resection, additional concomitant surgery, or insufficient medical records were excluded. The primary outcome was POAF. Preoperative PIV and other CBC-derived inflammatory indices were compared between patients with and without POAF. Multivariable logistic regression was performed using log-transformed preoperative PIV, adjusted for age, conversion to thoracotomy, and estimated blood loss. Sensitivity and exploratory analyses were also conducted. RESULTS: Among 475 patients, POAF occurred in 42 patients (8.8%). Patients with POAF were older, had greater estimated blood loss, and had longer postoperative hospital stay. Preoperative PIV did not differ significantly between groups. In multivariable analysis, log-transformed preoperative PIV was not independently associated with POAF. The discriminative ability of PIV for POAF was poor, with an area under the receiver operating characteristic curve of 0.560. Findings remained unchanged in sensitivity and exploratory analyses. CONCLUSIONS: This study did not detect a significant association between preoperative PIV and POAF after scheduled VATS lobectomy. Given the limited number of POAF events, a modest association cannot be excluded.