Procedural complications associated with invasive diagnostic procedures after lung cancer screening with low-dose computed tomography

•The complication rates associated with invasive diagnostic procedures after lung cancer screening were significantly higher in the real-world setting.•The complication rates by invasive diagnostic procedures type and by severity are also higher than those reported in the National Lung Screening Trial.•It is important to ensure adherence to clinical guidelines for nodule management and downstream work-up to minimize potential harms from screening.