Objective To investigate the risk factors about extensive subcutaneous emphysema secondary to thoracoscopic surgery.Methods Clinical data of 3 314 patients underwent thoracoscopic surgery from October 2015 to October 2020 were analyzed retrospectively. Clinical data of patients with extensive subcutaneous emphysema were analyzed to search the related factors of extensive subcutaneous emphysema and analyze the treatment effect of subcutaneous emphysema.Results The incidence of extensive subcutaneous emphysema was 1.90% (63/3 314). Among them, lung volume reduction surgery, pleural adhesions, pulmonary emphysema, prolonged air leaks, were important risk factors for subcutaneous emphysema, the differences had statistical significance (P < 0.05).Conclusion Lung volume reduction surgery, pleural adhesion, pulmonary emphysema, prolonged air leaks are risks factors leading to subcutaneous emphysema.