Surgical management of spontaneous pneumothorax: are there any prognostic factors influencing XXXX ?

@entity1 @entity548 @entity55 @entity649 @entity3509 @entity260 @entity891 @entity358
OBJECTIVES: There are no guidelines regarding the surgical approach for spontaneous pneumothorax. It has been reported, however, that the risk of recurrence following video-assisted thoracic surgery is higher than that following open thoracotomy (OT). The objective of this study was to determine whether this higher risk of recurrence following video-assisted thoracic surgery could be attributable to differences in intraoperative parenchymal resection and the pleurodesis technique. METHODS: Data for 7647 @entity1 operated on for primary or secondary spontaneous pneumothorax between 1 January 2005 and 31 December 2012 were extracted from Epithor  , the French national database. The type of pleurodesis and parenchymal resection was collected. Outcomes were (i) @entity548 , defined as postoperative @entity548 ; (ii) @entity358 , defined as @entity891 , @entity55 , @entity3509 , prolonged ventilation, acute @entity649 and prolonged air leaks; (iii) in-hospital length of stay and (iv) recurrence, defined as chest drainage or surgery for a second pneumothorax. RESULTS: Of note, 6643 @entity1 underwent videothoracoscopy and 1004 @entity1 underwent OT. When compared with the thoracotomy group, the videothoracoscopy group was associated with more parenchymal resections (62.4 vs 80%, P = 0.01), fewer mechanical pleurodesis procedures (93 vs 77.5%, P < 10(-3)), fewer @entity260 (12 vs 8.2%, P = 0.01), fewer cases of postoperative @entity548 (2.3 vs 1.4%, P = 0.04) and shorter hospital lengths of stay (16 vs 9 days, P = 0.01). The recurrence rate was 1.8% (n = 18) in the thoracotomy group versus 3.8% (n = 254) in the videothoracoscopy group (P = 0.01). The median time between surgery and recurrence was 3 months (range: 1-76 months). CONCLUSIONS: In the surgical management of spontaneous pneumothorax, videothoracoscopy is associated with a higher rate of recurrence than OT. This difference might be attributable to differences in the pleurodesis technique rather than differences in the parenchymal resection.
