Abstract
Background: British Thoracic Society guidelines for management of spontaneous pneumothorax (SP) state that surgical treatment or medical pleurodesis should be considered if there is a persistent air leak despite 7 days of chest tube drainage.
Objectives: To investigate the need of surgery or medical pleurodesis when pneumothorax persists more than 7 days after chest drain insertion.
Methods: We included patients admitted in a Pulmonology ward between January 2011 and October 2013 due to a SP initially treated with a chest drain. Demographic and anthropometric data, pneumothorax characteristics and outcomes were analysed.
Results: We included 80 patients; 27 needed a surgical treatment or medical pleurodesis. Mean age was 34±15years old and 85% were male. Pneumothorax was primary in 62 patients.
Gender, age, smoke status, height, BMI, pneumothorax size, side and classification were not statistically different between patients who needed or not surgical intervention.
The longer the duration (in days) of chest tube drainage, the greater the likelihood of surgery being required (HR: 1.352, p<0.001). However, 50% of primary and 38% of secondary SP with persistent air leak at day 7 of chest drainage had resolved at day 15. There was no mortality in the primary SP group and 1 patient died in the secondary SP group due to complications of previous diseases.
Conclusions: We didn't find predictive factors for surgical treatment of SP, besides the persistence of air leak. Nevertheless, a persistent air leak at day 7 might be resolved at day 15, suggesting that a watch and wait approach might be appropriate, deferring the surgery.
- © 2014 ERS